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[Lung Findings In Experimental Paragonimiasis]

A pathological study was done to elucidate sequential changes of the lungs in various time intervals following experimental paragonimiasis in 15 dogs and 15 cats. The dogs and cats were fed with 30~50 metacercariae of Paragonimus westermani, and were sacrificed at 15, 20, 30, 45, 60, 90 and 120 days after infection respecively. Autopsies were performed immediately after death. Gross and microscopic examination of the lungs showed following findings: 1. There were no qualitative difference in pathological findings between dogs and cats. 2. Pathological findings were first noticed at 20 days of infection in thoracic cavity, which consisted of fibrinous plueritis along with superficial hemorrhage. Although no worm was found in the lung parenchyma at this period, juveniles were seen in pleural cavity together with turbid effusion. 3. Paragonimus juveniles were first recognized inside the lung parenchyma by 30 days of infection. This was the period when the lungs showed multiple areas of hemorrhage and probably active penetration by smaller worms. Hemorrhagic bronchopneumonia was quite pronounced from this stage through 45 days of infection. 4. Paragonimus worm cyst was essentially composed of fibrous scar and heavy inflammatory cellular infiltrate. The lining epithelial cells were first became noticed by 2 months of infection. And these epithelial cells were thought to be probably transformed alveolar lining cells rather than bronchiolar epithelial cells. As the infection progress, the cyst wall became more stabilized and often showed squamous metaplasia. 5. Fibrinous pleuritis with pleural effusion was very prominent finding in early periods of infection. Bronchiolitis and focal vascular sclerosis were often seen in experimental paragonimiasis.

Journal Article↗

Application of micro-ELISA in serodiagnosis of Human paragonimiasis.

To observed whether the specific IgG antibody test using ELISA was useful in diagnosis of presently ill patients of paragonimiasis, a total of 95 sera were tested. The sera were collected from 21 egg positive cases, 8 from positive reactors of intradermal test, 7 from Clonorchis infected, 9 from other parasitic diseases and 50 from apparently non-infected cases. By the result, the sensitivity of the test was 86% and the specificity was 100%. There were no cross reactions between Paragonimus antigen and other parastic infections. Specific IgG antibody test by micro-ELISA was concluded to be useful for mass screening of the presently ill paragonimiasis in the field.

Journal Article↗

Paragonimiasis in a cystic breast mass: case report and implications for examination of aspirated cyst fluids.

We report a case of paragonimiasis diagnosed by fine-needle aspiration of a breast mass in a middle-aged Korean female with a history of breast silicone injections. Although parasitoses have been discovered by aspiration of cyst fluid in otherwise sterile sites (i.e., liver and lung), the cystic presentation in the breast of a middle-aged female complicated the diagnosis in this case. Some authors have argued against the routine cytologic examination of nonbloody cyst fluids in premenopausal women, but this protocol may lead to a false negative diagnosis in the rare instance of a parasitic cyst. While microscopic examination of breast cyst fluid is probably not warranted in every patient, it may be useful in patients at risk for unusual cystic lesions, especially if clinical and mammographic signs of fibrocystic change are absent.

Adult↗

CT findings of cerebral paragonimiasis in the chronic state.

The CT findings in 5 patients with cerebral paragonimiasis in the chronic state are presented. The findings were: 1) multiple, densely calcified areas with a variety of round or nodular shapes in the brain, 2) a large low density area surrounding or connecting with the calcified areas, and 3) cortical atrophy and ventricular dilatation. The relation between the CT findings and the previously reported plain skull X-ray findings or neuropathological findings are discussed.

Adult↗

Paragonimiasis westermani presenting as an asymptomatic nodular lesion in the lung: report of a case.

A 57-year-old man with a history of having consumed fresh-water crab 8 months previously presented with a solitary mass lesion in the left lung without any symptoms. Since neoplastic disease could not be ruled out, an open biopsy was performed, and histological examination confirmed a definite diagnosis of paragonimiasis. A high level of the anti-Paragonimus westermani antibody was detected in the sera of the patient, but this level decreased substantially 3 months after chemotherapy with bithionol.

