Two cases of Lophomonas blattarum infection combined with paragonimiasis and literature review / 中国基层医药

Objective:To investigate the clinical manifestations, diagnosis, and treatment methods of Lophomonas blattarum infection combined with paragonimiasis in children, and improve pediatricians' understanding of the disease. Methods:The clinical data of two children with Lophomonas blattarum infection combined with paragonimiasis who received treatment in the Department of Pediatrics of The First People's Hospital of Yunnan Province were retrospectively analyzed. Children's clinical manifestation and diagnosis and treatment were analyzed. Relative literature was reviewed. Results:Case 1 had the onset of gastrointestinal symptoms. Case 2 had the onset of headache and liver dysfunction. Routine blood tests showed elevated eosinophils two cases and sputum examination results revealed the presence of live eggs of Lophomonas blattarum and paragonimiasis in two cases. Fecal roundworm eggs were also detected in case 1. Follow-up results showed that both cases were cured after treatment with metronidazole injection and praziquantel tablets. Conclusion:Lophomonas blattarum infection is a relatively rare opportunistic infection. Paragonimiasis is a natural parasitic disease that affects both humans and animals. Mixed infection of the two pathogens is rare. We hope that the findings from this paper will broaden clinical physicians' thoughts and guide clinical practice.

Analysis of surveillance results of paragonimiasis in Zhejiang Province from 2005 to 2020 / 中华地方病学杂志

Objective:To ascertain the endemic status of paragonimiasis in Zhejiang Province.Methods:From 2005 to 2020, 2-3 villages in 1-2 counties (cities, districts, hereinafter refferred to as counties) in historical endemic areas of paragonimiasis in Zhejiang Province were selected for monitoring each year. In each village, 50 to 150 local residents were selected as monitoring subjects, venous blood samples were collected, and serum Paragonimus antibody was detected by enzyme-linked immunosorbent assay (ELISA). Fifty to 100 intermediate hosts crabs or crayfish were collected in each village, and the infection of Paragonimus metacercaria was detected by crushing precipitation. Results:The positive rate of Paragonimus antibody was 2.9% (94/3 297); 3 929 crabs or crayfish were divided into 2 749 groups, 790 of which were found to have Paragonimus metacercaria infection, with a Paragonimus metacercaria infection rate of 28.7%. Conclusions:Paragonimus transmission chain exists in some counties of Zhejiang Province, which still has the potential risk of Paragonimus epidemic. Therefore, it is necessary to strengthen monitoring and carry out extensive health education to improve residents' self-protection awareness.

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.

Dificultad en el diagnóstico de Paragonimiasis en centros de primer nivel. Reporte de un caso / Difficult Paragonimiasis diagnosis in first level centers. Case report

Paciente quien refiere ingesta de cangrejo sin cocción presentó cuadro caracterizado por ardor de garganta, dificultad respiratoria y deposiciones diarreicas. Seguidamente tos y hemoptisis; acudió a un centro de atención primaria donde le realizaron exámenes complementarios estableciéndose tratamiento sin mejoría, es referido a un hospital donde se diagnosticó Paragonimiasis Pulmonar

Patient who reports intake of crab without cooking presented a picture characterized by burning throat, respiratory distress and diarrheal depositions. Then cough and hemoptysis; went to a primary care center where they performed complementary exams establishing treatment without improvement, is referred to a hospital where Pulmonary Paragonimiasis was diagnosed

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.

Clinical and imaging features of thirty cases of paragonimiasis westermani / 中国血吸虫病防治杂志

Objective To analyze the clinical manifestations and imaging characteristics of pulmonary and extra pulmonary paragonimiasis westermani. Methods A retrospective analysis was performed of 30 patients diagnosed by clinical features, laboratory serological tests and surgical pathology. Results The symptoms of the lung included mainly chest distress, fever, chest pain, cough and expectoration, and dyspnea. The extra pulmonary symptoms included abdominal pain, vomiting, diarrhea, poor appetite, emaciation, both lower extremities asthenia, headache, dizziness, epileptic seizures, and subcutaneous migratory masses. The laboratory examination showed that the eosinophil numbers of serum and pleural effusion of all the thirty patients were increased, and the eggs of Paragonimus westermani were found by the stool tests in four cases. The chest CT tests found abnormal nodules, ground glass changes, insect damages, pleural effusion, "tunnel" signs, and "halo" signs. Cranial CT and MRI showed intracranial hemorrhage foci, and extensive "finger-like" edema. Abdominal CT showed serpentine deformation and “tunnel” signs in the hepatic and spleen capsules. Conclusions Paragonimiasis westermani is a multiple organ system involved infection, and it has complex and varied clinical manifestations. The "tunnel" sign and serpentine deformations in the intracranial part, lung, liver and spleen are important imaging manifestations of the disease.

