[Case of Abdominal Colicky Pain Caused by Hepatic Paragonimiasis]

In Korea, the prevalence of paragonimiasis has decreased markedly since 1970 and is now rarely encountered. Although the lung is the primary site of paragonimiasis, ectopic infestation can occur in other sites. The central nervous system is the most commonly involved ectopic site, accounting for only approximately 1% of all paragonimiasis patients. Therefore, the liver is an extremely rare site of ectopic infestation. The authors experienced the case of a 55-year-old female with hepatic paragonimiasis who presented with abdominal colicky pain.

An unusual presentation of pulmonary nodules

A pulmonary nodule is a common radiological finding encountered in routine medical practice. It needs to be extensively evaluated as the differential diagnosis can range from sinister malignancies to fully treatable infectious causes. Here, we present a rare case of pulmonary paragonimiasis presenting as pulmonary nodule. This case report aims to sensitise the medical practitioner regarding pulmonary paragonimiasis which is completely treatable but carries a high risk of being under diagnosed.

Trends in Paragonimiasis Global Research: Bibliometric Analysis of a Neglected Food-Borne Parasite

Background

Paragonimus is a genus of parasitic flatworms known as lung flukes that cause the parasitic disease paragonimiasis in humans and other mammals. We aimed to use bibliometric analysis to identify the global characteristics and temporal trends of published literature about paragonimiasis.

Methods

Using the Web of Science database, we identified all original articles on paragonimiasis 1997 to 2022. After collecting the bibliographic and citation data, keywords, citation networks, and co-citations pertaining to paragonimiasis was carried out using the VOSviewer program.

Results

The study identified 563 paragonimiasis articles published in 250 journals. Publications in paragonimiasis research have been cited 6190 times and 2803 times without self-citations. The years with the most publications were 2013, 2016, and 2021. The minimal threshold for analysis was met by 19 of the 52 countries investigated. The study included 19 items, yielding 170 links between countries. The total strength of these links was discovered to be 104772. The journal with the most publications in this category was Parasitology Research (n=31). The most frequently used terms in paragonimiasis study were "paragonimiasis", "Paragonimus westermanii", and "lung-fluke."

Conclusion

The study concluded by providing an overview of the paragonimiasis research field, including current trends, development, and researcher collaboration. By addressing gaps in this bibliometric analysis and increasing collaboration, stake-holders could strengthen their strategies to effectively combat paragonimiasis and improve public health outcomes.

Massive secretions in paragonimiasis pleural effusion: a new finding concerning clinical recognition and treatment

Some paragonimiasis patients in Chongqing, southwest China, have recently exhibited pleural effusions (PEs) with massive viscous secretions. This study aimed to investigate their clinical characteristics, thereby promoting effective treatments. A 3-year retrospective review of paragonimiasis patients who were admitted for nonhomogeneous PEs at Chongqing University Three Gorges Hospital was conducted. Epidemiological data, symptoms, laboratory and imaging findings, treatments, and outcomes were analyzed. Twenty-eight patients were identified, of which 22 (78.6%) were males and 22 (78.6%) were rural residents. Respiratory (85.7%) and constitutional (57.1%) symptoms were common. Paragonimus-specific ELISA was positive in all patients. Eosinophilia was detected in all patients in peripheral blood and PEs. Irregular hyperdense signals were observed in PEs by chest CT scans (96.4%) and ultrasonography (100.0%). Thoracic closed drainage failed in 10 patients (conservative group) because of tube blockage and was eventually replaced by video-assisted thoracoscopic surgery (VATS). Eighteen patients (surgery group) initially underwent VATS, or thoracotomy surgery, without complications. Massive secretions, described as "bean-dregs" or "egg-floccule," were detected intraoperatively, which explained the imaging findings and tube blockage. All patients recovered well after 2-3 courses of postoperative praziquantel treatment. Viscous secretions in paragonimiasis patients warrant great concern. Irregular hyperdense signals in effusions are important characteristics in CT scans and ultrasonography. Treatments such as thoracic closed drainage may fail due to viscous secretions blocking the tube; therefore, surgeries should be considered. In-depth multidisciplinary research may help determine the optimal treatment strategy and reveal the origin of these secretions.

Thoughts underlying "pneumonia" resulting from eating: A case report

As a rare zoonotic helminth disease, paragonimiasis is easy to be misdiagnosed. Adequate attention to the medical history of the patient and early detection of serological antibodies can improve the diagnosis rate. Praziquantel and trichlorobendazole are commonly used for treatment, and the prognosis is good. This case report mainly introduces the classification, diagnosis, and treatment of paragonimiasis, with an aim to draw the attention of doctors to the disease.

Cerebral Paragonimiasis Presenting with Dementia

We report a case of an 80-year-old Korean man with chronic cerebral paragonimiasis who presented with progressive memory impairment. He suffered from pulmonary paragonimiasis 60 years ago and has been experiencing epilepsy since the age of 45. He began experiencing memory and cognitive deterioration 3 years ago. He visited the neuropsychiatric department of our hospital to check his symptoms and health from a year ago. Contrast-enhanced brain magnetic resonance imaging study revealed calcifications and cystic lesions encompassing the right temporo-occipital region. Encephalomalatic changes were also observed in the right occipital and temporal areas. The anti-Paragonimus specific IgG antibodies in his serum showed a strong positive response. The neuropsychological test results showed a Global Deterioration Scale of 4 and a Clinical Dementia Rating Scale of 1. The chronic cerebral paragonimiasis lesions in the patient's right temporo-occipital region might induce the dementic change.

A curious case of hemoptysis

Paragonimiasis is a crustacean-borne parasitic zoonosis caused by lung fluke or Paragonimus. Several endemic foci of paragonimiasis have been discovered in Northeastern India. Chronic pulmonary infection with Paragonimus is characterized by hemoptysis, which is usually mistaken for Tuberculosis (TB). Paragonimiasis is acquired by eating raw, undercooked, or pickled crabs or crayfish containing encysted metacercariae of Paragonimus. Infection can usually be confirmed by finding Paragonimus eggs in sputum or bronchoalveolar lavage. We present a rare case of paragonimiasis masquerading as hypereosinophilia, asthma, and intracerebral hemorrhage for the last three years. Paragonimiasis is a rare cause of hemoptysis outside endemic regions. A strong index of suspicion is required to diagnose paragonimiasis outside the endemic areas. Diagnosis is usually delayed because of similarity of presentation to TB. Our patient was symptomatic with hemoptysis for three years. He gave history of eating raw crayfish and crabs while on leave to his native village in Nagaland. Diagnosis was confirmed on microscopy by detection of Paragonimus ova in sputum and bronchoalveolar lavage specimens. Symptoms resolved on treatment with praziquantel (25 mg/kg TDS for three days). Patient became symptom-free after a week of treatment.

Clinical, Laboratory and Radiological Features of Paragonimiasis Misdiagnosed as Pulmonary Tuberculosis

BACKGROUND

Paragonimiasis presents with nonspecific symptoms and radiologic findings, allowing for the possibility of misdiagnosis. Diagnosis is generally delayed due to lack of suspicion and presentation similar to pulmonary tuberculosis.

METHODS

A prospective observational study was carried out on 20 subjects at Civil Service Hospital of Nepal from March 2015 to June 2019 who presented with eosinophilia and pulmonary symptoms, and were treated empirically with Anti-tubercular therapy for suspicion of pulmonary tuberculosis.

