Case report: Paragonimiasis westermani with seroconversion from immunoglobulin (Ig) m to IgG antibody with the clinical course

Eosinophilia in Infectious Diseases

In determining the etiology of eosinophilia, it is necessary to consider the type of patient, including previous travel and exposure history, comorbidities, and symptoms. In this review, we discuss the approach to the patient with eosinophilia from an infectious diseases perspective based on symptom complexes.

Thoracoscopic examination of empyema in a patient with sparganosis mansoni

A 27-year-old man was admitted to our hospital with right pleural effusion. He had suffered from right chest and back pain and a high fever for one week prior to the admission. He had been treated with clarithromycin without improvement. Since thoracoscopy under local anesthesia revealed purulent effusion, synechiae and fibrous septa in the thoracic cavity, synechiotomy was performed and we started antibiotic treatment with the diagnosis of acute bacterial empyema. At the same time, we also suspected parasitic infection because of massive eosinophilic infiltration in pleural effusion and his dietary history of eating raw frogs. During the course of the disease, he had an infiltration in the right lower lobe and pneumothorax. Finally, we diagnosed him with sparganosis mansoni because his serum as well as pleural effusion was positive for the binding to sparganosis mansoni plerocercoid antigen, without any positive findings in bacteriology. His pleural effusion and lung infiltration were resolved after the administration of a high-dose praziquantel. We report this rare parasitic empyema with findings by thoracoscopic examination.

A paragonimiasis patient with allergic reaction to praziquantel and resistance to triclabendazole: successful treatment after desensitization to praziquantel

Paragonimiasis is an infectious disease caused by trematodes of the genus Paragonimus. This trematode can be treated successfully with praziquantel in more than 90% of the cases. Although praziquantel is generally well tolerated, anaphylactic reactions to this drug have been reported in a few cases. We report here a 46-year-old Korean female with paragonimiasis, presumed to be due to Paragonimus westermani, who displayed an allergic reaction to praziquantel and resistance to triclabendazole treatment. The patient was successfully treated with praziquantel following a rapid desensitization procedure. Desensitization to praziquantel could be considered when no alternative drugs are available.

Paragonimiasis cases recently found among immigrants in Japan

OBJECTIVE

Paragonimiasis is a typical food-borne parasitic disease mainly endemic in Southeast Asia. In Japan, the disease has been re-emerging since the 1980s. In addition, recently we encountered an increasing number of immigrants with paragonimiasis in Japan. In this study we summarized the clinical features of immigrants.

PATIENTS AND METHODS

Among a total of 152 paragonimiasis cases referred to and diagnosed in our laboratory during 1998 to 2002, 18 were immigrants. Their clinical features including laboratory data such as eosinophilia and total IgE level were gathered from the consultation sheets from attending physicians.

RESULTS

Among a total of 18 immigrant cases, 16 were from China and 2 from Thailand. A majority of immigrants had eaten freshwater crabs. Most of the Chinese patients were infected as small groups of family and/or compatriots. Chest radiographic findings were variable and multiple lung lesions were seen in about one-half of the patients. About 80% of patients had peripheral blood eosinophilia and 65% had elevated serum IgE level.

CONCLUSION

The clinical features of paragonimiasis in immigrants in Japan were much more severe compared to those of Japanese patients.

Paragonimiasis: a Japanese perspective

Paragonimiasis has been considered to be a foodborne zoonosis endemic only in limited areas in the world. Recently, however, patients have been seen almost all over the world because of the increase in number of overseas travelers and the popularization of ethnic dishes in developed countries. If paragonimiasis is misdiagnosed as tuberculosis or lung cancer patients suffer from a considerable burden of long-term hospitalization and unnecessary examinations and treatments. Clinicians should always be aware of the possibility of paragonimiasis when patients have pulmonary lesions with eosinophilia and an elevated serum IgE. For the diagnosis, rapid and reliable immunodiagnostic methods are now available. Highly effective drugs are also available for treatment.