Animals↗

A rodent model for pulmonary paragonimiasis.

This study reports a model of pulmonary paragonimiasis in outbred Wistar rats using the Indian strain of Paragonimus heterotremus isolated from the fresh water crab Barytelphusa lugubris collected from Arunachal Pradesh, India. Feeding metacercariae to the rats led to encapsulated adult worms in the lungs and pleural cavity. Some flukes migrated to the skeletal muscles of the hosts where they remained underdeveloped as immature flukes.

Animals↗

Pulmonary paragonimiasis in Cameroon.

Paragonimus africanus has been known to be endemic in the Bakossi area of Meme Division of Cameroon since it was first described in 1952. After a lapse of 25 years, exploratory work was undertaken in the area (but not in the same villages) to study the prevalence of the disease, to record the common presenting symptoms, to make a number of paraclinical examinations, to assess the beliefs and attitudes of the people towards the disease and the possible reasons for its persistent endemicity in that area and to carry out a therapeutic trial with Niclofolan (Bilevon). The disease was found to have a prevalence of 5% with a higher prevalence among those less than 20 years old. Boys were more affected than girls. The population did not appear to recognize the disease which they confused with tuberculosis. The disease was contracted by eating improperly cooked crabs, the intermediate host. The therapeutic trial with Bilevon given orally as a single dose was completely successful. This study showed that paragonimiasis must be considered seriously in the differential diagnosis of tuberculosis in this area and that a study on a much wider scale is required to establish the real extent of the disease.

Adolescent↗

Pulmonary paragonimiasis: clinical features, diagnosis and treatment of 39 cases in Manipur.

Thirty-nine cases of pulmonary paragonimiasis due to Paragonimus westermani were identified in Manipur, India. Recurrent haemoptysis, often increased on exertion, was the most common symptom. The clinical features and radiological appearances simulated pulmonary tuberculosis and 23 cases were treated for tuberculosis for varying periods before the final diagnosis. Young males aged 11 to 30 years comprised two-thirds of the cases. The disease was acquired by eating raw or improperly cooked crabs (Potamon deham). Intradermal tests (IDT) employing a saline extract of adult Paragonimus were a simple and reliable method of detecting present or past infection. Erythema of large size even without wheal and pseudopodia may indicate a positive IDT. Charcot-Leyden crystals (CLC) were detected in all sputum samples positive for Paragonimus ova. In patients (four) presenting with pleural effusion, Paragonimus ova were not present in the sputum, stool or pleural fluid. Bithionol (2,2'-thiobis [4,6-dichlorophenol]) orally, 40 mg/kg body-weight/day, 10 to 25 doses, cured all cases and, except in one, side effects were minimal. Relapse in one patient after six months' treatment was apparently cured by a second course of Bithionol.

Adolescent↗

[Pleuro-pulmonary paragonimiasis].

Paragonimiasis is a food borne zoonosis due to a trematode belonging to the genus Paragonimus. Although present throughout the world, about 90% of the cases occur in Asia where around 20 million people are infected. The parasitic cycle is complex with two different intermediate hosts. Man is infected by ingesting the raw or undercooked flesh of the second host - a freshwater crab or prawn - or possibly of a paratenic mammal host (wild boar), which contains the infective larval stage metacercariae that reaches the lung which is the main target organ. Epidemiological, pathological, and clinical aspects are reviewed. The main symptoms are protracted cough, and recurrent "benign" hemoptysis. Abnormal pleuro-pulmonary imaging features are constant, but protean and non-specific, leading to frequent confusion with tuberculosis. Diagnosis is easily achieved by ova search in the sputum or pleural fluid, or by serology. Evolution is usually considered benign, although not well known. Finally, praziquantel is the effective first choice treatment. Some paradoxical aspects of this disease are underlined such as: underdiagnosis despite a very simple diagnostic procedure, or opposite tendencies according to location, either extinction or re-emergence.

