Pulmonary Paragonimiasis in Native Community, Esmeraldas Province, Ecuador, 2022.

Paragonimiasis is a food-borne infection caused by several species of the Paragonimus fluke. Clinical manifestations can mimic tuberculosis and contribute to diagnostic delay. We report a cluster of paragonimiasis in a community in Ecuador, where active surveillance was set up after detection of the first 2 cases.

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.

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

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.

Mucocutaneous manifestations of helminth infections: Trematodes and cestodes.

In the 21st century, despite increased international travel for vacation, work, and medical missions and immigration into the United States, there is little published in the dermatology literature regarding the cutaneous manifestations of helminth infections. It has been estimated that 20% to 70% of international travelers suffer from some travel-related health problem. Approximately 17% of travelers seek medical care because of cutaneous disorders, many related to infectious etiologies. This review will focus on cutaneous diseases caused by helminth infections. Part I of the review focused on nematode infections; part II will focus on trematode and cestode infections. Nematodes are roundworms that cause diseases with cutaneous manifestations, such as cutaneous larval migrans, onchocerciasis, filariasis, gnathostomiasis, loiasis, dracunculiasis, strongyloidiasis, ascariasis, streptocerciasis, dirofilariasis, and trichinosis. Tremadotes, also known as flukes, cause schistosomiasis, paragonimiasis, and fascioliasis. Cestodes (tapeworms) are flat, hermaphroditic parasites that cause diseases such as sparganosis, cysticercosis, and echinococcus.

Current status of Paragonimus and paragonimiasis in Ecuador

A review of national and international publications on paragonimiasis in Ecuador, epidemiological records from the Ministry of Public Health and unpublished research data was conducted to summarise the current status of the parasite/disease. The purpose of the review is to educate physicians, policy-makers and health providers on the status of the disease and to stimulate scientific investigators to conduct further research. Paragonimiasis was first diagnosed in Ecuador 94 years ago and it is endemic to both tropical and subtropical regions in 19 of 24 provinces in the Pacific Coast and Amazon regions. Paragonimus mexicanus is the only known species in the country, with the mollusc Aroapyrgus colombiensis and the crabs Moreirocarcinus emarginatus, Hypolobocera chilensis and Hypolobocera aequatorialis being the primary and secondary intermediate hosts, respectively. Recent studies found P. mexicanus metacercariae in Trichodactylus faxoni crabs of the northern Amazon. Chronic pulmonary paragonimiasis is commonly misdiagnosed and treated as tuberculosis and although studies have demonstrated the efficacy of praziquantel and triclabendazole for the treatment of human infections, neither drug is available in Ecuador. Official data recorded from 1978-2007 indicate an annual incidence of 85.5 cases throughout the 19 provinces, with an estimated 17.2% of the population at risk of infection. There are no current data on the incidence/prevalence of infection, nor is there a national control programme.

Paragonimiasis pulmonar en niños: reporte de dos casos / Lung paragonimiais in children: Report of two cases

La paragonimiasis es una zoonosis parasitaria, de transmisión alimentaria, causada por especies de tremátodos del género Paragonimus, presente en áreas tropicales y subtropicales de Asia, África y América. El ser humano se infecta mediante la ingestión de crustáceos de agua dulce crudos o mal cocidos. La infección afecta principalmente los pulmones, con desarrollo de múltiples manifestaciones clínicas y radiológicas, dependiendo del momento del ciclo vital del parásito. El diagnóstico diferencial más importante de esta enfermedad es la tuberculosis pulmonar. En este artículo se describe esta enfermedad en dos niñas con diferentes manifestaciones pulmonares. La paragonimiasis se debe sospechar en pacientes con tos crónica, esputo herrumbroso, dolor torácico, con o sin compromiso cerebral, que viven o han residido en una zona endémica y que presentan una eosinofília elevada, con cambios radiológicos sugestivos del síndrome de Loeffler.

