A retrospective clinical analysis of pediatric paragonimiasis in a Chinese children\u2019s hospital from 2011 to 2019

Manning Qian,Yuhan Zhang,Jun Shen,Zhongwei Qiao,Yingyan Shi,Fei Li

doi:10.1038/s41598-021-81694-7

Abstract

Diagnosis of pediatric paragonimiasis is difficult because of its non-specific clinical manifestations. We retrospectively reviewed the records of pediatric paragonimiasis in Children’s Hospital of Fudan University from January 2011 to May 2019. The confirmed diagnosis of paragonimiasis was based on positive anti-parasite serological tests from the local Center for Disease Control (CDC). A total of 11 patients (mean age: 7.7 ± 3.1, male–female ratio: 7:4) diagnosed as paragonimiasis were included. 81.8% were from endemic areas such as Sichuan and Yunnan, and 36% had a clear history of raw crab or crayfish consumption. The characteristic clinical features of pediatric paragonimiasis were eosinophilia (100%), pleural effusion (81.8%), hepatomegaly (54.5%), ascites (54.5%), and subcutaneous nodules (45.5%). Misdiagnosed with other diseases including tuberculosis (18.2%), pneumonia (9.1%), intracranial space-occupying lesions (9.1%) and brain abcess (9.1%) led to rehospitalization and prolonged hospitalization. For treatment, a 3-day course of 150 mg/kg praziquantel (PZQ) didn’t show ideal treatment effectivity and 63.6% needed more than one course of PZQ, while triclabendazole in a total dose of 10 mg/kg had a better efficacy to stubborn manifestations. This study indicated that pediatric paragonimiasis was often misdiagnosed, and the treatment with a 3-day course of 150 mg/kg PZQ had a high rate of failure.

Highlights

Diagnosis of pediatric paragonimiasis is difficult because of its non-specific clinical manifestations
According to the Chinese Center for Disease Control (CDC), information is limited in the symptoms, diagnosis and treatment for pediatric paragonimiasis
Our objective was to summarize the clinical manifestations of pediatric paragonimiasis, which are related to early diagnosis and treatment

Summary

Introduction

Diagnosis of pediatric paragonimiasis is difficult because of its non-specific clinical manifestations. According to the Chinese Center for Disease Control (CDC), information is limited in the symptoms, diagnosis and treatment for pediatric paragonimiasis. Diagnosis is often difficult in the cases of paragonimiasis for its vague and non-specific symptoms, especially in children who cannot accurately describe their symptoms and dietary history. It is confused with tuberculosis, fungal infection, malignant diseases, purulent meningitis and brain tumors[8,9,10,11,12]. We retrospectively reviewed 11 cases of pediatric paragonimiasis who were diagnosed and treated at the Department of Infectious Diseases, Children’s Hospital of Fudan University. We aim to raise the awareness and understanding of clinicians towards this rare and neglected disease and give a discussion about the treatment of pediatric paragonimiasis

Objectives

Methods

Results

Conclusion