Recurrent eosinophilic pleuritis caused by sparganum infection: A case report and review of the literature.

RATIONALE: Sparganosis is an infectious disease caused by a larval tapeworm of the genus Spirometra, which commonly invades subcutaneous tissues. Pulmonary and pleural involvement due to sparganum has been rarely reported previously. PATIENT CONCERNS: We herein described a case of recurrent eosinophilic pleuritis in a 24-year-old woman. She was admitted with persistent cough and shortness of breath for more than 1 month. Initial chest computed tomography scan suggested right pleural effusion and diffuse pleural thickening. Slightly elevated eosinophil counts were found in both the peripheral blood and pleural fluid. She underwent right pleurectomy but histological examination failed to obtain an etiological diagnosis. Moreover, eosinophilic pleural effusion re-appeared in the contralateral thoracic cavity one month later. After re-admission, we reviewed her medical history meticulously and found she had a history of ingesting raw snake gallbladders before hospitalization. The final diagnosis was confirmed by the markedly positive reaction against sparganum antigen in both serum and pleural fluid sample. DIAGNOSIS: Eosinophilic pleuritis caused by sparganum infection. INTERVENTIONS: After the diagnosis, the patient was treated with praziquantel at 75 mg/kg/d for 3 days. OUTCOMES: Pleural effusion absorbed completely and eosinophil count in peripheral blood returned to normal range. No evidence of recurrent pleural effusion had been observed in over one year of follow-up. LESSONS: Clinicians need to be aware the possibility of sparganum infection in cases of eosinophilic pleuritis. The specific enzyme-linked immunosorbent assay remains a useful method in acquiring a rapid diagnosis, especially when histological examination is unable to detect the larvae in the thoracic cavity.

First report of sparganosis manifested by pleuritis and decreased peripheral blood eosinophils in Jiangsu province, China.

Sparganosis is a parasitic infection caused by the metacestode stage of Spirometra mansoni and some other related diphyllobothriidean cestodes. Although various internal organs were involved in sparganum infection, pulmonary and pleural involvement is rarely reported. We herein report an uncommon form of sparganosis manifested by pleuritis and decreased peripheral blood eosinophils. Sparganum worms were found in the pleural effusion accidentally and confirmed by pathological diagnosis. After being treated with praziquantel for 10 days, the patient's symptoms, laboratory examinations, and imaging findings were improved gradually.

Pleuropulmonary infection by Paragonimus westermani in the United States: a rare cause of Eosinophilic pneumonia after ingestion of live crabs.

Infections caused by the parasite Paragonimus westermani are endemic to Southeast Asia. Most infections reported in the United States are among immigrants who acquired the disease abroad. Due to the nonspecific nature of its presentation and rarity in the United States, the diagnosis may first be suggested by the pathologist on biopsy review. Definitive diagnosis may need serologic testing for confirmation. We report 4 cases of pleuropulmonary disease caused by United States-acquired P. westermani, which were identified in the consultation files of the authors. Patients (3 men and 1 woman; aged, 20 to 66 y) presented with pulmonary complaints and chest imaging abnormalities including cavitary infiltrates (2), lung mass (1), pleural effusion (1), and pneumothorax (1). Biopsies showed chronic eosinophilic pneumonia and organizing pneumonia in all cases. Other pathologic findings included granulomatous inflammation with geographic necrosis (3), vasculitis (3), and pleuritis (3). Paragonimus organisms and/or eggs were identified in 2 cases. Serologic studies were positive for P. westermani in 3 cases (2 enzyme-linked immunosorbent assay and 1 immunoblot). Three patients ate live crabs at sushi bars (including crabs in martinis, a previously unreported mechanism for infection). In 1 patient, the source of infection was uncertain. Paragonimiasis should be considered in the differential diagnosis of patients with eosinophilic pleuropulmonary disease in the United States. Although eosinophilic pneumonia was a consistent finding, the biopsies may be nonspecific as the organisms and/or eggs are not always visualized. Unusual features include marked pleuritis, foci of geographic necrosis and granulomatous vasculitis. A history of ingestion and targeted serologies are the keys to diagnosis.

[Familial infestation of Paragonimus westermani with peritonitis and pleurisy].

