Paragonimus Ova Research Articles

Demographic characteristic and analysis of pulmonary paragonimiasis in patients attending RIMS, Manipur.

Background:Human infection by the lung fluke Paragonimus westermani is widely distributed in Africa, Asia, and South America. Transmission of the parasite to humans primarily occurs through the consumption of raw or undercooked crabs. Clinical features of recently diagnosed pulmonary Paragonimiasis show that patients present with a variety of clinical and radiological findings, frequently mimics tuberculosis and lung cancer.Methods:Here in this study, we report a cross-sectional study of pulmonary paragonimiasis in our institute over a period of two year.Results:it was observed that out of eleven cases, prevalence of paragonimiasis was almost equal among both the genders, with a mean age of 38.1 ± 16.96, affecting people from hills. Three patients were erroneously treated with antitubercular drugs without any relief. The association with eosinophilia in the peripheral blood and tissue[16] was seen in all the study subjects and majority patients had pleural fluid eosinophilia. Patients were diagnosed by serological test, Paragonimus ova in Sputum smear and Pleural fluid. All study subjects had excellent clinical responses to praziquantel given at dose of 25 mg/kg given orally 3 times daily for 3 consecutive days.Conclusions:There is a need to generate awareness among the clinicians and public regarding Paragonimiasis and to consider it in differential diagnosis of TB and carcinoma lung. Physicians should consider the possibility of paragonimiasis among patients who present with chest complaints with eosinophilia from the endemic regions.

PREVALENCE OF <i>PARAGONIMUS</i> INFECTION

Paragonimiasis (human infections with the lung fluke Paragonimus westermani) is an important public health problem in parts of Africa. This study was aimed at assessing the prevalence of Paragonimus infection in Ebonyi State. Deep sputum samples from 3600 individuals and stool samples from 900 individuals in nine Local Government Areas in Ebonyi State, Nigeria were examined for Paragonimus ova using concentration technique. The overall prevalence of pulmonary Paragonimus infection in the area was 16.30%. Six foci of the infection were identified in Ebonyi North and Ebonyi Central but none in Ebonyi South. The intensity of the infection was generally moderate. Of the 720 individuals examined, 16 (12.12%) had less than 40 ova of Paragonimus in 5 mL sputum and 114 (86.36%) had between 40 and 79 ova of Paragonimus in 5 mL sputum. While 2 individuals (1.52%) had over 79 ova of Paragonimus in 5 mL Sputum. Furthermore, there was higher prevalence of paragonimiasis in rainy season than in dry season. The results of this study indicated the growing public health threat posed by paragonimiasis in Ebonyi North and Ebonyi Central. A combination of chemotherapy, to bring relief to persons already infected by the disease and public health education related to paragonimiasis transmission to increase awareness of the infection in the areas is recommended.

Paragonimiasis presenting with unilateral pseudochylothorax: Case report and literature review

A 64-y-old female previously treated for lung fluke presented with shortness of breath and moderate left pleural effusion. Thoracentesis was performed and milky pleural effusion was obtained. Paragonimus ova and rhomboidal cholesterol crystals were found. Paragonimiasis was diagnosed, and the patient was treated with praziquantel 25 mg/kg/d.

Pleural paragonimiasis in a Southeast Asia refugee.

We report a Laotian patient with pleural paragonimiasis who did not have the usual diagnostic triad for this parasitic disease. He did not have chronic hemoptysis (considered by many to be an "invariable" finding), there were no pulmonary infiltrations, and stool and sputum examinations did not yield Paragonimus ova. The diagnosis was made on the basis of ova found in the pleural fluid. Paragonimiasis pleural effusion did not resolve with bithionol, the drug of choice for pulmonary paragonimiasis, and, as a result, chest tube drainage was required. The difference between pleural paragonimiasis and pulmonary paragonimiasis is that the classic clinical presentation of the latter (hemoptysis, ova in sputum and stools, lung infiltration, etc.) requires an intrapulmonary location on the parasite. A search for ova in the pleural fluid may be the only diagnostic tool for patients suspected of pleural paragonimiasis. With the influx of Southeast Asia refugees, this case report may be of relevance to U.S. physicians involved in the care of patients in whom not all chronic pleuropulmonary diseases are tuberculous.

