Case Report: Paragonimiasis Presenting with Pericardial Tamponade

Sah, Ranjit; Gupta, Nalini; Chatterji, Poulomi; Krishan, Sonal; Aggarwal, Monika; Sood, Nitin; Neupane, Samikshya; Sah, Sanjit; Poppert, Sven; Ruf, Marie‐Thérèse; Nickel, Beatrice; Neumayr, Andreas

doi:10.4269/ajtmh.19-0018

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…On the other hand, in areas endemic for Taenia (T.) solium infection and possible unrecognized cerebral cysticercosis, the activity of praziquantel against T. solium metacestodes and the consequent immune response could possibly cause cerebral edema and epilectic attacks which is not expected for triclabendazole which is apparently not active on cysticerca [70,71] . Furthermore, TCZ is not only active against small liver flukes but also against the large liver fluke Fasciola hepatica [68,21,44,72] . Although TCZ is a well investigated and safe drug higher daily TCZ dosages and co-medication of PZQ and TCZ of unresponsive cases has apparently never been tried.…”

Section: Discussionmentioning

confidence: 99%

Current status of the treatment of paragonimiasis

Richter¹

2022

One Health Implement Res

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Paragonimiasis, a foodborne trematodiasis is caused by various Paragonimus species endemic in Asia, Africa, and the Americas. Human infection occurs through consuming improperly cooked freshwater crustaceans, crabs or crayfish, eating raw meat of paratenic hosts or by ingesting metacercariae from contaminated hands and cooking utensils. More than 292 million persons worldwide are at risk. The morbidity associated with paragonimiasis includes acute febrile illness and chronic pleuro-pulmonary manifestations which may be confounded with tuberculosis or lung cancer. Ectopic manifestations mostly involve the central nervous system, heart, or subcutaneous tissues. Objectives: to evaluate the efficacy and safety of currently available drugs praziquantel (PZQ) and triclabendazole (TCZ). Methods: a PubMed and Google Scholar search and reference selection was performed according to the the Preferred Reporting Items for Systematic Reviews protocol using a combination of the terms “paragonimiasis” AND “treatment” OR “therap*” from 01/2000 to 02/2022. Results: no randomized controlled trials were identified. Five open trials on 487 patients treated with PZQ showed 81%-100% parasite clearance depending on dosage and duration. Three open trials on 226 patients with TCZ showed a 99.6% efficacy. A quantitative comparison was not applicable to retrospective analyses of hospital records, case series and case reports because of surgical interventions, various co-morbidities and -medications and definitions of cure. Some patients treated with PZQ required multiple courses or re-treatment with TCZ, whereas one patient treated with TCZ required re-treatment with PZQ. Conclusions: PZQ and TCZ are usually effective for treating paragonimiasis. Controlled randomized trials are required to compare the safety, efficacy and applicability of PZQ versus TCZ and to evaluate combined PZQ-TCZ therapy.

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Section: Discussionmentioning

confidence: 99%

Current status of the treatment of paragonimiasis

Richter¹

2022

One Health Implement Res

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“…Diagnosis of paragonimiasis in this case was delayed given the uncommon presentation of pericardial involvement [ [10] , [11] , [12] , [13] ] and its context within local epidemiology [ 14 ]. Paragonimiasis has rarely been reported in Qatar [ 15 , 16 ] and to our knowledge this is the first such case complicated by constrictive pericarditis.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…One study showed that 11.3 % of patients infected with P. skrjabini, presented with cardiac symptoms [ 7 ]. There are only a few reported cases of pericardial effusion secondary to Paragonimus infection [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Paragonimus infection: Rare manifestation with pericardial effusion: A Case report and Literature review