RESULTS

The median age of the patient was 34 years. Mean blood absolute eosinophil count was 16678/ul. Fever was present in 80% (n=16). Cough was present in 90% (n=18). Pleural effusion was noticed in 100% (n=20). Chest computed tomography showed ground-glass opacities in 65% (n=13) of patients. Pleural fluid eosinophilia (>10%) was evident in all patients. Pleural fluid LDH was elevated in 85% (n=17) of patients. Similarly, ADA was high (>40U) in 75% (n= 15) of patients, and pleural fluid sugar was low in 80% (n=16) of patients. All patients (100%) gave a history of crab or snail consumption. Paragonimus egg was detected in five (25%) patients. Twenty patients fulfilled definite or probable diagnostic criteria of paragonimiasis. Ninety-five (n=19) patients responded to praziquantel.

CONCLUSION

Unavailability of serologic tests or failure to demonstrate parasitic egg under the microscope should not discourage physicians to consider the diagnosis of paragonimiasis when marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid of a patient with a history of raw crab or snail consumption.

Differences in microbiome of healthy Sprague Dawley rats with Paragonimus proliferus infection and potential pathogenic role of microbes in paragonimiasis

Paragonimiasis, which is caused by Paragonimus, is considered to be a neglected tropical disease by the World Health Organization. The pathogenicity of Paragonimus mainly manifests as mechanical damage and immunotoxicity caused by adult worms and larvae. However, microbiota associated with Paragonimus and potential disturbance of host microbiota after infection are unknown. Paragonimus proliferus is a rare species, and its successful infection rate in experimental rats is 100%. In the current study, we compared the microbial community in lung tissues, small intestine contents, and fecal samples from Sprague Dawley (SD) rats with and without P. proliferus infection. To determine the impact of P. proliferus on the microbial community in rats, we identified the microbiota in adult worms of P. proliferus via high-throughput sequencing. Results showed dramatic differences in the composition of microbiota in lung tissues between infected and uninfected rats. Paragonimus metacercariae introduced both environmental and gut microbes into the lung tissues of rats. Many potentially pathogenic microbes were also found in the lung of infected rats. Paragonimus infection increased the chances of potentially pathogenic microbiota invading and colonizing the lungs. However, for the purpose of long-term parasitism, there might be a complex interrelationship between Paragonimus and microorganisms. Our study might shed lights on the understanding of the pathogenicity of Paragonimus.

Ectopic peritoneal paragonimiasis mimicking tuberculous peritonitis: A care report

BACKGROUND

The most common site of paragonimiasis is in the lungs. The migratory route passes through the duodenal wall, peritoneum, and diaphragm to the lungs; thus, the thoracic cavity and central nervous system, as well as the liver, intestine, and abdominal cavity may be involved. Here, we present a case of intraperitoneal paragonimiasis without other organ involvement, mimicking tuberculous peritonitis.

CASE SUMMARY

A 57-year-old man presented with recurrent abdominal pain for 4 wk. Physical examination revealed tenderness in the right lower quadrant. Laboratory findings showed complete blood counts within the normal range without eosinophilia. Multiple reactive lymph nodes and diffuse peritoneal infiltration were noted on abdominal computed tomography (CT). There were no abnormalities on chest CT or colonoscopy. Intraoperative findings of diagnostic laparoscopy for the differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis included multiple small whitish nodules and an abscess in the peritoneum. Pathological reports confirmed the presence of numerous eggs of Paragonimus westermani (P. westermani). A postoperative serum enzyme-linked immunosorbent assay revealed P. westermani positivity. Persistent and repetitive history-taking led him to retrospectively recall the consumption of freshwater crab. After 3 d of treatment with praziquantel (1800 mg; 25 mg/kg), he recovered from all symptoms.

CONCLUSION

In patients who require diagnostic laparoscopy for the differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis, repetitive history-taking and preoperative serologic antibody tests against Paragonimus may be helpful in diagnosing intraperitoneal paragonimiasis without other organ involvement.

Morphological and Molecular Characterization of Paragonimus skrjabini Complex from Yunnan, China: A Brief Report

Purpose

To perform environmental sampling and molecular identification of Paragonimus in endemic regions, which may help in minimizing transmission among humans.

Methods

Mountain crabs from the genus Potamiscus were collected and the encysted metacercariae were extracted and subjected to morphological identification, followed by animal inoculation in Sprague–Dawley (SD) rats. After 112 days of infection, animals were killed and adult worms were extracted from lungs and muscles. The morphology of adult worms was characterized by microscopy and molecular identification was done by polymerase chain reaction, followed by sequencing of cox1 and ITS2 genes. Phylogenetic analysis was done by maximum parsimony method.

Results

A total of 447 crabs were captured from the streams of Tongchang Town, Jinping County, Yunnan Province, China. The infection rate was found to be 41% (186 out of 447 crabs). The metacercariae of Paragonimus skrjabini was identified by the characteristics round or spherical encysted form measuring 410 to 460 × 400 to 460 µm. After animal infection in SD rats, adults were presumptively confirmed to be P. skrjabini, which was also confirmed by gene amplification and sequence analysis of cox1 and ITS2 regions. Paragonimus skrjabini clustered with previously reported P. skrjabini from Yunnan and Vietnam. The confidence values of their branches were > 95%. Phylogenetic analysis of the ITS2 region revealed two distinct clusters with distinct geographical grouping. Phylogenetic analysis with the combined data sets reiterated the geographical grouping with P. skrjabini from Yunnan clustering with strains from Vietnam.

Conclusion

Metacercariae of P. skrjabini was discovered in freshwater crabs in Yunnan province, China, and the strains were phylogenetically related to P. skrjabini from Vietnam.

Pulmonary, liver and cerebral paragonimiasis: An unusual clinical case in Colombia

BACKGROUND

Mainly affecting poorer populations in remote (sub)tropical areas, paragonimiasis is considered one of the world's most neglected tropical diseases by the World Health Organization. It is usually acquired by consuming undercooked freshwater crustaceans and primarily affects the lungs, but may ectopically migrate to other organs to produce a multisystemic clinical presentation. This study details what appears to be the first documented case in South America and particularly in Colombia of cerebral paragonimiasis and infection by the crab Moreirocarcinus emarginatus.

CASE PRESENTATION

After consuming this crab, a 32-year-old Colombian male developed dyspnea and headache. A chest X-ray revealed tension pneumothorax (TPT) and a thoracoscopic lung biopsy bronchiolitis, eosinophilia, and granulomatous reaction due to Paragonimus parasites.

RESULTS

Brain tomography and MRI also showed a configuration typical of Paragonimus parasites, namely a predominantly cystic area near the left cuneus with diffusion restriction, a hemosiderin halo, and linear enhancement characteristic of the tunnel sign, indicating an adult worm moving in the brain.

CONCLUSIONS

Cerebral paragonimiasis can occur in the Colombian population and Moreirocarcinus emarginatus can be its cause. In rural areas, education about raw crab consumption would be beneficial, and physicians addressing lung-related complaints should bear paragonimiasis in mind and ask about raw crab consumption.

Paragonimiasis presenting as an acute hemorrhagic stroke

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Cerebral paragonimiasis is rare and usually seen in young patients.

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Infection is acquired by ingesting infected raw shell-fish.

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Serology is highly specific and sensitive for diagnosis of paragonimiasis.

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CNS paragonimiasis is treatable and has a favorable prognosis.

