Intracranial Pseudoaneurysm Caused by Cerebral Paragonimiasis in Pediatric Patients.

BACKGROUND: We investigated the proportion of pediatric patients with cerebral paragonimiasis and intracranial hemorrhage who have intracranial pseudoaneurysms. METHODS: Images of 17 pediatric patients with cerebral paragonimiasis that first manifested as secondary intracranial hemorrhage were evaluated. All patients underwent computed tomographic angiography before surgery. A diagnosis of cerebral paragonimiasis was confirmed based on a positive Paragonimus-specific antibody test in serum samples from all 17 patients. Cerebral paragonimiasis in five of the 17 patients was further confirmed by histopathological examination of surgical specimens. RESULTS: Computed tomographic angiographic images for six of the 17 patients (35.3%) showed the presence of intracranial pseudoaneurysms. Follow-up computed tomographic angiographic scans two years later showed that two of the six patients had persistent pseudoaneurysms and underwent aneurysmectomy. The diagnosis of pseudoaneurysm was confirmed by histopathological examination postsurgery. In another two of the six patients, the pseudoaneurysm lesions were absorbed and could no longer be seen on three- to six-month follow-up scans. The final two patients with pseudoaneurysms are still under follow-up. Intracranial pseudoaneurysms with various degrees of surrounding hemorrhage were frequently observed at first manifestation. CONCLUSIONS: The rupture of intracranial pseudoaneurysms is a common characteristic feature of secondary intracranial hemorrhage caused by cerebral paragonimiasis in pediatric patients.

Significance of Serology by Multi-Antigen ELISA for Tissue Helminthiases in Korea.

It is clinically important to differentiate tissue-invading helminthiasis. The purpose of this study was to assess the specific immunoglobulin G (IgG) antibody positive rates for clonorchiasis, paragonimiasis, cysticercosis, and sparganosis 4 helminthiases from 1996 to 2006 using multi-antigen enzyme-linked immunosorbent assay (ELISA) in Korea. Results of 6,017 samples, which were referred to our institute for serodiagnosis, were analyzed. The subjects with positive serum IgG antibodies were 1,502 (25.0%) for any of the 4 helminthiases. The overall positive numbers for clonorchiasis, paragonimiasis, cysticercosis, and sparganosis were 728 (12.1%), 166 (2.8%), 729 (12.1%), and 263 (4.4%), respectively. The positive serologic reaction to multi-antigens was determined in 309 (20.6%) of the 1,502 total seropositive subjects. Those with multi-antigen positivity were regarded as positive for the antigen of strongest reaction but cross-reaction to others with weak positive reaction. Annual seropositive rates for those 4 tissue helminthiases ranged from 12.1% to 35.7%. The highest rate was observed in age from 60 to 69 years old and prevalence of men (27.4%; 1,030/3,763) was significantly higher than of women (19.1%; 332/1,741). Hospital records of 165 ELISA positive patients were reviewed to confirm correlation with their clinical diagnosis. Paragonimiasis was highly correlated as 81.8% (9/11), cysticercosis 29.9% (20/67), clonorchiasis 29.0% (20/69), and sparganosis 11.1% (2/18). In conclusion, the multi-antigen ELISA using 4 helminth antigens is useful to differentiate suspected tissue-invading helminthiases, especially ELISA diagnosis of paragonimiasis is reliable. The seropositivity is still high among suspected patients in Korea.

[Clinical analysis of 12 cases of paragonimiasis].

OBJECTIVE: To analyze the clinical characteristics of paragonimiasis and improve the level of diagnosis and treatment. METHODS: A retrospective analysis was made of 12 cases of paragonimiasis. RESULTS: All the paragonimiasis patients had the epidemiological history, 83.33% of them had the obvious blood eosinophil increase, and 83.33% of them had the positive antibody against Paragonimus. Praziquantel oral treatment had a curative effect and little adverse reaction. CONCLUSIONS: The clinical symptoms and signs of paragonimiasis are complex and diverse, and the doctors should pay attention to the inquiry of epidemiological history, blood eosinophil increase and positive antibody against Paragonimus.

Response of primary vectors and related diseases to impoundment by the Three Gorges Dam.

