Derrame pleural por paragonimiasis pulmonar en la Región Amazónica del Ecuador

RESUMEN Introducción: La paragonimiasis pulmonar es una trematodiasis tropical poco común, causada por Paragonimus spp. Se adquiere por la ingestión de cangrejos de agua dulce, que puede provocar sintomatología respiratoria con tos crónica y expectoración herrumbrosa. El derrame pleural es una complicación rara con disnea y dificultad respiratoria. Objetivo: describir un caso con derrame pleural bilateral por infección de Paragonimus spp. Caso clínico: Mujer indígena Kichwa de 51 años, de la Amazonía del Ecuador, hospitalizada por dificultad respiratoria y disnea progresiva, con tos y expectoración hemoptoica. En radiografía y tomografía axial computarizada de tórax, se observa derrame pleural bilateral y en esputo se visualizan al microscopio huevos de Paragonimus spp. Se administró praziquantel 1 800 mg/día por 3 días. Al quinto día es dada de alta y a los 45 días existe resolución del cuadro respiratorio y del derrame pleural. Conclusiones: Considerar la búsqueda de huevos del parásito en esputo y/o líquido pleural en pacientes con sintomatología respiratoria y derrame pleural, incluso en migrantes de países endémicos, para un diagnóstico temprano y tratamiento oportuno.

ABSTRACT Introduction: Pulmonary paragonimiasis is an uncommon tropical trematode infection caused by Paragonimus spp. Acquired through the intake of freshwater crabs, this condition is characterized by respiratory symptoms such as chronic coughing and rusty expectoration. Pleural effusion is a rare complication accompanied by dyspnea and difficulty breathing. Objective: Describe a case of bilateral pleural effusion due to Paragonimus spp. infection. Clinical case: A female 51-year-old indigenous Kichwa woman was admitted for difficulty breathing and progressive dyspnea, coughing and hemoptoic expectoration. Chest radiography and computed axial tomography showed bilateral pleural effusion, whereas Paragonimus spp. eggs were visible in sputum samples under the microscope. Praziquantel 1 800 mg/day was administered for three days. The patient was discharged on the fifth day and at 45 days the respiratory picture and the pleural effusion were found to have resolved. Conclusions: Consideration should be given to the search for eggs of the parasite in sputum and/or pleural fluid of patients with respiratory symptoms and pleural effusion, even if they are migrants from endemic countries, with a view to an early diagnosis and timely treatment.

Identification of pulmonary paragonimiasis using Ziehl-Neelsen stain

Pulmonary paragonimiasis and tuberculosis are endemic in Asia, South America, and Africa. However, differential diagnosis among the diseases is difficult because they present with similar clinical symptoms and diagnostic features. Here, we report a case of pulmonary paragonimiasis that was identified using Ziehl-Neelsen stain after initially being assessed for pulmonary tuberculosis. Following anti-Paragonimus chemotherapy, the patient's symptoms, laboratory test results, and lung lesions improved. Thus, the identification of Paragonimus westermani using Ziehl-Neelsen stain can be considered in the diagnosis.

First case of Paragonimus westermani infection in a female patient in India.

Paragonimiasis is a foodborne parasitic zoonosis caused by lung fl uke species of the genus Paragonimus. The Paragonimus westermani is the most common human pathogen in Asian countries. In northeast India, Paragonimus heterotremus has been documented as the only human pathogen in the earlier literature. In India, P. westermani infection in humans remained undetermined. Herein, we report a case of pulmonary paragonimiasis due to P. westermani in an adult female in Manipur. The diagnosis was made by morphological and molecular characterisation of the eggs in the sputum. This is the fi rst confi rmed case of paragonimiasis due to P. westermani in India.

Pneumothorax Induced by Pulmonary Paragonimiasis: Two Cases Report

When the juvenile worms of the genus Paragonimus migrate and cause defects on the surface of the visceral pleura, pneumothorax can develop. A 34-year-old woman was admitted for pneumothorax with which was developed after she ate raw fish and crab. A 21-year-old male soldier presented with recurrent bilateral pneumothorax without eosinophilia, caused after drinking stream water frequently. In both patients, paragonimiasis was suspected from the computed tomography scan and confirmed by an enzyme-linked immunosorbent assay test of the pleural fluid. When pneumothorax develops in patients who have ingested raw fresh-water crab or stream water, paragonimiasis should always be considered in the differential diagnosis.

A Case of Pulmonary Paragonimiasis Presented as Solitary Pulmonary Nodule and Suspected as Lung Cancer on (18)F-Fluorodeoxyglucose Positron Emission Tomography / 결핵및호흡기질환

Pulmonary paragonimiasis continues to be a diagnostically challenging parasitic disease, despite a drastically decreased prevalence in South Korea during the past decade. Pulmonary paragonimiasis is characterized by fever, chest pain, and chronic cough with hemoptysis. Numerous radiographic and computed tomographic findings including the presence of pneumothorax, pleural effusion, and parenchymal lesions such as nodular or infiltrative opacities have been reported. The clinical and radiological manifestations of paragonimiasis can resemble those of lung cancer, tuberculosis or a metastatic malignancy. Furthermore, this disease can mimic lung cancer as seen on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). We report a case of pulmonary paragonimiasis in a 48-year old man that presented with a solitary pulmonary nodule and was suspected as a lung cancer based on FDG-PET imaging.

A Case of Pulmonary Paragonimiasis

Paragonimiasis is a parasitic disease found in carnivorous animals which is caused by trematodes of the genus Paragonimus. Human infestation occurs by ingestion of raw or not incompletely cooked freshwater crab or crayfish with the metacercaria. Recently, the prevalence of human paragonimiasis has decreased markedly, however, about one hundred clinical cases have been diagnosed annually by antibody test in Korea. The symptoms, such as chronic cough, hemoptysis, and radiological findings are often confused with those of tuberculosis. Therefore, differential diagnosis between tuberculosis and paragonimiasis is important in Korea which has a high prevalence of tuberculosis. Recently, we experienced a case of pulmonary paragonimiasis in a 13yearold girl with hemoptysis and chest pain. Chest roentgenogram with subsequent tomography demonstrating multiple cavitary lesions and linear tubular densities. Strong positive was noted in intradermal skin test for Paragonimus westermani as well as in IgG antibody detection using ELISA method. Diagnosis was confirmed by stool with multiple P. westermani ova, which was treated with a two day course of praziquantel.