Cerebral paragonimiasis is rare and is usually seen in younger patients. This is a case of a 19-year-old male presenting as a hemorrhagic stroke with headache and blurred vision. He was found to have cystic thick-walled spaces with focal linear tracking towards the pleural space on computed tomography of the chest. CSF analysis showed pleocytosis with 4% eosinophils. Serological testing confirmed the diagnosis of paragonimiasis. He was treated with praziquantel, corticosteroid taper and anti-epileptic medication and discharged home in stable condition. CNS paragonimiasis is treatable, has a fairly good prognosis but can often be missed. In a young person presenting with an acute hemorrhagic stroke, the possibility of paragonimiasis should be kept on the differential diagnosis.

Paragonimus westermani infection of freshwater crab Sundathelphusa philippina and melaniid snails in Cadacan River in Irosin, Sorsogon, Philippines

Paragonimiasis, the disease caused by Paragonimus westermani, is transmitted primarily by freshwater crabs Sundathelphusa philippina in the Philippines. Human infection has been recorded, but there is a dearth of published information on the extent of infection in animal reservoirs, particularly in crabs and snails. This study aimed to investigate the infection status and risk factors of P. westermani in freshwater crabs and melaniid snails collected in an endemic village along Cadacan River in Irosin, Sorsogon, where human cases of paragonimiasis were previously reported. A total of 246 freshwater crabs (118 females, 128 males) were dissected, and the gills, muscles, gonads, and viscera were examined for the presence of metacercariae; of which, 41.87% were found infected. The metacercariae were recovered from the gills (100%) and muscle tissues (7.3%) of infected crabs. Male crabs were more likely to be infected (49.22%) than female crabs (33.90%) (p < 0.05). Moreover, 70.87% of crabs showed low parasite intensity levels at ≤ 30 metacercariae/g tissue. A negative weak correlation was observed between parasite intensity and crab weight and carapace length, i.e., highly infected crabs were found to be smaller in size. Meanwhile, only 12% of the 150 melaniid snails collected were positive with cercariae with Tarebia granifera and Jagora asperata as the most infected species. Household survey conducted revealed that some knowledge, attitudes, and practices of the locals contribute to the sustained transmission of the parasite in this endemic area. These findings revealed that P. westermani is still prevalent among intermediate hosts and that some social and environmental factors contributed to the sustained parasite transmission in this endemic community.

A case of hepatic paragonimiasis was misdiagnosed as hepatocellular carcinoma with rupture and haemorrhage

Paragonimiasis is a disease caused by parasitic infections that mainly involve the lungs. However, it can also produce ectopic infections, such as when the parasites invade the liver, brain and subcutaneous tissue, which then cause different symptoms. This current case report describes a 55-year-old male patient with hepatic paragonimiasis that was misdiagnosed as liver cancer with rupture and haemorrhage. The initial computed tomography findings suggested ruptured liver cancer. The patient underwent laparoscopic right hemihepatectomy. Postoperative pathological analysis resulted in a diagnosis of hepatic paragonimiasis. The patient recovered well postoperatively and was treated with 25 mg/kg praziquantel orally three times a day for 3 days after discharge with good efficacy. In this present case, the rupture and haemorrhage of the liver mass made it difficult for the treating physicians to consider hepatic paragonimiasis, which lead to the initial misdiagnosis of this patient. Although paragonimiasis is very rare, medical staff should be vigilant and have a comprehensive understanding of the different diseases that can cause liver masses so that misdiagnosis can be avoided.

A case of paragonimiasis inducing bilateral pneumothorax with lung and liver involvement

Pulmonary paragonimiasis can occasionally induce bilateral pneumothorax and cause lesions in ectopic organs such as the liver. We report the case of a 26-year-old man who had been treated for bilateral hydropneumothorax one month earlier and returned to the emergency center complaining of epigastric pain that had persisted for four months. After being diagnosed with pulmonary and hepatic paragonimiasis, he was treated with praziquantel and his condition improved without complications.

Analysis of the misdiagnosis of 8 adult cases of paragonimiasis with lung masses as the main manifestation in Xishuangbanna, Yunnan

OBJECTIVE

To summarize the clinical characteristics of adult cases of paragonimiasis with lung masses as the main manifestation in Xishuangbanna, Yunnan Province, analyze the causes of misdiagnosis, and improve the levels of clinical diagnosis and treatment.

METHOD

We conducted a retrospective analysis of the clinical data and diagnosis and treatment of 8 adult cases of paragonimiasis with lung masses as the main manifestation that were diagnosed in the Oncology Department of People's hospital of Xishuangbanna Dai Autonomous Prefecture from July 2014 to July 2019.

RESULT

All 8 patients were from epidemic paragonimiasis areas and had a confirmed history of consuming uncooked freshwater crabs. The clinical manifestations were mainly fever, dry cough, and chest pain. The disease durations were long, and peripheral blood eosinophil counts were elevated. The cases had been misdiagnosed as pneumonia or pulmonary tuberculosis. After years of anti-inflammatory or anti-tuberculosis treatment, the symptoms had not improved significantly. Patients eventually sought treatment from the oncology department for hemoptysis. Chest computed tomography showed patchy consolidation in the lungs, with nodules, lung masses, and enlarged mediastinal lymph nodes.

CONCLUSION

Paragonimiasis is a food-borne parasitic disease. Early clinical manifestations and auxiliary examination results are nonspecific. The parasite most often invades the lungs, and the resulting disease is often misdiagnosed as pneumonia, pulmonary tuberculosis, or lung cancer (Acta Trop 199: 05074, 2019). To avoid misdiagnosis, clinicians should inquire, in detail, about residence history and history of unclean food and exposure to infected water and make an early diagnosis based on the inquired information and imaging examination results. For patients who have been diagnosed with pneumonia or pulmonary tuberculosis and whose symptoms do not improve significantly after anti-inflammatory or anti-tuberculosis treatments, their epidemiological history should be traced to further conduct differential diagnosis and avoid misdiagnosis.

Incidental diagnosis of paragonimiasis after histopathological examination of cholecystectomy specimen in Nepal: A case report

Introduction

Paragonimiasis or lung fluke disease is a typical food-borne parasitic zoonosis caused by infection with Paragonimus species. The Paragonimus is a trematode that mainly infects the lungs of humans after eating an infected raw or undercooked crab or crayfish.

Case presentation

Herein we report a case of peritoneal Paragonimiasis in the gallbladder of a 58-year-old female from Rukum district of Nepal. It was an incidental diagnosis following routine histopathological examination of the cholecystectomy specimen. She presented with the symptoms of abdominal pain, fever, cough, and had a history of consumption of partially cooked river crabs. She responded well to praziquantel and improved thereafter.

Clinical discussion

Ectopic paragonimiasis is a rare disease and it presents with few clinical symptoms so it is significantly difficult to make a diagnosis and treat the patients. Even if a sputum test and biopsy are performed, the ova or body of Paragonimus parasites may not be detectable due to insufficient amount of specimens. Therefore, thorough history taking should be given importance. The dietary history of partially cooked crab or crayfish should indicate towards a high suspicion of Paragonimiasis. Any such indication should be immediately confirmed, which in our case was done by routine histopathological examination of the cholecystectomy specimen.

Conclusion

We report the case of a patient with peritoneal paragonimiasis in the gallbladder. Ectopic paragonimiasis is hard to diagnose due to an ignorance of, misdiagnosis, and the rarity of this disease. Thus, thorough history-taking and clinical suspicion of parasitic infection is essential.

