Retrospective study of pleural parasitic infestations: a practical diagnostic approach

Abstract

Background Pleural parasitic infestation (PPI) is a disease prevalent in certain parts of the world. It is frequently misdiagnosed due to its lack of standardized diagnostic criteria. The purpose of this study was to evaluate the clinical characteristics of PPI patients and develop a practical diagnostic approach for PPI. Methods A retrospective study was conducted by reviewing the medical records of 11 patients with PPI. A practical diagnostic approach was proposed based on the unique laboratory findings. Results All patients demonstrated respiratory symptoms, including shortness of breath, cough, fever, chest pain, excessive sputum and hemoptysis. Leukocytosis (> 10,000/μL) and eosinophilia (> 500/μL) of peripheral blood were present in 45.5 and 36.4% patients, respectively. The mean concentrations of pleural effusion lactate dehydrogenase (LDH), adenosine deaminase (ADA), protein and carcinoembryonic antigen (CEA) were 338.2 U/L (range, 61–667 U/L), 11.6 U/L (range, 0.1–28.2 U/L), 43.7 g/dL (range, 21.9–88.1 g/dL), and 1.84 mg/mL (range, 0.28–4.8 mg/mL), respectively. The mean percentage of eosinophils in the pleural effusion was 19.5% (10.5–41%). Blood test was positive for parasite-specific IgG antibody in 9 patients, including 4 for Paragonimus westermani, 3 for Taenia solium, 1 for Clonorchis sinensis and 1 for Echinococcus granulosus. Eggs of Clonorchis sinensis were detected in the stool of two patients. Sparganum was found in the pleural effusion of one patient. Respiratory symptoms and abnormal appearances in pulmonary radiographic examination were disappeared in all patients who received anti-parasitic treatment. Conclusions In patients with unexplained pleural effusion, parasite-specific IgG antibody tests should be performed when pleural fluid testing shows eosinophilic pleural effusion. It is preferable to consider the diagnosis of PPI in clinical practice when serum parasite-specific IgG antibody test is positive.

Eosinophilic pleural effusion: A case and a review

“…Eosinophilic pleural effusion also occurs in filariasis, ascariasis, sparganosis, strongyloidiasis, and infections with other trematodes and cestodes. 7,8 Evanescent eosinophilic skin lesions with EPE, as in this case, suggests the possibility of Strongyloides or a generalized auto-immune disorder. Besides larva currens, strongyloidiasis may be accompanied by peripheral eosinophilia and a form of urticaria around the buttocks and waist.…”

Diagnostic procedure for idiopathic eosinophilic pleural effusion: a single-center experience

“…The diagnostic approach for PPI was as previously described by the authors [18]. The enzyme-linked immunosorbent assay (ELISA) test for parasite-specific IgG antibodies (Guangzhou Yikang Biotechnology Co. Ltd.) was performed on serum from all patients.…”

“…The diagnosis of PE includes both non-invasive and invasive approaches. Thoracic ultrasound, thoracic computed tomography (CT) scan and positron emission tomography with 18 F-fluorodeoxyglucose (FDG-PET CT) chemical confirm its presence [3]. Pleuroscopy, thoracentesis, laboratory tests, and cytological analysis, provide further information about the aetiology of the disease and thus, are also essential [2,3].…”

Eosinophilic pleural effusion as a manifestation of taeniasis

“…Even taking into account this background of uncertain pathogenesis of EPEs, we believe that the association of the Taenia sp infestation was related to the EPE, in our patient. A retrospective study by Wang et al 9 described a practical approach to diagnosing pleural parasitic infestations based on the presence of respiratory symptoms, pleural effusions, parasite or parasite eggs in the stool, EPEs and parasite-specific antibodies in the blood. By Wang's recommendations, a definitive diagnosis of EPEs due to parasitic infestation can be made in our patient.…”