Paragonimiasis is a parasitic, food-borne zoonosis, caused by species of trematodes of the genus Paragonimus, found in tropical and subtropical areas of Asia, Africa and America. Human beings become infected by ingestion of raw or undercooked freshwater shellfish. The infection primarily affects the lungs, with the development of multiple clinical and radiological manifestations, depending on the moment in the life cycle of the parasite. The most important differential diagnosis of this disease is pulmonary tuberculosis. We report two cases of lung paragonimiasis in aboriginal Colombian girls with different pulmonary manifestations. Paragonimiasis should be suspected in patients with chronic cough, rusty sputum, chest pain, with or without brain involvement, who live or have lived in endemic areas and have a high-level eosinophilia with radiographic changes suggestive of Loeffler's syndrome.

Lesiones pulmonares en tlacuaches (Didelphis virginiana) infectados naturalmente por Paragonimus mexicanus en Colima, México / Lung lesions in opossums (Didelphis virginiana) naturally infected by Paragonimus mexicanus in Colima, Mexico

Paragonimiasis is a zoonotic disease in Mexico caused by adult digeneans of Paragonimus mexicanus species. Life cycle of this parasite involves two necessary intermediate hosts: a snail and a crab, and a mammal serving as the definitive host. Humans acquire the infection when eating raw or undercooked crabs infected by metacercariae. In March 2005, six opossums (Didelphis virginiana) were captured in Colima, Mexico. These opossums were euthanized in order to identify lesions caused by lung paragonimiasis. Infected lungs were processed and stained following the standard histological techniques. Four of the six opossums (67%) carried 25 adult parasites identified as P. mexicanus. The lung with the greatest number of parasites showed 13 multifocally distributed granulomas. The main histological changes were: infiltration of monocytes, lymphocytes, macrophages, plasma cells, epithelioid and giant cells, abundant neutrophils and eosinophils, as well as central necrosis of the eosinophilic granuloma. Likewise, interstitial pneumonia was observed due to the presence of eggs between the granuloma walls and alveolar spaces. This study represents the first description of the pulmonary lesions caused by P. mexicanus in wild mammals.

La paragonimiasis constituye una enfermedad zoonótica con origen en México por el digeneo adulto Paragonimus mexicanus. El ciclo de vida de esta especie involucra dos hospederos intermediarios obligatorios: un caracol y un cangrejo, así como un mamífero que actúa como hospedero definitivo. La infección humana ocurre a través de la ingestión de carne de cangrejo cruda o insuficientemente cocida, parasitada por metacercarias. En marzo de 2005, seis tlacuaches (Didelphis virginiana) fueron capturados en Colima, México; fueron sacrificados con el fin de extraer los pulmones mediante necropsia para identificar las lesiones ocasionadas por el parásito. Los pulmones parasitados fueron procesados y teñidos de acuerdo con las técnicas histológicas convencionales. Cuatro de los seis (67%) hospederos resultaron infectados por 25 gusanos adultos identificados como P. mexicanus. En un pulmón se encontraron hasta 13 granulomas, distribuidos multifocalmente. Los principales cambios histológicos fueron: infiltración inflamatoria de monocitos, linfocitos, macrófagos, células plasmáticas, epitelioides y gigantes, con abundantes neutrófilos y eosinófilos, así como necrosis central del granuloma eosinofílico. Asimismo, se observó neumonía intersticial debido a la presencia de huevos entre las paredes del granuloma y los espacios alveolares. Este estudio representa la primera descripción de lesiones pulmonares ocasionadas por P. mexicanus en mamíferos silvestres.

Paragonimiasis pulmonar: informe de un caso / Pulmonary paragonimiasis. A report of an isolated case

La paragonimiasis es una enfermedad parasitaria causada por un tremátodo del género Paragonímus. Es endémica en Corea, Japón y China. En América Latina se han identificado algunos casos. En México hay 6 casos en la literatura revisada. El caso que nos ocupa es el de mujer de 41 años que ingresó al Instituto Nacional de Enfermedades Repiratorias con tos crónica, hemoptisis y pérdida de peso, a la que se practicó lobectomía superior derecha. En el estudio histopatológico se observaron lesiones granulomatosas que contenían huevecillos de Paragonimus