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Paragonimiasis is a parasitic zoonosis caused by Paragonimus species due to consumption of raw/partially cooked crustaceans.

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Paragonimiasis mainly infects the lungs of humans but ectopic sites like the brain and peritoneum are also seen.

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Ectopic paragonimiasis is hard to diagnose due to an ignorance of, misdiagnosis, and the rarity of this disease.

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Thorough history-taking and clinical suspicion of parasitic infection is essential for diagnosis of Paragonimiasis.

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Gallbladder histopathology after elective cholecystectomy helps in incidental diagnosis of many diseases like Paragonimiasis.

Genetic differentiation of Southeast Asian Paragonimus Braun, 1899 (Digenea: Paragonimidae) and genetic variation in the Paragonimus heterotremus complex examined by nuclear DNA sequences

Southeast Asian lung flukes, the causative agents of human and animal paragonimiasis, comprise at least 14 species. Of these, seven species; Paragonimus bangkokensis, P. harinasutai, P. macrorchis, P. siamensis, P. westermani, P. heterotremus and P. pseudoheterotremus were studied. Two regions of domain 1 of taurocyamine kinase; TkD1 (exon) and TkD1Int2 (intron 2), were used as genetic markers for elucidating their genetic differentiation, genetic variation, and heterozygosity. The TkD1 region was conserved between these species but can potentially be used to differentiate all seven species. However, the TkD1Int2 region had a high level of polymorphism, which is suitable for investigation of genetic variation within or between closely related species, especially P. heterotremus and P. pseudoheterotremus as well as for a phylogenetic analyses of the genus Paragonimus. Heterozygosity was mostly observed in DNA samples extracted from adult P. heterotremus including samples taken from sputum of paragonimiasis patients, whereas DNA extracted from metacercariae was not, except in the samples from Myanmar. Our findings provide evidence of DNA recombination and incomplete lineage sorting of P. heterotremus and P. pseudoheterotremus in TkD1Int2, which suggesting gene flow between these two species.

Characterization and localization of antigens for serodiagnosis of human paragonimiasis

Paragonimiasis is a foodborne trematode infection that affects 23 million people, mainly in Asia. Lung fluke infections lead frequently to chronic cough with fever and hemoptysis, and are often confused with lung cancer or tuberculosis. Paragonimiasis can be efficiently treated with praziquantel, but diagnosis is often delayed, and patients are frequently treated for other conditions. To improve diagnosis, we selected five Paragonimus kellicotti proteins based on transcriptional abundance, recognition by patient sera, and conservation among trematodes and expressed them as His-fusion proteins in Escherichia coli. Sequences for these proteins have 76-99% identity with amino acid sequences for orthologs in the genomes of Paragonimus westermani, Paragonimus heterotremus, and Paragonimus miyazakii. Immunohistology studies showed that antibodies raised to four recombinant proteins bound to the tegument of adult P. kellicotti worms, at the parasite host interface. Only a known egg antigen was absent from the tegument but present in developing and mature eggs. We evaluated the diagnostic potential of these antigens by Western blot with sera from patients with paragonimiasis (from MO and the Philippines), fascioliasis, and schistosomiasis, and with sera from healthy North American controls. Two recombinant proteins (a cysteine protease and a myoglobin) showed the highest sensitivity and specificity as diagnostic antigens, and they detected antibodies in sera from paragonimiasis patients with early or mature infections. In contrast, antibodies to egg yolk ferritin appeared to be specific marker for patients with adult fluke infections that produce eggs. Our study has identified and localized antigens that are promising for serodiagnosis of human paragonimiasis.

An outbreak of Paragonimus westermani infection among Cambodian technical intern trainees in Japan, exhibiting various extrapulmonary lesions

We encountered an outbreak of paragonimiasis among Cambodian technical intern trainees (TITs) at a food-processing factory in Fukuoka, Japan. The patients were 20-28 years old, seven females and two males, who had been in Japan for one to four years. All of them had consumed raw or undercooked Japanese mitten crab they purchased at a local grocery store near their training place. CT images showed multiple lesions not only in the lungs but in the extrapulmonary organs as well, such as subcutaneous tissues, abdominal muscles, and mesentery, in most of the patients. Their medical records indicated that all of them acquired infection in Japan, not in Cambodia. Diagnosis was made serologically and the patients were treated with praziquantel successfully. Foreign workers and TITs are increasing in Japan so rapidly, that food borne-infections, including paragonimiasis, should be considered in people from developing countries who have exotic dietary habits.

Paragonimiasis: A missed diagnosis from Nepal

Paragonimiasis, or Oriental lung fluke is a parasitic infestation seen in Asia, Africa and South America which is spread by the consumption of crabs and crayfish. To date four cases have been reported from Nepal. Here, we report a case of paragonimiasis in a young male from Kathmandu valley who presented with symptoms of fever, on and off for 1 month, shortness of breath and cough. He was found to have pleural effusion. Sputum examination did not reveal acid fast bacilli, However, based on clinical features, he was started on antitubercular treatment. There was initial improvement, but later, he continued to have cough and hemoptysis over the next 2 years and on subsequent High-Resolution Computerized Tomography (HRCT) he was found to have a cavitary lung lesion in the superior segment of lower lobe of left lung. A possibility of aspergillosis was considered for which he underwent a lobectomy. The gross examination of the lung showed a small cavity measuring 5 mm which revealed on histology a parasitic structure with serous glands within it. In addition, there were many foreign body granulomas with ova within them. A diagnosis of paragonimiasis was made and the patient was started on Praziquantal. He recovered well and is currently asymptomatic. We can learn from this case that the signs and symptoms of paragonimiasis mimic that of tuberculosis and the mistaken diagnosis can lead to unnecessary treatment, prolonged morbidity and loss of time and resources.

Identification of suspected paragonimiasis-endemic foci using a questionnaire and detection of Paragonimus ova using the Ziehl-Neelsen technique in Zamboanga Region, the Philippines

Improving paragonimiasis surveillance, which is crucial for disease control, requires adopting new tools and techniques useful in mapping endemic areas. This study aimed to (1) develop a questionnaire to identify suspected paragonimiasis-endemic foci, (2) describe the epidemiology of paragonimiasis, and (3) evaluate Ziehl-Nielsen Staining technique (ZNS) in detecting Paragonimus ova. The questionnaire, which municipal health officers filled out, was based on proposed site inclusion criteria utilized in the integrated tuberculosis (TB)-paragonimiasis surveillance and control project. Newly deployed medical technologists in Zamboanga Region underwent training, which included laboratory diagnosis of paragonimiasis using preserved and fresh specimens and an integrated tuberculosis-paragonimiasis survey in nine selected barangays (villages). Paragonimiasis cases were found in seven out of the nine barangays identified by the questionnaire. Of the 373 patients, three (0.80%) were TB-positive, and 29 (7.77%) were paragonimiasis-positive. The highest paragonimiasis prevalence (27%) was found in Barangay Libato. Ziehl-Neelsen Staining technique (ZNS) correctly detected 8 out of the 29 samples positive (sensitivity - 27.59%; 95% CI: 12.73-47.24%) and all the 334 samples negative (specificity - 100%; 95% CI: 98.90-100%) for Paragonimus ova. The questionnaire may be improved by refining the inclusion criteria. In paragonimiasis-endemic areas, the ZNS and the NaOH concentration technique may be used for detecting Paragonimus ova. Modifying the ZNS, for instance by including a concentration step, may improve its sensitivity. The model for the integrated capacity building of health workers and surveillance and research demonstrated in this project may contribute to improving surveillance and control of paragonimiasis and other neglected tropical diseases.