Bishawi

Salameh

Ehtesham

et al. 2021

IDCases

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Background Paragonimus, is a globally distributed trematode, with human disease limited to endemic regions. It can be transmitted to humans through ingestion of intermediate hosts that are crustaceans. Most symptomatic infections consist of pulmonary disease, and in aberrant migration of immature flukes, extrapulmonary manifestations may occur. These presentations are relatively uncommon and may affect various organs with atypical Clinico-radiological pathologies that are often challenging to diagnose. Pericardial involvement has scarcely been reported before. Furthermore, the management, clinical outcomes and potential complications of this involvement remain unclear. Case report Our patient is a 31-year-old Nepalese male who presented with abdominal distension and lower limb oedema. Initial work up revealed pericardial effusion, and analysis was suggestive of exudative lymphocytic effusion. Supported by positive QuantiFERON result along with his demographic data, the patient was treated presumptively as a case of tuberculous pericarditis, despite the negative initial Mycobacterial Tuberculosis work up. During follow up, the patient lacked clinical response and repeated echocardiography showed signs of tamponade with concomitant pleural effusion. subsequently video-assisted-thoracoscopy pericardial window along with pericardial and pleural biopsy were performed. Histopathological examination of the biopsied tissue revealed non-necrotizing granulomas containing a parasitic egg suggestive of Paragonimus. Fortunately, the patient received treatment with praziquantel and subsequently made good clinical recovery. Conclusion Diagnosis of extrapulmonary Paragonimus infection can be challenging given its rarity and clinical picture mimicking other infectious aetiologies. Pericardial involvement is seldom reported in the literature and clinical suspicion should be raised particularly when dealing with atypical presentations and relevant demographic data.

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“…The common pulmonary manifestations include chronic cough, hemoptysis, and pleuritic chest pain [ 5 , 6 ]. Extrapulmonary manifestations have been reported in the central nervous system, pericardium, mediastinum, peritoneal cavity, genitourinary system, and subcutaneous tissues [ [7] , [8] , [9] , [10] ]. The brain is the most frequent site of extrapulmonary paragonimiasis [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic excision for ectopic peritoneal paragonimiasis mimicking a gastric duplication cyst: A case report

Roh

Jung

2021

Annals of Medicine &Amp; Surgery

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Introduction Paragonimiasis, lung fluke disease caused by infection with Paragonimus species, is a food-borne parasitic zoonosis. The overriding symptoms of Paragonimus westermani infection include chronic cough, shortness of breath, and pleuritic pain. Extrapulmonary paragonimiasis caused by aberrant parasitic migration is known to occur in a variety of sites such as the brain, abdominal wall, and intraperitoneal cavity. Ectopic paragonimiasis is an uncommon disease that presents with a few clinical manifestations, which makes it difficult to diagnose and treat. Case presentation A 47-year-old man with an unremarkable medical and surgical history presented with a peritoneal lesion that was discovered incidentally on abdominal computed tomography during routine health screening. The patient did not exhibit any associated symptoms such as abdominal pain. The radiologic diagnosis was a gastric duplication cyst and we performed laparoscopic excision of the peritoneal mass. Histopathological examination revealed paragonimiasis, and the result of the skin test for paragonimiasis was positive. The patient was treated with praziquantel. Clinical discussion The diagnosis of ectopic peritoneal paragonimiasis remains challenging due to inexperience, misdiagnosis, and its rarity. Clinicians should bear in mind that an intra-abdominal mass may be related to a parasitic infection. The detection of the ova of Paragonimus parasites in sputum and biopsy specimens may be difficult due to an insufficient amount. Conclusion Clinicians need to thoroughly take the patient's history and clinically suspect parasitic infections. Laparoscopic resection of this rare mass is safe, feasible, and allows for rapid recovery.

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Case Report: Paragonimiasis Presenting with Pericardial Tamponade

Cited by 6 publications

References 9 publications

Current status of the treatment of paragonimiasis

Current status of the treatment of paragonimiasis

Paragonimus infection: Rare manifestation with pericardial effusion: A Case report and Literature review

Laparoscopic excision for ectopic peritoneal paragonimiasis mimicking a gastric duplication cyst: A case report

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