Clinical and imaging features of thirty cases of paragonimiasis westermani / 中国血吸虫病防治杂志

Objective To analyze the clinical manifestations and imaging characteristics of pulmonary and extra pulmonary paragonimiasis westermani. Methods A retrospective analysis was performed of 30 patients diagnosed by clinical features, laboratory serological tests and surgical pathology. Results The symptoms of the lung included mainly chest distress, fever, chest pain, cough and expectoration, and dyspnea. The extra pulmonary symptoms included abdominal pain, vomiting, diarrhea, poor appetite, emaciation, both lower extremities asthenia, headache, dizziness, epileptic seizures, and subcutaneous migratory masses. The laboratory examination showed that the eosinophil numbers of serum and pleural effusion of all the thirty patients were increased, and the eggs of Paragonimus westermani were found by the stool tests in four cases. The chest CT tests found abnormal nodules, ground glass changes, insect damages, pleural effusion, "tunnel" signs, and "halo" signs. Cranial CT and MRI showed intracranial hemorrhage foci, and extensive "finger-like" edema. Abdominal CT showed serpentine deformation and “tunnel” signs in the hepatic and spleen capsules. Conclusions Paragonimiasis westermani is a multiple organ system involved infection, and it has complex and varied clinical manifestations. The "tunnel" sign and serpentine deformations in the intracranial part, lung, liver and spleen are important imaging manifestations of the disease.

A Case of Pulmonary Paragonimiasis with Chronic Abdominal Pain and Erythematous Rash in a 6-year-old Girl

Pleural paragonimiasis is uncommon in the pediatric population and therefore can be challenging to diagnose. This is a case of a 6-year-old girl with pleural effusion who had been having intermittent persistent epigastric pain and erythematous rash on the face, hands, and arms for 6 months. Exudative pleural effusion with prominent eosinophils and serum eosinophilia were observed. As patient showed high immunoglobulin M (IgM) titers against Mycoplasma pneumoniae , she was treated with antibiotics; however, the pleural effusion did not improve during hospitalization. Despite showing negative stool ova and cyst results, patient's serum and pleural effusion were positive for Paragonimus westermani-specific IgGs on enzyme-linked immunosorbent assay. Respiratory symptoms, pleural effusion, and skin symptoms improved after praziquantel treatment.

Thirty-six cases of paragonimiasis in children,Ningbo,China / 中国人兽共患病学报

We analyzed the clinical characteristics of paragonimiasis in children in Ningbo City,in order to provide a basis for diagnosis and treatment of this disease,and to reduce the misdiagnosis.Thirty-six children seen in ningbo women and chil-dren's hospital from January 2010 to December 2016 with a diagnosis of paragonimiasis were studied,and the medical history, conditions of diagnosis and treatment were retrospectively analyzed.A total of 36 cases were included,and there were 20 boys and 16 girls with a mean ages of 6.6 (3.4-12)years.Among these patients,22 lived in urban area and 14 in rural area.There were 29 cases with the history of eating raw or baked crabs,freshwater shrimp and 7 cases with the history of catching the crab or drinking raw stream water before the disease onset.The clinical symptoms varied,mainly for cough and expectoration,fe-ver,chest tightness or pain and abdominal pain.All children had the elevated eosinophilia in peripheral blood,and the blood IgE were significantly increased in 3 1 cases.Paragonimiasis serum antibody detection were all positive.The chest CT showed abnormal performance in 32 cases which mainly for the pulmonary lesions and pleural effusion.And 2 cases showed the imaging findings of paragonimiasis encephalopathy in their head MRI.All patients were given praziquantel treatment after the definite diagnosis,and all were not found significant adverse reactions.The clinical manifestations of children paragonimiasis in Ningbo City were complex and diverse,the children's diet and lifestyle history should be asked in detail,at the same time,combined with peripheral blood eosinophils,IgE test results and the imaging data,made a comprehensive analysis,so as to make a early diagnosis and treatment as soon as possible,and reduce the misdiagnosis rate.

Diagnostic value of CT at early infection stage of thoracic and pulmonary paragonimiasis / 中华地方病学杂志