OBJECTIVES: To investigate the impact of the Three Gorges Dam on the local ecological environment. We conducted a 3-year cross-sectional survey of natural focus infectious diseases in the area before and after the water level rose to 156 m to evaluate the dam's health impacts. METHODS: Direct and indirect immunofluorescence methods were applied to detect rat antigen and antibody of haemorrhagic fever with renal syndrome (HFRS). Fresh rat kidneys were inoculated in Korth's culture medium to detect Leptospira. A group of captured crabs were ground to observe the metacercariae of Paragonimus. Serum samples were collected from healthy local individuals. ELISA kits were used to detect human antibody against HFRS and paragonimiasis. Human Leptospira infections were detected by a microscopic agglutination test. RESULTS: Upstream rodent density increased significantly with Rattus flavipectus and Apodemus agrarius as the major pathophoric genera. The infection rate of human HFRS and Leptospira in the upstream human population samples was significantly higher than in the downstream samples and correlated with the increase in rodent density. Paragonimus infection rates remained at a low level during the study. Culex pipiens fatigan and Armigeres obturbans were the dominant species of mosquito. CONCLUSIONS: The creation of the Three Gorges Dam changed the proliferation of intermediary agents of diseases, but not notably. However, the ecological effects on the environment may require a prolonged period of time to manifest themselves; thus, long-term and effective surveillance of vectors and related diseases needs to be established.

Paragonimiasis prevalences in Saraburi Province, Thailand, measured 20 years apart.

Saraburi Province, Central Thailand has been a paragonimiasis-endemic area since 1956. This study compared the prevalences of human paragonimiasis in two villages near Chet Khot Waterfall, Kaeng Khoi District, investigated in 1984-1985 and 2005. The results from the 1980s showed 6.3% and 1% of villagers were positive for Paragonimus eggs in sputum and stool, respectively. In 2005, Paragonimus eggs were not found in feces or sputum. An IgG-ELISA for paragonimiasis was conducted on 33 serum samples collected in the 1980s, 23 collected in 2005 and 25 diagnosed with other parasitic infections. Ninety percent of the samples from the eighties were positive for paragoimiasis, and 43% from 2005 were positive, equivalent to 10.9% and 4.9% of the total population examined in the 1980s and 2005, respectively. Serodiagnosis is currently the best method for detecting paragonimiasis. The positive cases in the 1980s were age 10-60 years and in 2005 were age 34- 67-years-old. The prevalence and intensity of Paragonimus metacercariae in fresh Waterfall crabs collected from Chet Khot Waterfall were significantly lower in the 1980s than in 2005. The prevalence of paragonimiasis in this endemic area has decreased to the level that no egg-producing cases were detected. No infections were found in villagers age < 30 years, despite the high density of metacercariae in the crabs, indicating a change in the habit of eating raw food among the younger people.

[Pulmonary paragonimiasis. Case report]. / Paragonimiasis pulmonar. Descripción de un caso.

Paragonimiasis is a zoonosis affecting wild and domestic animals and human beings, caused by species of trematodes of the genus Paragonimus. Humans become infected after ingestion of raw or poorly cooked fresh water crustaceans. The aim of the present work is the description of a case of a 3-years old child, coming from Guárico State in Venezuela with a year of residence in the seashore of the Provincia Manabí in Ecuador, where he ate crabs in "ceviche". During hospitalization, he presented respiratory distress, hepatomegaly and nodules in the back. The thorax cat scan showed heavy infiltrate in both pulmonary bases and pleural compromise. Based on clinic, radiological images, an eosinophilia of 47% (Eosinophils absolute count (EAC) 6.682/mm3) and the antecedent of raw crabs ingestion, pulmonary paragonimiasis was diagnosed. Paragonimus eggs were not found in sputum and feces. ELISA with crude Paragonimus antigen was positive and Western blot revealed recognition of specific molecules. After treatment for three days with Praziquantel at a daily dose of 25 mg/kg body weight divided into three intakes, the sintomatology disappeared and radiological images and number of eosinophils diminished considerably.

[Epidemiological survey on paragonimiasis in Ningbo City, Zhejiang Province].

Serum samples were collected from 2643 suspected cases of paragonimiasis in 2000-2007 from the outpatient departments of the city hospitals and surrounding areas, and the infection rate in the inhabitants, the first and second intermediate hosts, and animal reservoir hosts were investigated in the historical endemic areas. Serum samples were detected and 417 were found antibody positive (15.8%). Among residents in the historical endemic areas, the seropositive rate was 3.1% (46/1462), 2.8% (18/649) and 3.2% (26/813) in males and females respectively (CHI2 = 0.1833, P > 0.05). The infection rate in first intermediate host (snails), second intermediate host (crabs) and animal reservoir hosts was 0.05% (9/ 19,368), 31.1% (15,627/ 50,313) and 11.9% (52/438) respectively. Evidently, natural nidi for Paragonimus spp. still exist in Ningbo City.

