Paragonimiasis: a common cause of persistent pleural effusion in Lao PDR

Abstract

Southeast Asia is the major endemic area for paragonimiasis. Diagnosis relies on identification of ova in the sputum, pleural fluid or tissue specimen, or serology. Low awareness, however, frequently results in the disease being overlooked. We report nine cases presenting as primary, massive and protracted pleural effusions. All patients had evidence of Paragonimus spp. in the pleural fluid; one discharged an adult worm through a chest tube during treatment with praziquantel. In three cases, resolution of symptoms and pleural effusions could not be achieved, despite repeated fluid evacuation procedures and courses of praziquantel, which contradicts the widely accepted statement of paragonimiasis being self-limited and easy to cure. The disease should be considered in any case of elusive pleural effusion occurring in endemic areas.

Can Pleuropulmonary Paragonimiasis be Cured by Only the 1st Set of Chemotherapy? Treatment Outcome and Clinical Features of Recently Developed Pleuropulmonary Paragonimiasis

“…Secondary findings were that the outbreak of pleuropulmonary paragonimiasis with pleural effusion is still developing, although local control programs have been able to significantly decrease this rate, and that a variety of clinical and radiological findings were shown in these patients. To our knowledge, this is one of the largest casereview studies on pleuropulmonary paragonimiasis with effusion among the recent publications (3,7,(16)(17)(18)(19).…”

“…Most papers have mentioned cure rates of around 90-100%. However, the recent series has reported some treatment failure after an initial set PZQ medication (3,7,12). In the present study, the cure rate was only 75.0% (24/32) after the first set of PZQ and pleural drainage.…”

“…Pleuropulmonary paragonimiasis is an illness caused by lung flukes of the genus Paragonimus that are endemic to Southeast Asia, the Indian subcontinent, Central and South America and Africa (1)(2)(3). In other countries, the disease is most commonly diagnosed in immigrants from endemic countries (4)(5)(6).…”

“…Cure rates approach almost 100% (10,11). However, the recent cases with effusion have been reported to have unsatisfactory responses to the initial PZQ treatment (3,7,12). Therefore, we retrospectively reviewed treatment outcomes and clinical findings from the medical records of patients who had pleuropulmonary paragonimiasis with effusion.…”

Paragonimiasis and Renewed Crab-Eating Behavior in Six Communities from Two Ethnocultural Clusters in Southeastern Nigeria

“…Prevalence of infection could be higher but for the suboptimal sensitivities of the use of eggs/ova in sputum [10], compared to the good sensitivity and speci�city of the ELISA method, especially ELISA using partially puri�ed cysteine proteinases method [6,11]. However, the repeated sputum examinations per person adopted in this study are known to improve the sensitivity of the parasitological method [1].…”