Pulmonary Paragonimiasis: A Case Series.

Paragonimiasis contributes to significant foodborne zoonosis worldwide. The major mode of transmission in humans is by consumption of uncooked or undercooked crabs and crayfish harbouring Paragonimus metacercariae. It begins with symptoms like fever and lower respiratory involvement from a few months to a year, mimicking those of tuberculosis and leading to diagnostic delay. Here, we report two cases of paragonimiasis during a period of nine months. Both cases presented with symptoms of productive cough with rusty sputum, chest pain, along with eosinophilia, and pleural effusion and had a history of consumption of smoked crab from the local river. The diagnosis was established by microscopic demonstration of Paragonimus ova in the sputum. They were treated with praziquantel and recovered. Indeed, it is challenging to diagnose paragonimiasis due to the lack of its specific symptoms but should be considered in the differential diagnosis of eosinophilia and pleural effusion in such lung diseases. Keywords: case reports; eosinophilia; paragonimiasis; pleural effusion.

Unresolving Pneumonia with Pleural effusion: Pulmonary Paragonimiasis.

Paragonimiasis is a zoonosis caused by many species of Paragonimus commonly P. westermani. Human get infected by eating raw, salted, pickled, smoked, partially cooked crustaceans (crayfish or crabs). Clinical manifestations ranges from non-specific symptoms like pain abdomen, diarrhea, urticarial rashes, fever to pleuropulmonary symptoms like cough, hemoptysis, chest pain and dyspnea. A 48 years, female presented at TUTH emergency with fever on and off for nine months, cough and shortness of breath for three months, lethargy, malaise and urticaria with history of raw crab intake one month prior to the onset of symptoms. Blood and pleural fluid analysis revealed raised total counts with eosinophilia and x-ray showed bilateral infiltration of lower lobes with pleural effusion. Diagnosis was confirmed by microscopic examination of sputum for Paragonimus. She responded well to Praziquantel. Pulmonary paragonimiasis must be considered in the differential diagnosis of unresolving pneumonia and unexplained hypereosinophilia.

Paragonimiasis in Japan: a twelve-year retrospective case review (2001-2012).

OBJECTIVE: Paragonimiasis, or lung fluke infection, is a food-borne parasitic disease caused by infection with trematodes belonging to the genus Paragonimus. Although paragonimiasis was once considered successfully controlled in the 1970s, new cases began to emerge in the late 1980s. To apprehend the current-day situation of the re-emergent cases of paragonimiasis in Japan, we conducted a retrospective review of 443 patients who were referred to our laboratory and diagnosed as having paragonimiasis during 2001-2012. METHODS: Patients were diagnosed as having paragonimiasis based primarily on immunodiagnostic methods in addition to clinical, laboratory, and radiographic findings. Patient data were extracted from consultation sheets from attending physicians and were analyzed. RESULTS: Majority of the patients were residents of Kyushu Island. However, a substantial number of cases were also from other parts of Japan. Immigrants (mostly from China, Thailand, and Korea) accounted for a quarter of the cases. Native Japanese contracted paragonimiasis by consuming wild boar meat or freshwater crabs, whereas immigrants contracted the infection almost exclusively by consumption of freshwater crabs. Eosinophilia and elevated serum IgE levels were found in around 80% of the patients. Parasite egg detection was documented only in 11.7% of the cases, showing the reliance on serological tests for diagnosing paragonimiasis in current clinical practice. CONCLUSION: Paragonimiasis remains a public health issue in Japan, and the situation should be closely monitored.

Cerebral paragonimiasis: an unusual manifestation of a rare parasitic infection.

BACKGROUND: Paragonimiasis is a parasitic disease that typically produces a subacute to chronic inflammatory disease of the lung. Although rare in the United States, paragonimiasis is sporadically observed in the immigrant population. Rarely, paragonimiasis can affect the nervous system. This infection is even more unusual in the pediatric population, and therefore can be challenging to diagnose. PATIENTS: Here we present a child with cerebral paragonimiasis. She presented with new onset seizures in the setting of a febrile illness. Magnetic resonance imaging of the brain with contrast revealed a ring-enhancing lesion within the right frontal lobe and a second lesion in the left parietal lobe extending from the cortex to the centrum semiovale. Extensive evaluation including stool ova and parasite analysis confirmed the diagnosis of Paragonimus westermani. She was treated with praziquantel and prednisone and improved both clinically and radiographically. CONCLUSIONS: Cerebral paragonimiasis is diagnosable and treatable and therefore is important to consider in the differential of immigrants presenting with cavitary lung lesions and central nervous system findings.

[Surveillance results of paragonimiasis endemic in regular surveillance sites in Sichuan Province from 2011 to 2013].

