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PLoS Neglected Tropical Diseases Mar 2022Cerebral paragonimiasis (CP), caused by aberrant migration of Paragonimus worms, frequently invokes serious illness. The causal relationship between the lesion...
Cerebral paragonimiasis (CP), caused by aberrant migration of Paragonimus worms, frequently invokes serious illness. The causal relationship between the lesion characteristics and patients' symptoms has poorly been understood. CP serodiagnosis has not been properly evaluated to date. A total of 111 CP cases were diagnosed in our laboratory between 1982 and 2003. This study retrospectively assessed the clinical and imaging characteristics of the 105 patients along with the evaluation of diagnostic potentials of recombinant P. westermani yolk ferritin (rPwYF) by enzyme-linked immunosorbent assay (ELISA) employing patients' sera and cerebrospinal fluids (CSFs). We analyzed 60 male and 45 female patients; 50 early-stage patients with non-calcified enhancing nodule(s) (median age, 38 years; interquartile range [IQR], 24.75-52; median symptom duration, 0.75 years; IQR, 0.2-2) and 54 chronic cases having calcified lesion(s) (median age, 33 years; IQR, 25-41; median symptom duration, 10 years; IQR, 5-20). One patient showed a normal neuroimage. The patients were largely diagnosed in their 30s. The parietal lobe was most commonly affected, followed by occipital, frontal, and temporal lobes. Twenty-six patients had lesions encompassing ≥ two lobes. The patients complained mainly of seizures, headaches, hemiparesis, and focal neurologic deficits (P < 0.001). Seizures and visual defects were predominant in patients with calcified lesion(s) (P < 0.001). The diagnostic sensitivity and specificity of rPwYF against serum/CSF were 100%/97% and 97.2%/92.5%, respectively. The specific IgG antibody levels against rPwYF in sera and CSFs showed a positive correlation (r = 0.59). The clinical manifestations of the early-stage patients might be associated with cortical lesions or meningeal irritation, while those in the chronic stage were caused by conglomerated space-occupying lesions. rPwYF would be useful for the serodiagnosis of both early and chronic CP cases.
Topics: Animals; Antibodies, Helminth; Enzyme-Linked Immunosorbent Assay; Female; Ferritins; Humans; Male; Paragonimiasis; Paragonimus; Retrospective Studies; Seizures; Serologic Tests
PubMed: 35294433
DOI: 10.1371/journal.pntd.0010240 -
PLoS Neglected Tropical Diseases Feb 2021Paragonimiasis is caused by zoonotic trematodes of Paragonimus spp., found in Asia, the Americas and Africa, particularly in tropical regions. These parasites have a... (Meta-Analysis)
Meta-Analysis
Endemicity of Paragonimus and paragonimiasis in Sub-Saharan Africa: A systematic review and mapping reveals stability of transmission in endemic foci for a multi-host parasite system.
Paragonimiasis is caused by zoonotic trematodes of Paragonimus spp., found in Asia, the Americas and Africa, particularly in tropical regions. These parasites have a complex, multi-host life cycle, with mammalian definitive hosts and larval stages cycling through two intermediate hosts (snails and freshwater decapod crustaceans). In Africa, paragonimiasis is particularly neglected, and remains the only human parasitic disease without a fully characterised life cycle. However paragonimiasis has potentially significant impacts on public health in Africa, and prevalence has likely been underestimated through under-reporting and misdiagnosis as tuberculosis due to a similar clinical presentation. We identified the need to synthesise current knowledge and map endemic foci for African Paragonimus spp. together with Poikilorchis congolensis, a rare, taxonomically distant trematode with a similar distribution and morphology. We present the first systematic review of the literature relating to African paragonimiasis, combined with mapping of all reported occurrences of Paragonimus spp. throughout Africa, from the 1910s to the present. In human surveys, numerous reports of significant recent transmission in Southeast Nigeria were uncovered, with high prevalence and intensity of infection. Overall prevalence was significantly higher for P. uterobilateralis compared to P. africanus across studies. The potential endemicity of P. africanus in Côte d'Ivoire is also reported. In freshwater crab intermediate hosts, differences in prevalence and intensity of either P. uterobilateralis or P. africanus were evident across genera and species, suggesting differences in susceptibility. Mapping showed temporal stability of endemic foci, with the majority of known occurrences of Paragonimus found in the rainforest zone of West and Central Africa, but with several outliers elsewhere on the continent. This suggests substantial under sampling and localised infection where potential host distributions overlap. Our review highlights the urgent need for increased sampling in active disease foci in Africa, particularly using molecular analysis to fully characterise Paragonimus species and their hosts.
