Comparative study of radiological findings in pulmonary tuberculosis and paragonimiasis in children in a Southern Nigeria fishing community

Abstract

Background: Paragonimiasis is one of the re-emerging public health diseases. Most of the presenting symptoms of pulmonary paragonimiasis are similar to those of tuberculosis (TB), which is also another major public health issue. Unfortunately both infections occur in the same environment of low socioeconomic status. Clinical and radiological differentiation between pulmonary paragonimiasis and tuberculosis can be difficult. Aim: This study was therefore designed to identify the chest radiological features that could be consistently used to differentiate between pulmonary TB and paragonimiasis in children. Materials and Methods: Two hundred and forty children aged five to eighteen years, were selected by stratified random samplings from a public primary and a secondary school in Ewang village, Mbo local government area of Akwa Ibom State, Nigeria. These children were screened for pulmonary paragonimiasis and pulmonary tuberculosis using sputum microscopy and Ziehl Neilson staining, respectively. Thereafter, the chest radiographs of children who were sputa-positive for paragonimus egg and acid fast bacilli were taken on full inspiration. Statistical Analysis: The data was analyzed with the STATA 10 software, produced by Stata Corp, Texas, USA. The results were expressed as means, standard deviations (SD), as well as percentages. A P < 0.05 was considered statistically significant. Results: A total of 204 children were examined; 91 (44.6%) were males and 113 (55.4%) were females. Ten (4.9%) of the subjects were sputum-positive for the paragonimus egg, while four (1.96%) of the subjects were sputum-positive for tuberculosis. The signs and symptoms of both diseases were similar. Radiologically, subcutaneous tissue wasting was an important differentiating feature between both diseases (P = 0.002). Conclusion: The study has shown that paragonimiasis and tuberculosis in children coexist in this locality. The clinical features of both conditions were similar hence differentiation on clinical grounds was difficult. Thus in a child being investigated for tuberculosis, the absence of subcutaneous tissue wasting radiologically should prompt further investigation for paragonimiasis.