Objective To investigate the CT features of early infection stage of thoracic and pulmonary paragonimiasis. Methods Medical records of 56 patients with thoracic and pulmonary paragonimiasis from January 2010 to June 2017 were collected, and the patients were diagnosed and treated at Yongjia County People's Hospital, and the results of laboratory examination and CT imaging features were analyzed retrospectively. Results The absolute value of eosinophils in peripheral blood of 56 patients was (5.61 ± 3.18) × 109/L, and the percentage of eosinophils was (35.90 ± 19.16)％, all of which increased to varying degrees. Forty-two patients had different degrees of pleural effusion and 52 cases with lung lesions. Lung lesions demonstrated one or several kinds of foci at the same time, randomly distributed in the lung field, mostly located in the sub-pleural lung tissue. There were 12 cases with pulmonary ground glass shadow, 4 cases with peribronchitis, 31 cases with pulmonary invasive lesions and 28 cases with pulmonary nodular/strip shadow. The size of most nodules were 0.5 - 1.0 cm, accompanied with halo sign. Conclusions The CT features of early infection stage of thoracic and pulmonary paragonimiasis are diverse. The size of 0.5 - 1.0 cm lung nodules with halo sign has certain characteristics in the diagnosis of paragonimiasis. Peribronchitis, infiltrative lesions, pleural effusion and increased peripheral blood eosinophil percentage can suggest diagnosis.

Clinical analysis of 50 cases of serous cavity effusion related with paragonimiasis / 中国血吸虫病防治杂志

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.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.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.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 / 中国血吸虫病防治杂志

Objective To understand the current status of paragonimiasis epidemic in western mountain areas in Hubei Prov-ince. 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 Para-gonimus 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 1143 residents were investigated in the active surveillance,the total positive rate of the serology test was 1.84%(21/1143),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,respective-ly. Totally 1143 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.

Characteristics of group-occurring lung paragonimiasis in early stage in CT / 中国人兽共患病学报

To investigate the CT appearances in early stage of clustering lung paragonimiasis,9 cases of two clustering lung paragonimiasis caused by eating raw stone-crab and laboratory examination were included in the study.Eight cases consulted by doctors in the hospital and their appearances were retrospectively analyzed.There were pleural effusion of varying degree (n=8) and random distribution sub-pleural pulmonary infiltrative lesions (n=7).The accompany appearances of the latter had lunar halo sign,characteristic tunnel sign (n=1) and peri-bronchitis (n=1).If CT detects pulmonary infiltrative lesions of random distribution within sub-pleura or tunnel sign,combining with the history of eating raw stone crabs and other freshwater fishes,with the rise of eosinophilic granulocytes in peripheral blood,the diagnosis of paragonimiasis should be suggested.

Clinical features and misdiagnosis analysis of children with cerebral paragonimiasis with intracranial hemorrhage as initial symptom / 中华实用儿科临床杂志

Objective To explore the clinical characteristics and the cause of misdiagnosis of child suffering from cerebral parago-nimiasis with intracranial hemorrhage as initial symptom,and to improve the diagnosis and treatment level of cerebral paragonimiasis.Methods The clinical data of the children who suffered from cerebral paragonimiasis with intracranial hemorrhage as initial symptom were collected from January 2011 to December 2015 in Affiliated Hospital of Zunyi Medical College.The clinical manifestation,imageology and laboratory tests,outcome of therapy were analyzed and then the effect of treatment and the prognosis were followed up.Results There were 7 patients meeting the inclusion criteria for cerebral paragonimiasis,including 4 male and 3 female.They were from 6 to 13 years old with the average age of 9.3 years old.All patients presented with headache and vomiting,and showed intracranial hemorrhage through CT or MRI of brain.All of the 7 patients were misdiagnosed as cerebrovascular malformation by the neurosurgeons.Three of them showed typical imaging pattern including tunnel sign and the ring-like shape of cerebral paragonimiasis.Five of these cases were attacked by pulmonary distomiasis at the same time.Six of them had an increasing eosinophil,and the paragonimus antibody was positive.They were treated with Praziquantel.Six patients recovered completely,and 1 patient had the dysfunction of left extremities.Conclusions The childhood cerebral paragonimiasis has strong clinical heterogeneity and diversity in manifestation.Intracranial hemorrhage may be the initial symptom,which should be paid more attention to.Cerebral paragonimiasis can be diagnosed and treated early according to the clinical characteristics,the increase of eosinophil,the typical changes in imageology and the specific antibody test.

Imaging features and pathological basis of hepatic paragonimiasis / 实用放射学杂志

Objective To evaluate the MDCT and MRI features of hepatic paragonimiasis and correlate the results with pathological findings. Methods MDCT and MRI findings of 1 9 patients diagnosed pathologically as hepatic paragonimiasis were analyzed retrospectively.1 5 patients underwent MDCT examination only,2 patients underwent MRI only,and 2 patients underwent both MDCT and MRI.Results There were 22 lesions detected on MDCT and MRI.All of the lesions were in the hepatic subcapsular area and 18 lesions directly contacted with the hepatic capsule.The lesions could be classified into the complex and simple lesions according to the enhancement features. 13 lesions were complex and demonstrated as multiple cysts with internal septations.The non-enhanced capsular space and sinuses were mutually communicated.9 lesions were simple.Among the 9 lesions,2 were tubular,3 were tortuous sinus-like,and 4 were oval solid.In all of the 22 lesions,the internal septa and margin showed mild enhancement,and the degree of enhancement on portal phase was higher than that on arterial phase.In addition,the enhanced internal septa and margin of the 2 complex lesions showed hyperintensity on T1 WI.Conclusion The complex lesions and the tubular,tortuous sinus-like simple lesions may be the typical imaging features of hepatic paragonimiasis.The hyper-intense septa and margin on T1 WI can be suggestive of this disease.Recognition of these imaging features is helpful to the correct early diagnosis and avoid unnecessary surgical procedures.