Topics: Animals; Databases, Factual; Humans; Life Cycle Stages; Lung; Paragonimiasis; Paragonimus; Prevalence; Public Health; Snails
PubMed: 33544705
DOI: 10.1371/journal.pntd.0009120 -
Food and Waterborne Parasitology Mar 2023Infections with the lung fluke, have been diagnosed in a variety of domestic and wild animals and humans in USA and Canada. Although there are many species of in other... (Review)
Review
Infections with the lung fluke, have been diagnosed in a variety of domestic and wild animals and humans in USA and Canada. Although there are many species of in other parts of the world; is the only species definitively diagnosed in USA and Canada. Fresh water snails (several species) and crayfish (mainly spp.) are its intermediate hosts. Humans and animals become infected with only by ingesting metacercariae encysted in the heart of crayfish. After ingestion, the fluke penetrates intestinal wall, enters peritoneal cavity, and reaches pleural cavity by direct penetration of diaphragm, 2-3 weeks post inoculation (p.i.). Young flukes penetrate lungs and become encysted in pulmonary tissue, often in pairs. Time to maturity is around 4-7 weeks p.i. Eggs are coughed up, swallowed, and are excreted in feces. Although the parasite has been known for more than a century, there has been an upsurge of human infections in the USA. Here, I review infections in naturally infected hosts. Pathogenesis, diagnosis, and treatment in parasite-free cats and dogs experimentally infected are reviewed to shed light on the pathogenesis of human paragonimiasis. Problems and challenges facing diagnosis of paragonimiasis, especially non-pulmonary infections, are discussed. Fluke stages are deposited in Smithsonian Museum.
PubMed: 36588917
DOI: 10.1016/j.fawpar.2022.e00184 -
Respiratory Medicine Case Reports 2020Paragonimiasis, or Oriental lung fluke is a parasitic infestation seen in Asia, Africa and South America which is spread by the consumption of crabs and crayfish. To...
Paragonimiasis, or Oriental lung fluke is a parasitic infestation seen in Asia, Africa and South America which is spread by the consumption of crabs and crayfish. To date four cases have been reported from Nepal. Here, we report a case of paragonimiasis in a young male from Kathmandu valley who presented with symptoms of fever, on and off for 1 month, shortness of breath and cough. He was found to have pleural effusion. Sputum examination did not reveal acid fast bacilli, However, based on clinical features, he was started on antitubercular treatment. There was initial improvement, but later, he continued to have cough and hemoptysis over the next 2 years and on subsequent High-Resolution Computerized Tomography (HRCT) he was found to have a cavitary lung lesion in the superior segment of lower lobe of left lung. A possibility of aspergillosis was considered for which he underwent a lobectomy. The gross examination of the lung showed a small cavity measuring 5 mm which revealed on histology a parasitic structure with serous glands within it. In addition, there were many foreign body granulomas with ova within them. A diagnosis of paragonimiasis was made and the patient was started on Praziquantal. He recovered well and is currently asymptomatic. We can learn from this case that the signs and symptoms of paragonimiasis mimic that of tuberculosis and the mistaken diagnosis can lead to unnecessary treatment, prolonged morbidity and loss of time and resources.
PubMed: 33304807
DOI: 10.1016/j.rmcr.2020.101298 -
Frontiers in Pediatrics 2023The clinical manifestations of paragonimiasis are diverse and non-specific, and can easily lead to misdiagnosis. We aimed to analyze the clinical manifestations,...
INTRODUCTION
The clinical manifestations of paragonimiasis are diverse and non-specific, and can easily lead to misdiagnosis. We aimed to analyze the clinical manifestations, laboratory features, treatment, and clinical outcome of children with paragonimiasis in order to improve recognition of this disease and avoid misdiagnosis.
METHODS
Children diagnosed with paragonimiasis from August 2016 to July 2022 were included in the study. Information on population informatics, medical history, and laboratory features was extracted from case data. The clinical features of paragonimiasis were retrospectively analyzed.