Paragonimus meningitis

Meningitic episodes occurring in the histories of patients with known cerebral paragonimiasis appear to be common, but reports of such cases observed and studied in hospital are scarce. It has only been possible to find 6 cases reported in the literature. At the National Medical Center, Seoul, Korea, 6 cases of meningitis associated with cerebral paragonimiasis have been observed and at the Seoul National University Hospital, Seoul, Korea, an additional 2 cases have been observed. A detailed description of the history and clinical findings in these 8 cases is given, and the 6 cases previously reported are reviewed. Based on a review of the literature and upon our own observations the following points are stressed. 1. (1) Meningitis may be the only manifestation of paragonimiasis in the nervous system or it may occur in association with parenchymatous manifestations of the disease. 2. (2) The onset is acute with fever, vomiting, and headache of variable degree. Neck stiffness and Kernig's sign are usually present but may not be severe. In the reported cases and in our 8 patients, such symptoms as headache, irritability, poor general condition and mental confusion are sometimes mild or absent, contrary to the picture seen in other forms of meningitis. This point is valuable in the differential diagnosis from other meningitides, especially from tuberculous meningitis. 3. (3) The spinal fluid findings are similar to those seen in bacterial meningitis. The sugar content of the fluid is usually decreased. The chlorides may be within normal limits or slightly decreased. In a number of cases there is an excess of eosinophils in the fluid. The importance of a careful search for eosinophilia in the spinal fluid is stressed. Paragonimus ova are rarely found in the fluid. 4. (4) In our experience paragonimus meningitis has often been misdiagnosed as tuberculous meningitis. Points of differential diagnostic significance are that in the latter condition the onset is more gradual with a moderate initial rise of the temperature, both the sugar and chloride values are low in the spinal fluid, the general condition of the patient and the conscious level are more severely affected. In paragonimus meningitis the onset is acute with moderate fever and the chloride in the spinal fluid may be normal or only slightly lowered. In suspected cases the CSF should be examined for eosinophils and the skin test for paragonimus should be performed. 5. (5) Bithionol appears to be effective in the treatment of paragonimus meningitis and should be given to all cases.

The Mass X-Ray Survey of the Hospital Patients

1. The author reviewed the results of a mass X-ray survey by 70mm Odelca photofluorography conducted with an assistance of Ministry of Health on the subjects of 8,733 outpatients of Pusan University Hospital for 9 months period from January 1961 to September 1961. 2. The low rate of participation on this program seemed to be due to the lack of understanding on the patient's side as well as the inadequate information given by the hospital. However, it was relatively higher among the patients of internal medicine with a rate of 44% and the patients of pediatrics with a rate of 37%. The lowest one was 4% in dental patients, 8% to 9% in E.N.T. Eye, Urology and Dermatology patients. Judging from these phenomenon the most influential factor on the rate of participation would be the feeling of necessity by the patients lives. However, the rates of the anomalous findings were well paralleled with the rates of participation and the subjective feelings of the patients seemed to be also undeniable.3. The discovery rate of pulmonary tuberculosis was 13.4% overall and it was 2 to 6 times higher than the rates found by the mass survey of general populations, schools and others. From this fat it could be a very effective measure to include the hospital patients as one of the important subjects for mass X-ray.4. The classifications of this pulmonary tuberculosis were 33.3% minimal, 28% of moderately advanced, 38.7% of far advanced. The sputum examinations have done only by direct or concentration smear method except few cases of culture, from 400 patients among 1,900 patients with a pathologic chest X-ray, revealed the positive results of 28.8% for Acid Fast Bacilli and 2.7% for Paragonimus ova.5. The majority age group of the participations and the patients revealed pulmonary tuberculosis was between 20 and 30 years old. However, the relative rates of discovery of the tuberculosis showed a gradual increase toward the older age groups. The sex ratio was about 2 times higher in the male than the female.

Paragonimus cyst in a West African native

A case of a cyst in the left side of the neck containing Paragonimus ova is described in a West African native. It was associated with signs and symptoms of lesions in the central nervous system and the left ear, and it is suggested that these may also be due to Paragonimus infection.