Pleuropulmonary Paragonimiasis mimicking Pulmonary Tuberculosis - A Report of Three Cases

Abstract

Paragonimiasis is an important cause of pulmonary disease worldwide. Infection in humans mainly occurs by ingestion of raw or undercooked freshwater crabs or crayfish. The disease is well known in endemic regions of Asian countries, where culturally based methods of food preparation foster human transmission. Three patients with clinical and radiological features compatible with pulmonary tuberculosis had been treated for tuberculosis without remedy despite an inability to demonstrate acid fast bacilli in sputum smears. All patients had history of ingestion of raw crabs and crayfish. The confirmed diagnosis of pleuropulmonary paragonimiasis was made based on the demonstration of Paragonimus eggs in the sputum, and high absolute eosinophilia in their peripheral blood and pleural fluid. All the patients had been treated with praziquantel successfully.

North American Paragonimiasis (Caused by Paragonimus kellicotti ) in the Context of Global Paragonimiasis

“…It has been estimated that between 50 and 70% of patients with paragonimiasis may initially be thought to have tuberculosis and erroneously receive antituberculous therapy (76,80,129,167). This has also been described by other authors (164,165). There are a number of important sequelae associated with the misdiagnosis of tuberculosis.…”

Emerging and Re-Emerging Parasitic Zoonoses in India

“…In India, many of the human paragonimosis cases were reported from North Eastern states of the country and hence these states were considered to be endemic for the disease. The first human case was reported from Manipur in 1981 (Singh et al, 1982(Singh et al, , 1993(Singh et al, , 2004(Singh et al, , 2005Singh and Vashum, 1994), followed by another report from Maharashtra in 1984 (Patil et al, 1984). Later, several cases were reported from Manipur itself (Singh et al, 1986).…”

Parasitic Pneumonia and Lung Involvement

“…Oloyede et al reported that the roentgenographic features of both pulmonary paragonimiasis and pulmonary tuberculosis identified in their study were mostly parenchymal and were similar [153]. The main differential diagnosis of cavitating pulmonary infiltrates includes bacterial abscess, tuberculosis, fungal infections, nocardiosis, and parasitic lung diseases [157]. Computerized tomography of the chest is found as a better technique compared to the chest roentgenogram by visualization of burrows and tunnels joining the Paragonimus cystic lesions [150].…”