RESULTS
A total of 45 children were included in this study. All children had, at least, one risk factor. The clinical features mainly included fever, cough, pleural effusion, peritoneal effusion, and subcutaneous nodules. The main imaging findings were alveolar exudation, peritoneal effusion, pleural thickening, and local nodules. The "tunnel sign" finding on computed tomography (CT)/magnetic resonance imaging (MRI) was helpful in establishing the diagnosis of paragonimiasis. After praziquantel treatment, most of the children improved, and one child with cerebral paragonimiasis experienced sequelae.
CONCLUSION
Most children with paragonimiasis have a good prognosis, but few children can experience sequelae. Avoidance of untreated water and raw food is a simple, feasible, and effective preventive measure.
PubMed: 37266536
DOI: 10.3389/fped.2023.1143262 -
Turkish Neurosurgery 2020To investigate the clinical manifestations and radiologic characteristics in diagnosing and treating hemorrhagic cerebral paragonimiasis. (Review)
Review
AIM
To investigate the clinical manifestations and radiologic characteristics in diagnosing and treating hemorrhagic cerebral paragonimiasis.
MATERIAL AND METHODS
The study retrospectively analyzed the data of three cases of hemorrhagic paragonimiasis who received treatment in the hospital from January 2014 to March 2017. All three patients were diagnosed with paragonimiasis by positive detection of paragonimiasis antibody. Based on the imaging data, the disease was confirmed as hemorrhagic cerebral paragonimiasis. One of the three patients was treated with oral praziquantel alone, one with praziquantel and thoracentesis, and one with praziquantel in combination with closed thoracic drainage and craniotomy.
RESULTS
All the lesions disappeared after computed tomography scan during the follow-up. Two of the three patients had no dysneuria, and one had mild dysneuria.
CONCLUSION
Hemorrhagic cerebral paragonimiasis should be diagnosed as early as possible using antibodies against paragonimiasis for patients with unexplained intracerebral hemorrhage, especially young patients with atypical imaging findings and multiple systemic lesions. It is possible to avoid craniotomy and improve the cure rate by the early, full-dose, and sufficient course of anti-parasitic treatment.
Topics: Cerebral Hemorrhage; Child; Combined Modality Therapy; Craniotomy; Humans; Male; Paragonimiasis; Praziquantel; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 30984986
DOI: 10.5137/1019-5149.JTN.22666-18.3 -
AJNR. American Journal of Neuroradiology Dec 2019Intraspinal paragonimiasis is a rare entity for which imaging findings have seldom been described. The present study investigated the MR imaging features of spinal...
BACKGROUND AND PURPOSE
Intraspinal paragonimiasis is a rare entity for which imaging findings have seldom been described. The present study investigated the MR imaging features of spinal paragonimiasis, thus providing diagnostic imaging evidence and exploring the possible pathogenesis of intraspinal paragonimiasis.
MATERIALS AND METHODS
The clinical and imaging findings of spinal paragonimiasis in 6 children were analyzed retrospectively. Spinal MR imaging was performed in all patients, 5 of whom also underwent enhanced MR imaging. The diagnosis was confirmed by enzyme-linked immunosorbent assay in all cases and postoperative pathology in 4 cases.
RESULTS
All cases manifested as fusiform-shaped or beanlike masses in the extradural space in the thoracic spine. The extradural masses were connected with pleural lesions through the intervertebral foramen. The plain MR imaging scan showed mixed signals with predominant isointensity on T1WI and hyperintensity on T2WI, among which 5 (5/6) masses presented as patchy hemorrhage with hyperintensity on T1WI. On enhanced scans, all masses (5/5) showed heterogeneous marked enhancement, with thickening and enhancement in the adjacent spinal meninges (5/5). Various degrees of spinal cord compression and edema were found in 5 cases (5/6).
CONCLUSIONS
MR imaging is sensitive for detecting and characterizing spinal paragonimiasis. The MR imaging features of intraspinal granulomas included localization to the extradural space and thoracic segment, connections between intraspinal lesions and pleural lesions through the intervertebral foramen, and hemorrhagic foci within the mass. These findings support an intraspinal mode of paragonimiasis pathogenesis: The larvae migrate from the chest into the extradural space through the intervertebral foramen.