Development of point-of-care testing tool using immunochromatography for rapid diagnosis of human paragonimiasis

Paragonimiasis, an important food-borne zoonosis, is caused by lung flukes of the genus Paragonimus. Several million people are actually infected or at risk. Paragonimiasis is a re-emerging disease in developing countries. Diagnosis of pulmonary paragonimiasis is made by finding eggs in sputa and/or fecal samples. Eggs are typically not found in ectopic paragonimiasis cases, so diagnosis depends on supportive information, such as a history of eating fresh water crabs or crayfishes, radiographic findings and immunological tests. Here, a new point-of-care-testing (POCT) tool is presented. It uses immunochromatography for serodiagnosis of human paragonimiasis using excretory-secretory antigen from Paragonimus heterotremus. It proved effective in diagnosing infections due to P. heterotremus, and was also successfully diagnosed with sera from infections with P. westermani and P. miyazakii. The diagnostic sensitivity, specificity, positive and negative predictive values and accuracy were 97.9%, 87.6%, 78%, 98.9%, and 90.8%, respectively. The developed POCT tool is rapid and simple to use not only for clinical diagnosis of paragonimiasis at the bedside or at well-equipped laboratories, but also at local and remote hospitals with limited facilities. Moreover, the POCT tool could be applied for epidemiological surveys of paragonimaisis in Asia where P. heterotremus, P. westermani and P. miyazakii are endemic.

A case of group infections with Paraginimus species in Henan, Central China

In July of 2012, mass infections with Paragonimus species were detected in the Henan province sickening 11 of 51 people. In May 2011, these individuals had participated in an excursion during which freshwater crabs were caught and served after being toasted. Before the group infections with Paraginimus species was confirmed, 5 of the 11 patients had been misdiagnosed as tuberculosis (TB) and treated with an anti-TB drug regimen for six months. The most common and typical manifestations were eosinophilia (11/11, 100%) and pulmonary manifestations including, among others, stethalgia and cough (7/11 63.6%). Sero-examination revealed that all 11 patients were seropositive for Paragonimus species. Surprisingly, in our case, one patient presented with hemoptysis and eggs in respiratory secretions, and this is the first time P. skrjabini eggs are detected in the sputum of a patient from the Henan province. Paragonimus metacercariae were collected from 6 of 11 (54.5%) crabs caught at the infection site and were identified as Paraginiumus skrjabini by morphological and molecular examinations. Epidemiological and laboratory evidence confirmed that this is a case of group infection with P. skrjabini. As one of the most neglected tropical diseases (NTD), paragonimiasis should be differentiated diagnosed from TB to avoid the delay of treatment. To our knowledge, this is the second report of a case of group infections with Paraginimus species in Henan, Central China. The first case was reported in 1995. As a kind of food-borne parasitic disease, paragonimiasis should be included in the public health education agenda.

Simultaneous Paragonimus infection involving the breast and lung: A case report

BACKGROUND

Paragonimiasis is a food-borne parasitic infection caused by lung flukes of the genus Paragonimus. Although the most common site of infection is the pleuropulmonary area, the parasite can also reach other parts of the body on its journey from the intestines to the lungs, ending up in locations such as the brain, abdomen, skin, and subcutaneous tissues. Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease.

CASE SUMMARY

Here, we report a rare case of simultaneous breast and pulmonary paragonimiasis in a woman presenting painless breast mass and lung nodule with a history of eating raw trout. To confirm the diagnosis, serologic testing and tissue confirmation of the breast mass were performed. The patient was treated with surgical resection of the mass and praziquantel medication.

CONCLUSION

Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease. Thus, thorough history-taking and clinical suspicion of parasitic infection are important.

Paragonimus and paragonimiasis in Asia: An update

Paragonimiasis, or lung fluke disease, is a typical food-borne parasitic zoonosis caused by infection with trematodes belonging to the genus Paragonimus. More than 50 species of Paragonimus have been reported throughout the world, of which seven valid species infect humans, an estimated one million people annually worldwide. Among the seven species, P. westermani, P. heterotremus, and P. skrjabini/P. s. miyazakii, distributed in Asia, are the most important species as the cause of paragonimiasis. Humans acquire infection through the ingestion of raw, pickled or undercooked freshwater crustaceans, 2nd intermediate hosts, or consuming raw meat of wild boar or deer, paratenic hosts. Infections often occur clustered in foci where dietary habits allow transmission of the parasites. Paragonimiasis typically causes a subacute to chronic inflammatory disease of the lungs. The symptoms, including chronic cough, chest pain, dyspnea and hemoptysis, mimic those of tuberculosis and lung cancer. Serologic tests are commonly used for the diagnosis of paragonimiasis, and Praziquantel is the treatment of choice. In this review, the current status of Paragonimus and paragonimiasis in Asia is outlined based on the latest information and findings. We also summarize current trends of paragonimiasis in Japan, which is one of the most endemic area of paragonimiasis in the world, for the better understanding and control of paragonimiasis.

Multi-disciplinary integration of networking through the RNAS+: Research on other target diseases

In 2005, the network decided to increase its number of target diseases to include other helminthic zoonoses such as fascioliasis, clonorchiasis, opisthorchiasis, paragonimiasis and cysticercosis and in the process expanding membership to include South Korea, Vietnam, Thailand and Japan. NTDs were eventually included as awareness is heightened on these diseases affecting poor and developing countries. Researches on clonorchiasis and opisthorchiasis unravel the mechanism by which these diseases eventually predispose to cholangiocarcinoma. The liver cancer associated with these liver fluke infections necessitate the need to clarify the global burden of disease of these infections. The magnitude of these liver fluke diseases in endemic countries like China, Vietnam, Laos, Cambodia and Thailand is described. Success in elimination of lymphatic filariasis in PR China and Cambodia is highlighted to show how intensified multisectoral collaboration and strong political become strong ingredients in elimination of parasitic diseases like LF. New advances are presented that clarify species and strain differences in Fasciola spp., Paragonimus spp., Taenia spp. and Echinococcocus spp. Conventional diagnostic techniques are compared with new serologic techniques that are being developed. New control strategies such as the Lawa model are presented.

Progress on the development of rapid diagnostic tests for foodborne neglected zoonotic helminthiases: A systematic review

BACKGROUND

Foodborne Neglected Zoonotic Helminths (FNZH) are parasites of both economic and public health importance. They include Taenia solium, Echinococcus granulosus sensu lato, Echinococcus multilocularis and Foodborne trematodes (FBT). FNZH are earmarked for major interventions for control, elimination and eradication. This systematic review highlights the progress towards development of rapid tests for the diagnosis of FNZH since 2010 when they were listed as neglected tropical diseases.

METHODOLOGY

A systematic search was conducted in three databases, World of Science, Embase and PubMed using the same search phrase. The search produced 480 hits. Three studies from back referencing were included. Only 22 of these met the inclusion criteria. Data was extracted from these and presented qualitatively.

