Abstract
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international publications on paragonimiasis in Ecuador, epidemiological records from the Ministry of Public Health and unpublished research data was conducted to summarise the current status of the parasite/disease.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.
Highlights
85.5 cases per year (Fig. 1) until 2007
The data available at the Ministry of Public Health (MSP) are from passive records, whereas we have demonstrated in several studies that performing active searches in communities reveals higher rates of diagnosis (Calvopiña et al 1994, 1995)
Geographic distribution and prevalence of human infections - Ecuador is located in the northwestern region of South America and is crossed transversely by the equator line and from north to south by the Andes belt, providing three natural regions: the Pacific coastal area, the Amazon to the east and the Andean region in the centre
Summary
85.5 cases per year (Fig. 1) until 2007. This prevalence is lower than expected, which can be attributed to underreporting because human infections occur in rural and remote tropical areas, where infected patients are poor and health services are lacking. Two active field searches of indigenous Chachi communities in the coastal province of Esmeraldas documented the presence of Paragonimus eggs in 7.1% and 30.3% of the sputum samples examined (Paredes et al 1978, Guevara et al 1999).
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