Human paragonimiasis was endemic in Korea until the 1960's, and nowadays, the prevalence is decreasing. However, it is still one of the important helminthic diseases. Though it is essentially a pulmonary disorder, it may involve brain, muscle, mesentery, genital tract, pleura, peritoneum, spinal cord, spleen, and liver. We experienced two cases of paragonimiasis in a family who had ingested raw crabs together for 7 months. A 57-year-old female patient was admitted due to abdominal pain, diarrhea and tenesmus for 6 months. And, her 35-year-old son complained of cough, chest discomfort and dyspnea. The definite diagnosis for paragonimiasis could be made by the detection of the egg and adult worm from stool, sputum and involved lesion. Neither an egg or worm was detected. However, they were diagnosed based on the food history, laboratory data including serum eosinophilia, ELISA for specific IgG, pleural and peritoneal fluid examination, radiological findings, and intradermal tests. They were treated with praziquantel and their symptoms improved rapidly over 2 days. Both patients were asymptomatic at a follow-up visit 2 months later.

[A case of chronic pleuritis by Paragonimus Westermani infection resistant to standard chemotherapy and cured by three additional cycles of chemotherapy].

A 16-year-old boy had eaten Chinese freshwater crabs soaked in liquor in October 2000, and the left pleural effusion was pointed out on chest X-ray films at a regular medical checkup at school in June 2002. Since his father and friends had suffered from Paragonimiasis Westermani and had been treated in January 2001, the patient agreed to immunoserological examination, and Paragonimiasis Westermani was diagnosed. After drainage of pleural effusion, the patient was treated with praziquantel for three days at a daily dosage of 75 mg/kg, but without effect. The patient received drainage of pleural effusion again, and was treated with praziquantel for 3 days at a daily dosage of 75 mg/kg in a series of three treatments at three week interval. After that, improvement of the disease was achieved.

[Serous fibrinous pleurisy disclosing hydatid cyst of the liver fistulizing into the pleura]. / Pleurésie séro-fibrineuse révélatrice d'un kyste hydatique du foie fistulisé dans la plèvre.

Hydatic cyst of the liver remains a serious public health problem in Morocco and several other Mediterranean countries. This benign affection can cause serious sometimes fatal complications such as cyst rupture into the biliary ducts or the thorax. We present the case of a patient with serofibrous pleurisy and recall the often late diagnosis of hydatic cyst. Biliary pleural fistulization is a rare but serious complication.

Clinical features and parasite-specific IgM/IgG antibodies of paragonimiasis patients recently found in Japan.

Clinical features of a total of 30 paragonimiasis westermani patients referred to and diagnosed in our laboratory in 1999 were analyzed retrospectively. Most patients were middle-aged (average: 48 years, range: 13-72 years) with the male/female ratio of 19/11. Over 70% of the patients had respiratory symptom and over 80% had peripheral blood eosinophilia and high serum IgE level. All but two cases had radiologic abnormalities on the chest X-ray. Only in 3 cases were Paragonimus eggs detected in the sputum smear. We classified the patients into two groups depending on the chest X-ray findings: patients having pleurisy alone and those having nodular/cavitating lesions in the lung parenchyma. We measured parasite specific IgM/IgG antibodies in all patients sera by microplate ELISA. The mean parasite-specific IgM/IgG antibody ratio was significantly higher in the parenchymatous lesion group than in the pleurisy group. While IgM antibody titer had a strong positive correlation with the degree of eosinophilia in peripheral blood, IgG antibody titer had an inverse correlation. Although the degree of eosinophilia in peripheral blood was higher in the pleurisy group than in the parenchymatous lesion group, total IgE level in serum was comparable between the two groups. The present results indicate that pleurisy with eosinophilia and dominant IgM antibody are the characteristic features of the early stage of paragonimiasis, whereas parenchymatous lesions in lungs with low grade eosinophilia and dominant IgG antibody are of the late stage. These results suggest that detection of IgM antibody should always be considered for the immunodiagnosis for paragonimiasis-suspected patients with pleurisy.

Pseudochylous pleural effusion with fat-fluid levels: report of six cases.

The authors report the clinical and computed tomographic (CT) findings in six patients with chyliform pleural effusion. All six patients had a medical history of pleurisy before presentation; five of them had tuberculous pleural effusion. The CT scans of all six patients showed variable amounts of pleural fluid collection with a layering of fat at the nondependent site.