RESULTS

Twenty-five rapid diagnostic tests were found to have been developed since 2010, eight for diagnosis of T. solium infections, eight for echinococcosis and nine for FBT infections. The rapid tests for diagnosing T. solium infections included six antibody detecting and two antigen detecting tests. They constitute a combination among them, with some tests providing qualitative, others quantitative results. Similarly, seven out of the eight rapid tests developed for Echinococcus infections were antibody detecting tests save for one loop mediated isothermal amplification test. All of them were qualitative tests. For FBT infections, nine rapid tests were described; two antibody and one nucleic acid detecting test for diagnosis of Fascioliasis; three nucleic acid detecting tests for Opisthorchiasis; one antibody detecting test for Paragonimiasis; and for Clonorchiasis, one antibody and one nucleic acid detecting test. The FBT infection rapid tests were all qualitative in nature. Most of these tests have not undergone field evaluation in endemic areas where they will be used most.

CONCLUSION

This review describes the development and evaluation of rapid diagnostic tests, while highlighting the need for in depth validations of the tools to determine how well they can perform in endemic areas.

Diagnosis and surgical management of pericardial effusion due to paragonimiasis

OBJECTIVES

The pericardial effusion (PE) caused by paragonimiasis is rarely reported. This study aims to present experience in the diagnosis and surgical management of PE due to paragonimiasis.

METHODS

Medical records of 57 children who were diagnosed with PE due to paragonimiasis and underwent surgery at Children's Hospital of Chongqing Medical University between January 2012 and August 2018 were retrospectively reviewed.

RESULTS

The average age of this group was 7.6 ± 3.0 years. Patients were mainly from Chongqing and Sichuan areas. ELISA for Paragonimus skrjabini in all 57 patients showed positive results. Moderate or large PE were identified in 12 and 45 patients, respectively. All patients underwent surgery either by pericardectomy or thoracoscopic surgery. Pathological exams indicated massive eosinophil infiltration in all 57 specimens. After 3-4 courses of praziquantel therapy, the clinical outcomes were satisfactory.

CONCLUSIONS

Typical endemic history, eosinophilia and multiple serous effusion raise suspicions of paragonimiasis. Once moderate to large PE is identified in patients with paragonimiasis, surgical treatment is necessary.

Estimation of disability weight for paragonimiasis: a systematic analysis

Background

Paragonimiasis, caused by helminths of the genus Paragonimus spp., is a neglected tropical disease. Human suffering from paragonimiasis is often misunderstood and its quantification by the disability weight of the disability-adjusted life years largely varies in different global burden of disease (GBD) estimates. This paper is to systematically review clinical paragonimiasis cases and requantify the disability weight of human paragonimiasis.

Methods

A systematic analysis was conducted using articles from the following databases: PubMed, Institute for Scientific Information Web of Science, China National Knowledge Infrastructure, the Chinese scientific journal databases Wanfang Data and CQVIP, Africa Journal Online, and the System for Information on Grey Literature in Europe. Search terms were the combination of “paragonim*” with “clinical” or “infection”. Only articles fulfilling the following conditions were recruited for this study: the occurrence of clinical signs and symptoms of paragonimiasis in human beings were reported; diagnosis was confirmed; no comorbidities were reported; the reviewed clinical cases or epidemiological findings were not already included in any other articles. The information and frequencies of paragonimiasis outcomes from included articles using predefined data fields were extracted two times by two separate individuals. Outcome disability weights were selected mainly from the GBD 2004 and GBD 2013 datasets. Frequencies and disability weights of paragonimiasis outcomes were modelled into a decision tree using the additive approach and multiplicative approach, respectively. Monte Carlo simulations were run 5000 times for an uncertainty analysis.

Results

The disability weight estimates of paragonimiasis were simulated with 5302 clinical cases from 80 general articles. The overall disability weight was estimated at 0.1927 (median 0.1956) with a 95% uncertainty interval (UI) of 0.1632–0.2378 using the additive approach, and 0.1791 (median 0.1816) with a 95% UI of 0.1530–0.2182 using the multiplicative approach. The simulated disability weights of Paragonimus westermani cases were higher than that of P. skrjabini cases. Lung outcomes and headache were the top two contributors to disability weight for both species.

Conclusions

The use of paragonimiasis disability weight needs to be reconsidered with regard to availability of morbidity data and species variation. Calculating the disease burden of paragonimiasis requires further modification and thus has considerable implications for public health prioritization in research, monitoring, and control.

Electronic supplementary material

The online version of this article (10.1186/s40249-018-0485-5) contains supplementary material, which is available to authorized users.

Paragonimus westermani infection manifesting as a pulmonary cavity and adrenal gland mass: A case report. J Infect Chemother. 2019;25:200-203. [PMID: 30213500 DOI: 10.1016/j.jiac.2018.08.005]

We report a case of Paragonimus westermani infection simultaneously affecting two separate organs that presented as both a pulmonary cavity and adrenal mass in an immunocompromised host. A 65-year-old male with a previous kidney transplant visited our clinic because of hemoptysis. Chest computed tomography (CT) showed a pulmonary cavity and right adrenal gland mass. The Aspergillus antigen titer in bronchial lavage fluid was elevated and showed positive conversion. It was necessary to differentiate lung cancer with adrenal gland metastasis from a fungal infection with an adrenal gland adenoma. Positron emission tomography CT suggested benign disease, and it was misdiagnosed as pulmonary aspergillosis based on the elevated Aspergillus antigen titer in the bronchial lavage fluid. Owing to the adverse effects of anti-fungal treatment, the patient underwent wedge resection of the lung and P. westermani was confirmed. A careful history revealed that the patient had eaten raw freshwater crabs 3 years earlier, and a test for serum antibodies to P. westermani was positive. Despite treatment with praziquantel, the adrenal mass persisted on 3-month follow-up CT. A right adrenalectomy was performed and a P. westermani infection was confirmed.

[Clinical analysis of 50 cases of serous cavity effusion related with paragonimiasis]

OBJECTIVE

To analyze the clinical characteristics of serous cavity effusion related with paragonimiasis, so as to improve the physician's ability of the clinical diagnosis and treatment.

METHODS

The clinical data of 50 cases of serous cavity effusion related with paragonimiasis diagnosed in a hospital in recent 3 years were collected and retrospectively analyzed.

RESULTS

Among the 50 patients, there were 35 males and 15 females, and 35 children and 15 adults. Eighteen patients had a clear history of exposure to the foci. Among the children, the respiratory symptoms accounted for 68.6% (24/35), gastrointestinal symptoms for 22.9% (8/35), and no apparent symptoms for 8.6% (3/35); among the adults, the respiratory symptoms accounted for 93.3% (14/15) and the abdominal distention for 6.7% (1/15). The paragonimus antibody was positive in all the patients. The chest radiography or CT showed pulmonary inflammatory exudation and serous cavity effusion. Eosinophilia in blood was found in 25 cases, a large number of eosinophils in serous cavity effusion were found under microscopy in 12 cases, and eosinophil infiltration of pleura was found in 7 cases. All were cured after the patients received chemotherapy (praziquantel) and drainage fluid.

CONCLUSIONS

The clinical manifestations of paragonimiasis are not very specific and paragonimiasis is often accompanied with serous cavity effusions. Clinically, paragonimiasis is easily misdiagnosed as tuberculosis or cancer. We should consider about the possibility of paragonimiasis when eosinophil is high in blood, serous cavity effusion and pleura.

[Survey of epidemic status of paragonimiasis in western mountainous areas in Hubei Province]

OBJECTIVE

To understand the current status of paragonimiasis epidemic in western mountain areas in Hubei Province.

METHODS

Four counties (cities) of Western Hubei Province (Xingshan, Enshi, Yunxi, Baokang) were selected as the investigation sites for active surveillance. Crabs were captured and the metacercariae of Paragonimus were detected. Meanwhile, the blood samples were collected from the residents in the surveillance sites and the unique IgG and IgM antibodies against Paragonimus in the sera were detected by ELISA. In addition, a questionnaire survey about knowledge and behavior of prevention and control of paragonimiasis was taken among the residents.