OBJECTIVE: To understand the endemic situation and impact factors of paragonimiasis in Sichuan Province, so as to provide the evidence for its control work. METHODS: Four administrative villages from Xuanhan County, Kaijiang County, Pengzhou City and Yucheng District of Ya'an City were selected as regular surveillance sites. In the surveillance sites, ELISA was applied to test the infection situation of residents, questionnaire surveys were performed simultaneously; and water crabs were collected to detect the metacercariae of Paragonimus. RESULTS: From 2011 to 2013, totally 3 666 residents were tested by serum test and 104 of them were positive with a positive rate of 2.8%. Totally 3 671 residents underwent the questionnaire survey and 24.8% of them had heard about paragonimiasis, 36.3% had eaten undercooked water crabs, 56.4% had played with water crabs, and 84.6% had drunk stream water. Totally 2 463 water crabs were dissected, and metacercariae of Paragonimus were found in 620 of them with the infection rate of 25.2% and infectiosity of 4.53 per crab, respectively. CONCLUSIONS: The endemic situation of paragonimiasis in natural environments is serious in Sichuan Province. The residents in endemic area practice unhealthy diet behavior, and there is an urgent risk of the breakout of paragonimiasis.

Human paragonimiasis after eating raw or undercooked crayfish --- Missouri, July 2006-September 2010.

Paragonimiasis is a parasitic disease caused by Paragonimus trematodes, commonly known as lung flukes. Humans become infected by eating raw or undercooked crayfish (also known as crawfish and crawdads) or freshwater crabs that harbor the parasites. Paragonimiasis most frequently involves the lungs, but can affect other organs, including the brain and skin. In North America, Paragonimus kellicotti causes infections among dogs, cats, and wild carnivores, but rarely infects humans. Paragonimiasis is not a nationally notifiable condition. In September 2009, physicians from the Washington University School of Medicine (WUSM) in St. Louis published details of three paragonimiasis cases diagnosed since July 2006 in persons who had eaten raw crayfish from rivers in Missouri, prompting the Missouri Department of Health and Senior Services (MDHSS), CDC, and WUSM to collaborate in paragonimiasis surveillance and prevention. During September 2009-September 2010, six additional cases were diagnosed in Missouri. These nine patients, aged 10-32 years, had fever, cough, pleural effusion, and eosinophilia. All had eaten raw or undercooked crayfish from rivers in Missouri while on canoeing or camping trips within 4 months of illness onset. Health-care providers should consider paragonimiasis when examining patients with unexplained fever, cough, eosinophilia, and pleural effusion or other chest radiographic abnormalities and should ask those patients whether they have eaten raw or undercooked crayfish.

Estudio de foco de paragonimosis en Fuente Clara, Robledo, área periurbana de Medellín, Antioquia / Paragonimosis in the peri-urban zone of Medellín, Antioquia

Introducción. La información sobre paragonimosis humana en Colombia llevó a suponer que los focos de la enfermedad estaban localizados en sectores selváticos; sin embargo, durante 2005 se hallaron cangrejos infectados con Paragonimus sp. en Fuente Clara, zona urbana de Medellín. Esto motivó la investigación. Objetivo. Realizar un estudio ecoepidemiológico de la paragonimosis con la participación de la comunidad para promover un manejo adecuado de los ecosistemas acuáticos. Materiales y métodos. Se realizó búsqueda de huéspedes silvestres y humanos de Paragonimus sp. en Fuente Clara. La presencia de formas larvarias y gusanos adultos del digéneo se evaluó en moluscos, crustáceos y mamíferos. En las personas voluntarias se hizo diagnóstico en esputo. Al agua de la quebrada La Puerta se le midieron: coliformes totales/fecales, pH, conductividad y oxígeno disuelto. Con niños y adolescentes se realizaron talleres educativos utilizando técnicas lúdicas. Resultados. Los porcentajes de infección encontrados fueron: caracoles, 0,07 por ciento; cangrejos, 55,5 por ciento; mamíferos, 25 por ciento, y personas, 0 por ciento. Durante los talleres educativos se manifestó la importancia de los recursos naturales del barrio. Los niños identificaron los huéspedes de Paragonimus sp. y detectaron los factores de riesgo para adquirir la enfermedad. Se determinó que el agua de la quebrada La Puerta no es apta para el consumo y la recreación de las personas. Conclusiones. Se señala a Fuente Clara como el primer foco de paragonimosis en zona urbana de Colombia, donde la manipulación y el consumo de cangrejos ponen en riesgo de adquirir la infección a sus habitantes; se sugiere realizar vigilancia de la enfermedad en el sector.