[A case of pleuritis caused by strongyloides in a carrier of T-cell lymphoma virus type I (HTLV-I)].

A 73-year-old woman was admitted to our hospital complaining of dyspnea, fever and general edema. Chest roentgenogram showed bilateral pleural effusion and cardiomegaly. Cardiovascular examination demonstrated atrial tachycardia and left ventricle dysfunction, suggesting congestive heart failure. She was sero-positive for human T-cell lymphoma virus I (HTLV-I). The dyspnea and general edema improved after therapy for heart failure. Because the pleural effusion persisted after therapy, thoracentesis was performed. The pleural effusion was an exudate, and Strongyloides sterocoralis was detected by microscopy. Two courses of thiabendazole (1,500 mg/day, 3 days) were given orally. After this therapy, the pleural effusion improved markedly. This case suggests that Strongyloides stercoralis may be a causative agent of pleuritis in HTLV-I endemic areas.

[A case of Paragonimus Miyazaki with pleuritis and meningoencephalitis].

A 35-year-old man was admitted to our hospital with fever and headache. Chest X-ray revealed right pleural effusion. Lab tests revealed increase of eosinophils in his serum and pleural effusion. After admission he complained of doplopia and neck stiffness. Lumber puncture revealed eosinophilia in the cerbrospinal fluid. Brain CT and MRI showed characteristic images of meningoencephalitis. The patient had eaten raw Potamon dehaani and the case was diagnosed as paragonimus miyazaki after administration of intradermal reaction and Ouchterony's double diffusion test. The patient was successfully treated with praziqantel. It revealed that the pleural effusion and brain edema disappeared chest X-ray and brain MRI. This case can be considered as a characteristic example of Paragonimus Miyazaki with pleuritis and meningoencephalitis.

Mechanisms of cell accumulation induced by Mycobacterium bovis BCG

Mycobacteria, specially Mycobacterium tuberculosis are among the micro-organisms that are increasing dramatically the number of infections with death all over the world. A great number of animal experimental models have been proposed to investigate the mechanism involved in the host response against these intracellular parasites. Studies of airway infection in guinea-pigs and rabbits, as well as in mice intravenously infected with BCG have made an important contribution to our understanding of the virulence, pathogenesis and the immunology of mycobacterial infections. Although, there are few models to study the mechanisms of the initial inflammatory process induced by the first contact with the Mycobacteria, and the relevance of the cute generation of inflammatory mediators, cytokines and leukocyte infiltration to the development of the mycobacterial infection. In this work we reviewed our results obtained with a model of M. bovis BCG-induced pleurisy in mice, describing the mechanisms involved in the leukocyte influx induced by BCG at 24 hr. Different mechanisms appear to be related with the influx of neutrophils, eosinophils and mononuclear cells and distinct inflammatory mediators, cytokines and adhesion molecules are involved in the BCG-induced cell accumulation.

Pleural and peritoneal leishmaniasis in an AIDS patient.

The case of an AIDS patient who developed pleuritis and peritonitis in the course of relapsing visceral leishmaniasis is reported. Visceral leishmaniasis, considered an opportunistic infection in patients infected with the human immunodeficiency virus (HIV) who live in endemic areas, has a chronic relapsing course. Typical manifestations such as fever, hepatosplenomegaly, lymphadenopathy, weight loss, or pancytopenia are not specific in advanced HIV infection. Atypical clinical presentations are becoming more frequent. This is believed to be the first report of peritoneal involvement by Leishmania in an AIDS patient.

Eosinophilic mediastinitis, myositis, pleuritis, and pneumonia of cattle associated with migration of first-instar larvae of Hypoderma lineatum.

Migrating first-instar larvae of Hypoderma lineatum are a frequent cause of focal inflammatory lesions in connective tissues of the mediastinum, parietal and visceral pleura, peritoneum, lungs, diaphragm, and other loci. The lesions are characterized grossly by foci of yellowish or greenish gelatinous edema and microscopically by infiltration of the edematous tissue by a dense array of eosinophils. Lesions were recognized during a period of several weeks in late spring; the timing was attributable to events in the life cycle of the fly. The larvae, which were small (approximately 1 x 4.5 mm), transparent, and unobtrusive, were recovered from lesions in 12 of 20 cattle in which careful parasitologic examination was made.