RESULTS

A total of 1 143 residents were investigated in the active surveillance, the total positive rate of the serology test was 1.84% (21/1 143), while the rates of the male and the female were 1.78% (10/562) and 1.89% (11/581), respectively, with no statistical significance between them ( χ² = 0.002, P > 0.05). The average weight of 161 fresh-water crabs captured was 11.72 g, with the positive rate of 9.32% (15/161) and the infective density of 7.07 metacercariae per positive crab. The positive rates of the male and female crabs were 11.54% (9/78) and 7.23% (6/83), respectively ( χ² = 0.884, P > 0.05), and the infective densities were 6.67 and 7.67 metacercariae per positive crab, respectively. Totally 1 143 residents were investigated by questionnaires, and 0.44% of them had the behavior of eating raw or half-done fresh-water crab, and 0.87% of them had the behavior of drinking un-boiled stream water.

CONCLUSIONS

The transmission chain of paragonimiasis still exists in the nature environment of mountain area in Western Hubei Province. The positive rate of the second intermediate host rebounds in some investigation sites. Therefore, the measures of continuous surveillance and health education should be taken to avoid the appearance of the prevalence or outbreak.

ELISA based on a recombinant Paragonimus heterotremus protein for serodiagnosis of human paragonimiasis in Thailand

Background

Paragonimus heterotremus is the main causative agent of paragonimiasis in Thailand. In Western blot diagnostic assays for paragonimiasis, the 35 kDa band present in crude P. heterotremus somatic extracts represents one of the known diagnostic bands. This study aimed to use a P. heterotremus cDNA library to create a recombinant version of this antigen for use in immunodiagnosis of paragonimiasis.

Methods

To accomplish this aim a cDNA expression library was constructed from adult worm mRNA and immuno-screened using antibodies from mice that had been immunized with the 35 kDa antigen. Screening resulted in the identification of an immunoreactive protein encoded by clone CE3, which contained an inserted sequence composed of 1292 base pairs. This clone was selected for use in the construction of a recombinant P. heterotremus protein because of its similarity to proactivator polypeptide. For recombinant protein expression, the CE3 gene sequence was inserted into the plasmid vector pRset and the resulting product had the expected molecular weight of 35 kDa. An IgG-ELISA based on the CE3 recombinant protein was evaluated by using sera from healthy individuals, from patients with paragonimiasis and other parasitic infections. This ELISA was performed by using human sera diluted at 1:2000, an optimized antigen concentration of 1 μg/ml, and anti-human IgG diluted at 1:4000.

Results

The cut-off optical density value was set as the mean + 2 standard deviations (0.54), which resulted in the test having a sensitivity of 88.89% and a specificity of 95.51%. The recombinant antigen could react with antibodies from P. heterotremus, P. pseudoheterotremus and P. westermani infections. Cross-reactivity occurred with a few cases of Blastocystis hominis infection (2/3), Bancroftian filariasis (1/10), opisthorchiasis (3/10), strongyloidiasis (4/10) and neurocysticercosis (1/11).

Conclusions

Given the high test sensitivity and specificity, reflected in the low level of heterologous infection cross-reactivity (11/215 serum samples), observed in the IgG-ELISA, this 35 kDa antigen may be useful for the detection of paragonimiasis.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-2878-5) contains supplementary material, which is available to authorized users.

Hepatic Paragonimiasis Mimicking Hepatocellular Carcinoma

Paragonimiasis is a parasitic lung infection caused by lung flukes of the genus Paragonimus. Ectopic infection may occur but rarely involves the liver. Here, we report a case of hepatic paragonimiasis in a Chinese man who was initially suspected to have hepatocellular carcinoma. He had been previously diagnosed with chronic hepatitis B. No specific symptoms or abnormal blood test results were observed, except for a significant rise in serum alfa-fetoprotein. Magnetic resonance imaging revealed a 12-cm mass with inhomogeneous signal intensity at the left lobe of the liver. Laparoscopic left hemihepatectomy was performed. He was finally diagnosed as hepatic paragonimiasis upon pathological examination and antibody serology. The postoperative course was uneventful. He received a standard course of praziquantel and recovered well. Our case is unique in its tumor-like characteristic and protrudes the difficulty of differential diagnosis with both benignant and malignant hepatic diseases by imaging studies or non-specific symptoms. Hepatic paragonimiasis is unusual; however, it should be considered in the differential diagnosis of liver malignancy by clinicians.

Examining human paragonimiasis as a differential diagnosis to tuberculosis in The Gambia

OBJECTIVE

Paragonimiasis is a foodborne trematode infection of the lungs caused by Paragonimus spp., presenting clinically with similar symptoms to active tuberculosis (TB). Worldwide, an estimated 20.7 million people are infected with paragonimiasis, but relatively little epidemiological data exists for Africa. Given a recently reported case, we sought to establish whether paragonimiasis should be considered as an important differential diagnosis for human TB in The Gambia, West Africa.

RESULTS

We developed a novel PCR-based diagnostic test for Paragonimus species known to be found in West Africa, which we used to examine archived TB negative sputum samples from a cross-sectional study of volunteers with tuberculosis-like symptoms from communities in the Western coastal region of The Gambia. Based on a "zero patient" design for detection of rare diseases, 300 anonymised AFB smear negative sputum samples, randomly selected from 25 villages, were screened for active paragonimiasis by molecular detection of Paragonimus spp. DNA. No parasite DNA was found in any of the sputa of our patient group. Despite the recent case report, we found no evidence of active paragonimiasis infection masking as TB in the Western region of The Gambia.

Hepatic paragonimiasis in a 15-month-old girl: a case report

Background

Paragonimiasis, particularly hepatic paragonimiasis (HP), is a type of zoonotic parasitic disease rarely encountered in infants. There have been only a few reports of HP, and no case of HP has been reported in an infant.

Case presentation

A 15-month-old girl presented with persistent mild fever with a duration of 1 month, hepatomegaly, and low-density lesions in the right hepatic lobe on abdominal ultrasound and computer tomography. Pathological examination and serum antibody detection were performed to verify HP. The diagnosis of HP was established based on findings of Charcot-Leyden crystals on liver lesion biopsy and antibodies against paragonimus westermani detected by enzyme-linked immunosorbent assay. After initiation of praziquantel (75 mg/kg/day for 3 days), all clinical findings promptly improved and the patient was discharged.

Conclusion

It is very important to consider paragonimiasis in the clinical examination of infants from an area with paragonimiasis epidemic presenting with fever, hepatomegaly, low-density lesions in the liver.

[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.

[Investigation on epidemic foci of paragonimiasis in eastern part of Zhenghe County, Fujian Province]

OBJECTIVE

To investigate the species and hosts of Paragonimus and its infection rate in eastern part of Zhenghe County, Fujian Province, so as to determine the local foci of Paragonimus.

METHODS

The snails, crabs and stools of wild cats were collected for the examinations of cercariae, metacercariae and eggs of Paragonimus. The geographical and environmental conditions of the areas were also investigated.