[Establishment and application of circulating antigen detection in Paragonimus westermani infection].

Circulating antigen and antibody were detected by CAg-dot-ELISA & CAb-ELISA respectively on the clinically confirmed patients of paragonimiasis, people in paragonimus endemic area, cases with early infection of P. westermani, and cases with other parasitic infections. Circulating antigen was detected in 29 out of 70 cases with paragonimiasis with a sensitivity of 41.5%. The rate of cross reaction in cases with clonorchiasis sinensis and schistosomiasis was 25% (5/20) and 20% (4/20), respectively, and it was negative in 60 cases with other parasitic infections and healthy subjects, with an overall specificity of 93.6%. Specific antibody was detected in 67 of 70 cases with paragonimiasis with a sensitivity of 95.7%. The cross reaction rate in cases of clonorchiasis sinensis and schistosomiasis was 25% (5/20) and 20% (4/20), but negative in 60 cases with other parasitic infections and healthy subjects, with a specificity of 92.1%. 220 persons from paragonimus endemic area were all negative in antigen detection and 7 (3.2%) showed antibody positive. Dot-ELISA for circulating antigen detection may be helpful in diagnosing early infection of P. westermani.

A possible role of TARC in antigen-specific Th2-dominant responses in patients with Paragonimiasis westermani.

BACKGROUND: Paragonimiasis westermani (Pw), a common parasitic zoonosis in Asia, is typically associated with eosinophilia. Th2 cytokines seem to have an important role in the clinical manifestations of this disease. Thymus and activation-regulated chemokine (TARC) is a potential key regulator of Th2-mediated inflammation. The purpose of the present study was to evaluate the antigen-specific Th2-dominant responses in patients with Pw. METHODS: The concentrations of cytokines and chemokines in supernatants of peripheral blood mononuclear cell (PBMC) cultures with or without antigen stimulation were measured by enzyme-linked immunosorbent assay (ELISA). TARC levels in serum from Pw patients were also evaluated by ELISA. The number of Th2 cells expressing the CC-chemokine receptor 4 (CCR4) in the peripheral blood was evaluated by flow cytometry. RESULTS: Antigen-stimulation induced production of IL-5 and IL-13, but not IFN-gamma from PBMC cultures in patients with Pw. Pw patients had elevated serum TARC levels and a higher proportion of CCR4-expressing cells among CD4+ T cells in the peripheral blood. There were also higher levels of TARC, but not IP-10, in supernatants of antigen-stimulated PBMC culture compared to unstimulated PBMC culture in patients with Pw. CONCLUSION: Our findings clarify antigen-specific Th2-dominant responses in patients with Pw and suggest a possible role for TARC in Th2-dominant responses.

Clinical features of paragonimiasis cases recently found in japan: parasite-specific immunoglobulin M and G antibody classes.

We retrospectively analyzed clinical features in 30 patients who were referred to our laboratory and given a diagnosis of Paragonimus westermani infection in 1999. Our results indicate that pleurisy with eosinophilia and dominant immunoglobulin (Ig) M antibody are characteristic features of the early stage of paragonimiasis, whereas IgG antibody is dominant in the late stage. Thus, in addition to tests for parasite-specific IgG antibody, tests for IgM-class antibody should always be considered for patients with pleurisy in whom paragonimiasis is suspected.

Elevated IL-5 levels in pleural fluid of patients with paragonimiasis westermani.

To investigate the pathogenic mechanisms of eosinophilic pleural effusion in patients with paragonimiasis, we measured the levels of IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF) and interferon-gamma (IFN-gamma) in pleural effusions. Samples were obtained from 11 patients with Paragonimus westermani infection. In addition, samples from 12 patients with pleural transudates, 16 with tuberculous pleurisy, seven with empyema and 20 with lung cancer were also examined. Eosinophilia was remarkable in peripheral blood (range 4-34%, median 23.4%) and pleural fluid (range 0-95%, median 71%) of paragonimiasis patients. IL-5 concentrations in pleural effusions of paragonimiasis were markedly higher than those in other groups. Although marked elevation of GM-CSF and IFN-gamma levels was observed in pleural effusion of empyema and tuberculosis patients, it was marginal in the pleural effusion of paragonimiasis patients. In paragonimiasis patients, IL-5 levels in the pleural effusion correlated well with the percentage of eosinophils in peripheral blood and pleural fluid. Such a correlation was not observed between GM-CSF levels in pleural effusion and percentages of eosinophils in pleural fluid or peripheral blood. Our findings suggest that in paragonimiasis IL-5 in the local inflammatory site is particularly important in mediating eosinophilia in peripheral blood and pleural effusion.