Clinical analysis of 12 cases of paragonimiasis / 中国血吸虫病防治杂志

Objective To analyze the clinical characteristics of paragonimiasis and improve the level of diagnosis and treat-ment. 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 an-tibody against Paragonimus. Praziquantel oral treatment had a curative effect and little adverse reaction. Conclusion The clini-cal symptoms and signs of paragonimiasis are complex and diverse,and the doctors should pay attention to the inquiry of epide-miological history,blood eosinophil increase and positive antibody against Paragonimus.

Pulmonary Paragonimiasis Misdiagnosed with Pulmonary Tuberculosis

Paragonimiasis was one of the most common causes of cavitary lung lesions until the 1960s, but now it has become a very rare disease in Korea. A 16-year-old boy presented with hemoptysis and several days of cough. His plain chest radiograph showed nodular opacity with a cavity in the left upper lung region. Although his symptoms disappeared after taking antituberculous drugs, his plain chest radiograph and computed tomography images after completion of therapy showed a new nodule with a cavity in the left lung field. Through video-assisted thoracoscopic wedge resection, Paragonimus eggs were found in the lung tissues.

Pulmonary Paragonimiasis Misdiagnosed with Pulmonary Tuberculosis

Paragonimiasis was one of the most common causes of cavitary lung lesions until the 1960s, but now it has become a very rare disease in Korea. A 16-year-old boy presented with hemoptysis and several days of cough. His plain chest radiograph showed nodular opacity with a cavity in the left upper lung region. Although his symptoms disappeared after taking antituberculous drugs, his plain chest radiograph and computed tomography images after completion of therapy showed a new nodule with a cavity in the left lung field. Through video-assisted thoracoscopic wedge resection, Paragonimus eggs were found in the lung tissues.

A Case of Ectopic Peritoneal Paragonimiasis Mimicking Diverticulitis or Abdominal Abscess

Paragonimiasis is a parasitic disease caused by Paragnonimus species. The primary site of infection is the lung, and extrapulmonary involvement is also reported. When infected with Paragonimus westermani, which is the dominant species in Korea, the central nervous system is frequently involved along with the liver, intestine, peritoneal cavity, retroperitoneum, and abdominal wall. Ectopic paragonimiasis raises diagnostic challenge since it is uncommon and may be confused with malignancy or other inflammatory diseases. Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain. The patient developed abdominal pain 3 times for the previous 3 years and the computed tomography (CT) of the abdomen revealed fluid collection with wall enhancement. Recurrent diverticulitis was initially suspected and part of the ascending colon was resected. However, the specimen showed intact colon wall without evidence of diverticulitis and multiple parasite eggs and granulomas were found instead. The size of about 70 μm, the presence of an operculum and relatively thick egg shell suggested eggs of Paragonimus species. With appropriate exposure history and a positive antibody test, the definitive diagnosis was made as peritoneal paragonimiasis.

Distribución de moluscos (Gastropoda) de importancia médica en Venezuela / Distribution of freshwater mollusks (Gastropoda) of medical importance in Venezuela

El presente trabajo describe la distribución geográfica actual de las principales especies de caracoles de agua dulce incriminadas como hospedadoras intermediarias de Schistosoma mansoni (4 especies de Biomphalaria), Fasciola hepatica (4 especies de Galba y Pseudosuccinea columella) y Paragonimus sp. (Aroapyrgus vivens) en Venezuela. Adicionalmente, se discute el status epidemiológico así como el hábitat de ocurrencia de cada una de estas especies, a fin de brindar información base para la vigilancia, manejo y control de los hospedadores intermediarios que participan en los ciclos vitales de los agentes causales de la esquistosomiasis, fascioliasis y paragonimiasis, que constituyen enfermedades desatendidas actualmente en Venezuela.

This study describes the current distribution patterns of the main species of freshwater mollusks incriminated as intermediate hosts of Schistosoma mansoni (Biomphalaria, 4 species), Fasciola hepatica (Galba, 4 species and Pseudosuccinea columella), and Paragonimus sp. (Aroapyrgus vivens) in Venezuela. Additionally, the epidemiological status and the main aquatic habitats of each species are discussed in order to bring basic information to help the surveillance and control of these neglected tropical diseases in Venezuela.