RESULTS

A total of 4 890 Pseudobythinella jianouensis snails and 1 035 Semisulcospira liberlina snails were examined, and the cercariae of Paragonimus were only found in P. jianouensis, with an infection rate of 0.10% (5/4 890). Bottapotamon zhengheensis sp. nov. as the second intermediate host of P. skrjabini, were examined, and the infection rate was 85.29% (29/34) and the average numbers of metacercariae per crab and per gram of crab tissues were 3.85 and 0.62, respectively. Thirty-six Sinopotamun fujianensis crabs, as the second intermediate host of P. westermani, were examined, and the infection rate was 38.89% (14/36) and the average numbers of metacercariae per crab and per gram of crab tissues were 6.43 and 0.03, respectively. The eggs of Paragonimus were detected in 1 of 2 muck specimens of wild cats.

CONCLUSIONS

The data suggest that there is a focus of middle-to-high level of infection caused by P. westermani and P. skrjabini in the eastern part of Zhenghe County.

A tool for mass-screening of paragonimiasis: an enzyme-linked immunosorbent assay with urine samples

BACKGROUND

Paragonimiasis is one of the foodborn trematodiases and number of the patients was estimated to be about 23 million around the world. To obtain good compliance of people for the surveillance of paragonimiasis, an enzyme-linked immunosorbent assay (ELISA) for the diagnosis of paragonimiasis with unconcentrated urine samples was developed.

RESULTS

Paragonimus westermani antigen specific IgG and IgG4 were detected in urine samples from paragonimiasis patients and the levels correlated well with those detected in the paired serum samples. Cross-reactions observed among other trematodiasis and a tuberculosis patient with the antigen specific IgG were much reduced by detecting the antigen specific IgG4; 9.2 % to 2.3 %.

CONCLUSIONS

The ELISA with urine samples, which are collected safely and easily, will be a useful tool for a mass-screening of paragonimiasis.

[Effect evaluation of three ELISA kits in detection of paragonimiasis]

OBJECTIVE

To evaluate the effects of 3 kinds of ELISA reagents on the detection of human paragonimiasis.

METHODS

A total of 45 serum samples from patients with paragonimiasis, 218 serum samples from patients with other parasitic diseases as well as 80 serum samples from healthy people were detected by GD-ELISA (IgG antigen ELISA detection reagent), ESELISA (using excretory/secretory (ES) products of Paragonimus westermani), and sAg-ELISA (using semi-purified antigen (sAg) of P. westermani), respectively. The effects of the 3 reagents were evaluated and compared.

RESULTS

The sensitivities of GD-ELISA, ES-ELISA, and sAg-ELISA were 95.6% (95% CI：89.6%～100.0%), 93.3% (95% CI：86.0%～100.0%) and 86.7% (95% CI：76.8%～96.6%), respectively; the specificities of the above three reagents were 88.6% (95% CI：85.0%～ 92.2%), 88.9% (95% CI：85.3%～92.5%) and 99.0 % (95% CI：97.9%～100.0%), respectively, and the Youden indexes of them were 0.84, 0.82 and 0.86, respectively.

CONCLUSIONS

sAg-ELISA is more suitable than GD-ELISA and ES-ELISA for clinical sample tests in paragonimiasis endemic areas in China.

[A Case of Intra-abdominal Paragonimiasis Mimicking Metastasis of Lung Cancer Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration]

Paragonimiasis has been continuously decreasing in Korea. However, it still occurs by ingesting raw or incompletely cooked fresh water crab or crayfish. The diagnosis of paragonimiasis is challenging because of its rarity. It may be confused with other inflammatory disease or carcinomatosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has lower risk of complications such as bleeding, perforation than percutaneous fine needle aspiration. EUS-FNA is more accurate and popular method to find mucosal or submucosal tumors and the lesions of several organs. Benign and malignant tumors, infectious diseases have been diagnosed by EUS-FNA, but there was no report describing the use of EUS-FNA for diagnosing paragonimiasis. Herein, we present a 47-year-old male patient with paragonimiasis diagnosed by EUS-FNA. Imaging studies revealed mass lesions in the lung and peritoneal cavity, which was eventually confirmed as paragonimiasis using EUS-FNA.

[Clinical analysis of 17 cases of paragonimiasis]

OBJECTIVE

To investigate the clinical features, diagnosis and treatment of paragonimiasis, so as to improve the prevention and treatment of it.

METHODS

The clinical data of paragonimiasis patients were collected and retrospectively analyzed.

RESULTS

Totally 17 patients were diagnosed as paragonimiasis and the main clinical features of 11 patients were cough, chest pain and fever, and the pleural effusion was found in 13 cases. Peripheral blood eosinophil percentages of all patients were significantly increased, and the detections of antibody IgG againstParagonimus parasite of ELISA method were positive in all patients. All the patients were cured after praziquantel treatment and no recurrence found in the follow-up visit.

CONCLUSIONS

The clinical features of paragonimiasis patients are diverse, and pleural effusion is quite common in imaging examinations. The eosinophil percentages and antibody detections have important values for the diagnosis of paragonimiasis. Praziquantel is an effective medicine in the treatment.

Pancreatic paragonimiasis mimics pancreatic cystic-solid tumor--A case report

Paragonimiasis is frequently misdiagnosed owing to its various and complicated clinical manifestations. Although paragonimiasis has diverse manifestations, there is no report of paragonimiasis involving the pancreas. Herein we report the first case of pancreatic paragonimiasis, which was misdiagnosed as pancreatic cystic-solid tumor by CT scan. The pancreatic lesion was finally proved to be pancreatic paragonimiasis by pathological examination and serum antibody detection. The clinical manifestations and imaging features of this patient were analyzed. Pancreatic paragonimiasis should be an important differential diagnosis for pancreatic cyst-solid lesions.

A rare case of paragonimiasis miyazakii with lung involvement diagnosed 7 years after infection: A case report and literature review

We report a rare case of pulmonary paragonimiasis caused by Paragonimus miyazakii that showed pulmonary manifestations and a long-term clinical course after infection. A 45-year-old Japanese male developed cough and dyspnea in 2004 and was diagnosed with eosinophilic pneumonia. He had been treated with low-dose oral corticosteroid for 7 years. He recalled that he had consumed a large amount of raw freshwater crab (Geothelphusa dehaani) several weeks before he had been admitted for the first time, and that had been the only occasion when he had eaten this meat. The patient was referred to our hospital due to persistent hemoptysis, and his chest computed tomography scan showed pulmonary nodules and cavities, and his serum total IgE level was elevated. Bronchoscopy was performed, and ova were detected in the bronchoalveolar lavage fluid. The morphological examination of the ova and immunoserological examination yielded typical findings of P. miyazakii. Treatment with praziquantel improved his chest radiographic findings and a decrease of serum total IgE, as well as the values of immunoserological examination for P. miyazakii. The clinical course of this patient indicated that he had been infected with P. miyazakii for 7 years at least, which is unusual for paragonimiasis miyazakii.

A case of pleural paragonimiasis confused with tuberculous pleurisy

Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.

Rare case of paragonimiasis with involvement of the parotid gland alone in a 5-year-old boy

Paragonimiasis is a parasitic disease caused by Paragonimus trematodes, which are typical food-borne zoonoses prevalent in Asia, West Africa, and Latin America. A clinical infection by paragonimiasis usually begins with cough, haemoptysis, and dyspnoea, some of which overlap with symptoms of tuberculosis and other pulmonary disorders. Human paragonimiasis presents as a complex set of symptoms that may result in misdiagnosis and delayed treatment. The parotid is seldom affected. We describe the case of a 5-year-old boy with paragonimiasis who presented with a swelling of the parotid and no pulmonary signs or symptoms.