História natural da infecção por Paragonimus: abordagem clínica e ecológica / Natural history of Paragonimus’ infection: clinical and ecological approach

A paragonimíase é uma doença zoonótica, não-contagiosa, produzida por trematódeos do gênero Paragonimus. O homem e outros animais infectam-se ao ingerir crustáceos de água doce — crus, mal cozidos ou em conserva — ou, ainda, água e/ou alimentos contaminados com metacercárias. Apresenta evolução crônica e acometimento predominantemente pulmonar, ainda que sejam descritas descritas alterações extrapulmonares. Podem surgir sinais e sintomas como tosse com expectoração sanguinolenta, febre intermitente, dor torácica, suores noturnos e, mais raramente, astenia, anorexia e perda de peso. Como principais métodos diagnósticos destacam-se o exame a fresco do escarro e/ou das fezes do paciente e os testes imunológicos. O tratamento é realizado com praziquantel. A infecção, habitualmente, tem bom prognóstico.

Active hepatic capsulitis caused by Paragonimus westermani infection.

Paragonimiasis is an important re-emerging parasitosis in Japan. Although the lungs and pleural cavity are the principal sites affected with the parasite, ectopic infection can occur in unexpected sites such as skin and brain. This case report describes a patient with active hepatic capsulitis due to Paragonimus westermani infection. The patient was successfully treated with praziquantel at the dose of 75 mg/kg/day for 3 days.

Infecciones tropicales en viajeros a Latinoamérica: parte II / Tropical diseases in travelers to Latin America: part II

Las infecciones permanecen como una de las más importantes causas de morbilidad entre los viajeros. Los países de América Latina son uno de los puntos de destino más importantes. Las dos enfermedades de mayor frecuencia son malaria y diarrea del viajero; sin embargo, Latinoamérica es aún un importante lugar de transmisión de fiebre amarilla, dengue, leishmaniasis, hepatitis por virus A, hepatitis por virus B y enfermedades de transmisión sexual. Alrededor del 7 por ciento de los casos de malaria en el viajero en todo el mundo, se adquirieron en Sudamérica y 40 a 60 por ciento de ellos son causados por Plasmodium falciparum. Se deben suministrar a los viajeros recomendaciones adecuadas de vacunación, quimioprofilaxis y medidas de protección individual, orientadas a sus lugares de destino. Un problema interesante de discutir es la enfermedad en el viajero que retorna a casa

Evaluation of praziquantel for treatment of experimentally induced paragonimiasis in dogs and cats.

Praziquantel was used successfully for treatment of a small number of dogs and 1 cat infected with Paragonimus kellicotti. To further evaluate the usefulness of this drug in treating such infections, 7 cats and 7 dogs were inoculated orally with metacercariae (12 and 20 to 22, respectively) obtained from crayfish, then were treated after the infections became patent; 2 cats and 2 dogs served as noninfected controls. Beginning 1 week before infection, and continuing weekly thereafter, physical, hematologic, and fecal examinations were performed on each animal; thoracic radiography was performed every other week. By postinoculation week 6, all dogs given metacercariae had patent infection diagnosed on the basis of positive results of fecal examination. By postinoculation week 7, 5 cats had confirmed patent infection, but 2 cats given metacercariae never had patent infection or had signs of infection. Clinical signs of infection were minor and included increased respiratory tract noise, slight inducible cough, or mild dyspnea. Transient eosinophilia was detected in dogs around postinoculation week 3. Pretreatment radiography revealed cavitated lesions in cats only; pleural lines and patchy infiltrates in cats and dogs; or pneumothorax in dogs only. The treatment regimen consisted of 23 mg of praziquantel/kg of body weight given every 8 hours for 3 days; 1 infected cat and dog were not treated. By 11 days after treatment, eggs had disappeared from the feces of infected animals, and marked resolution of lung lesions was evident radiographically.(ABSTRACT TRUNCATED AT 250 WORDS)

Susceptibility of inbred mice to Paragonimus miyazakii infection.

Differences in the susceptibility among inbred strains of mice to Paragonimus miyazakii infection were examined. Recovery of worms varied among the strains used. More were recovered from BALB/c mice than from any of the other strains; whereas, the fewest were recovered from C57BL/6 and C57BL/10. No worm formed a cyst in the lung or matured in any of the strains.

Parasitic infections of the central nervous system.

The authors give a comprehensive review of the epidemiology, clinical presentations, diagnosis and current therapy of parasitic infections with CNS manifestations in both the normal and immunocompromised host. These include toxoplasmosis, malaria, amebiasis, neurocystcersosis, hydatid disease, and trichinosis. Additional sections cover disseminated strongyloidiasis, eosinophilic meningitis, visceral and ocular larva migrans, schistosomiasis, and cerebral paragonimiasis. Emphasis is on the neurologic complications of these diseases and their presentations in populations at increased risk for acquiring or reactivating these infections.