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.

Extraordinarily high eosinophilia and elevated serum interleukin-5 level observed in a patient infected with Paragonimus westermani.

OBJECTIVE: Although eosinophilia is one of the typical clinical features of some helminth infections, the degree of eosinophilia in helminthiasis is usually 10% to 30% with a total white blood cell count of 10,000 to 20,000/mm3. Here we report a case of extraordinarily high eosinophilia (91%; absolute eosinophil count, 84,000/mm3) caused by Paragonimus westermani infection. To determine the mechanisms of eosinophilia, the levels of several eosinophilopoietic cytokines in the patient's sera were measured during the course of treatment. METHODS: Serum levels of three cytokines, granulocyte-macrophage colony-stimulating factor, interleukin-3 (IL-3), and IL-5 were measured by enzyme-linked immunosorbent assay using commercial kits or our own assay system for IL-5. RESULTS: Although the kinetic changes of IL-5 correlated well with eosinophilia, the serum IL-3 level remained below the detection level throughout the period examined. Although the granulocyte-macrophage colony-stimulating factor level was twofold to threefold higher than the normal level, its kinetics did not parallel the degree of eosinophilia. CONCLUSIONS: These results show that Paragonimus westermani infection can induce an extraordinarily high level of eosinophilia with an associated increase in IL-5 production. Immunoserologic diagnosis for parasitic diseases should be included in the differential diagnosis of eosinophilia.

IL-5 mRNA expression in blood lymphocytes from patients with Kimura's disease and parasite infection.

Blood lymphocytes from patients with eosinophilia are known to produce interleukin-5 (IL-5) with appropriate stimulation in vitro. To determine whether blood lymphocytes from these patients produce IL-5 in vivo, we tested the IL-5 mRNA expression in blood lymphocytes immediately after separation by reverse-transcriptase polymerase chain reaction (RT-PCR) method. We found that lymphocytes from eosinophilic patients expressed IL-5 mRNA, but lymphocytes from normal volunteers did not express the lymphokine. These findings suggest that in patients with eosinophilia, peripheral blood lymphocytes produce IL-5 in vivo.

Partially purified antigens of Paragonimus heterotremus for serodiagnosis of human paragonimiasis.

The preparative crude extract of Paragonimus heterotremus was fractionated by isoelectric focusing. Fractions at pH 5 which contained a specific antigen with a relative molecular weight of 31.5 kDa were pooled and used in an indirect enzyme-linked immunosorbent assay (ELISA) and immunoblot analysis for diagnosis of human paragonimiasis. The sensitivity and specificity of ELISA were found to be 100% and 99% respectively. The band of 31.5 kDa antigenic component was found to give consistent reaction with paragonimiasis sera. The sensitivity, specificity and predictive value (positive and negative) of immunoblot analysis for the 31.5 kDa band were all 100%.

[Epidemiologic and clinical study of paragonimosis in Cameroon. Results of niclofolan treatment]. / Etude épidémiologique et clinique de la paragonimose au Cameroun. Résultats du traitement par le niclofolan.

Paragonimiasis does not occur only in the South West Province of Cameroon. Four foci exist in the country. They are the well known focus in the Mount Kupe area, the Mbam focus, the Nyong focus and the Ntem focus. All of them are located in the rainforest within the distribution area of Potadoma. This disease, characterized by the presence of eggs in sputum and feces, has often been confused with tuberculosis. In the villages where paragonimiasis is diagnosed by means of parasitological techniques circulating antibodies, revealed with a P. westermani antigen (ELISA), are often found in blood specimens taken from inhabitants. Teen agers suffer the most from the disease and females more often than males. Women and children are traditionally concerned with crabs fishing and they eat them after partly raw. Crabs of the genus Sudanautes contain the infective metacercariae. Paragonimiasis is enzootic and the civet cat V. civetta seems to be the main natural definitive host in Cameroon. Niclofolan given orally in a single dose of 2 mg/kg body weight showed a 100% cure rate. Side reactions are mild and transient.