Animals↗

Extra-pulmonary paragonimiasis with unusual arthritis and cutaneous features among a tourist returning from Gabon.

Paragonimiasis is a helminthic disease that affect accidentally man after consumption of raw or poorly cooked crustacean dishes. The clinical feature is represented mainly by pulmonary signs. Extra-pulmonary manifestations including arthritic and skin attempt remain less frequent. The case is described of a young white French woman who become infected with Paragonimus while travelling to Gabon for a tourist trip. Clinical presentation accounted for extensive recurrent pruritic urticarian subcutaneous induration, permanent assymetrical pauciarthritis associated with joint swelling, and marked eosinophilia. Diagnosis was reached using serological testing showing seroconversion for specific antibodies. The patient was cured with a single oral dose of praziquantel. Even if the condition is rare among tourists to endemic zones, it must be considered when hypereosinophilia occurs in the returning traveller and migrant.

Adult↗

Epidemiology of paragonimiasis in Colombia.

Five newly discovered endemic foci for paragonimiasis in Colombia are described for the first time. The disease was diagnosed in 24 people from the Embera Indian communities located at the Colombian Pacific Coast and investigated in 1993-98. We also describe the clinical, epidemiological and treatment response aspects. In these foci an Aroapyrgus sp. snail different from A. colombiensis was found to be the first intermediate host, and the crab Hypolobocera emberarum nsp. the second intermediate host.

Adolescent↗

Paragonimiasis and the genus Paragonimus.

The review concentrates on literature that has appeared since the 1960s. Since then, numerous species of Paragonimus have been described, mainly from Asia but also from Africa and the Americas. Some of these cause disease in humans. Recent information on life cycles and routes of transmission is summarized. All described species and their hosts are listed, with synonyms where known. For well-known species such as Paragonimus westermani, subspecific taxa and strains are reviewed and genetic studies discussed. Paragonimiasis in humans and experimental animals is discussed with emphasis on clinical manifestations and pathology, diagnosis, immune interactions with the host, treatment and public health issues.

Animals↗

Expression of Th1 and Th2 cytokine mRNAs in freshly isolated peripheral blood mononuclear cells of a patient with cutaneous paragonimiasis.

Using semiquantitative reverse transcriptase polymerase chain reaction, we examined the levels of various cytokine mRNAs of freshly isolated peripheral blood mononuclear cells (PBMCs) from a cutaneous paragonimiasis patient in the course of successful treatment with praziquantel administration. The pre-treatment levels of Th2 cytokines such as interleukin (IL)-4, IL-5, IL-10 and IL-13 mRNAs in PBMCs of the patient were much higher than those of healthy controls. The levels of IL-4, IL-5 and IL-13 mRNAs slightly elevated on day 2 of the treatment and then declined to the control levels on day 25. The IL-10 mRNA level rapidly decreased after the chemotherapy. In contrast, the mRNA levels of interferon (IFN)-gamma, a Th1 cytokine, remained in the control levels during the course. Peripheral eosinophil counts and levels of total IgE and eosinophil cationic protein in the sera correlated well with the levels of these Th2 cytokine mRNAs. These results suggested the major role of Th2 cytokines in clinical manifestation of human helminthic infection.

Adult↗

A case of cerebral paragonimiasis in Denmark. Case report.

A case of cerebral paragonimiasis with severe neurological symptoms is presented. The patient, a 45-year-old woman, recovered completely after resection of a large cyst at the C3 level. The pathogenesis is discussed.

Animals↗

A case of paragonimiasis.

A 2 1/2-year-old girl recently arrived from eastern Nigeria presented with a soft tissue swelling of the infraclavicular region. Subsequent investigation revealed a cavity in the left lung associated with a small pleural effusion and leucocytosis with pronounced eosinophilia. Clinical and serological findings were compatible with the diagnosis of paragonimiasis. After a course of Bitin-S the chest x-ray returned to normal, the soft tissue changes disappeared, and the eosinophil count fell.

Child, Preschool↗