Topics: Child; Female; Granuloma; Humans; Magnetic Resonance Imaging; Male; Paragonimiasis; Retrospective Studies; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 31727748
DOI: 10.3174/ajnr.A6296 -
PLoS Neglected Tropical Diseases Mar 2023Foodborne trematodiases (FBTs) are a group of trematodes targeted for control as part of the World Health Organization (WHO) road map for neglected tropical diseases... (Review)
Review
BACKGROUND
Foodborne trematodiases (FBTs) are a group of trematodes targeted for control as part of the World Health Organization (WHO) road map for neglected tropical diseases from 2021 to 2030. Disease mapping; surveillance; and capacity, awareness, and advocacy building are critical to reach the 2030 targets. This review aims to synthesise available data on FBT prevalence, risk factors, prevention, testing, and treatment.
METHODS
We searched the scientific literature and extracted prevalence data as well as qualitative data on the geographical and sociocultural risk factors associated with infection, preventive/protective factors, and methods and challenges of diagnostics and treatment. We also extracted WHO Global Health Observatory data representing the countries that reported FBTs during 2010 to 2019.
RESULTS
One hundred and fifteen studies reporting data on any of the 4 FBTs of focus (Fasciola spp., Paragonimus spp., Clonorchis sp., and Opisthorchis spp.) were included in the final selection. Opisthorchiasis was the most commonly reported and researched FBT, with recorded study prevalence ranging from 0.66% to 88.7% in Asia, and this was the highest FBT prevalence overall. The highest recorded study prevalence for clonorchiasis was 59.6%, reported in Asia. Fascioliasis was reported in all regions, with the highest prevalence of 24.77% reported in the Americas. The least data was available on paragonimiasis, with the highest reported study prevalence of 14.9% in Africa. WHO Global Health Observatory data indicated 93/224 (42%) countries reported at least 1 FBT and 26 countries are likely co-endemic to 2 or more FBTs. However, only 3 countries had conducted prevalence estimates for multiple FBTs in the published literature between 2010 to 2020. Despite differing epidemiology, there were overlapping risk factors for all FBTs in all geographical areas, including proximity to rural and agricultural environments; consumption of raw contaminated food; and limited water, hygiene, and sanitation. Mass drug administration and increased awareness and health education were commonly reported preventive factors for all FBTs. FBTs were primarily diagnosed using faecal parasitological testing. Triclabendazole was the most reported treatment for fascioliasis, while praziquantel was the primary treatment for paragonimiasis, clonorchiasis, and opisthorchiasis. Low sensitivity of diagnostic tests as well as reinfection due to continued high-risk food consumption habits were common factors.
CONCLUSION
This review presents an up-to-date synthesis on the quantitative and qualitative evidence available for the 4 FBTs. The data show a large gap between what is being estimated and what is being reported. Although progress has been made with control programmes in several endemic areas, sustained effort is needed to improve surveillance data on FBTs and identify endemic and high-risk areas for environmental exposures, through a One Health approach, to achieve the 2030 goals of FBT prevention.
Topics: Animals; Opisthorchiasis; Fascioliasis; Clonorchiasis; Paragonimiasis; Prevalence; Trematoda; World Health Organization
PubMed: 36862635
DOI: 10.1371/journal.pntd.0011073 -
Tropical Parasitology 2020
PubMed: 33747890
DOI: 10.4103/tp.TP_120_20 -
IDCases 2021Cerebral paragonimiasis is rare and is usually seen in younger patients. This is a case of a 19-year-old male presenting as a hemorrhagic stroke with headache and...
Cerebral paragonimiasis is rare and is usually seen in younger patients. This is a case of a 19-year-old male presenting as a hemorrhagic stroke with headache and blurred vision. He was found to have cystic thick-walled spaces with focal linear tracking towards the pleural space on computed tomography of the chest. CSF analysis showed pleocytosis with 4% eosinophils. Serological testing confirmed the diagnosis of paragonimiasis. He was treated with praziquantel, corticosteroid taper and anti-epileptic medication and discharged home in stable condition. CNS paragonimiasis is treatable, has a fairly good prognosis but can often be missed. In a young person presenting with an acute hemorrhagic stroke, the possibility of paragonimiasis should be kept on the differential diagnosis.
PubMed: 34589413
DOI: 10.1016/j.idcr.2021.e01287