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A case of pleuropulmonary paragonimiasis that mimicked reactivation of pulmonary tuberculosis, pneumonia, and neoplasm occurred in a Laotian immigrant to Australia. The key to the diagnosis of this condition is awareness of the disease in persons from this region. The diagnosis was supported by enzyme-linked immunosorbent assay testing. The patient was successfully treated with praziquantel.
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PMID:Pleuropulmonary paragonimiasis in a Laotian immigrant to Australia. 154 Nov 57

In an attempt to find a small animal model for paragonimiasis, Syrian hamsters were infected with between 1 and 16 metacercariae of Paragonimus kellicotti. A definitive mortality dose-response was observed with 90% of all hamsters given 3 or more parasites succumbing to the infection within 35 days. Hamsters demonstrated acute pleuritis, reactive mesothelial hyperplasia, subpleural accumulations of reactive and mature plasma cells, neovascularization, fibrohistiocytic thickening with and without giant cells, raised fibroconnective tissue lesions, and granulomatous inflammation with hemorrhage. Perivascular plasmacytic (lymphocytic) infiltrate, multifocal bronchopneumonia, and parenchymal necrotizing suppurative granulomatous inflammation, hemorrhagic pneumonia, and diffuse sprinkling of eosinophils, neutrophils, and intraalveolar macrophages also were observed. The response observed here may represent a new small animal mortality model useful in the search for new compounds to treat early trematode infections.
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PMID:Mortality in Syrian hamsters infected with Paragonimus kellicotti. 155 55

A 45-year-old man, who had eaten fried fresh water crabs (Geothelphusa dehaani), was admitted to our hospital because of productive cough and bloodysputum. Blood chemistry showed increased levels of white blood cells and C-reactive protein, but peripheral blood eosinophil counts and serum IgE values were not elevated. Chest roentgenogram and chest computed tomographic scan revealed infiltration of the right middle and left upper lung fields. He was diagnosed as having pneumonia, but his symptoms and radiological examination findings did not improve with antibiotics. The diagnosis of paragonimiasis was confirmed by immunoserological examination and detection of ova in sputum, stool and bronchoalveolar lavage fluid samples. Transbronchial lung biopsy showed infiltration and degranulation of eosinophils. The patient was treated with praziquantel for 3 days at a daily dosage of 75 mg/kg. After uneventful completion of treatment all clinical symptoms and radiological abnormalities disappeared. This is the first case in which ova of paragonimiasis westermani were identified in Nagano prefecture.
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PMID:[A case of paragonimiasis westermani]. 980 15

Asia is a highly heterogeneous region with vastly different cultures, social constitutions and populations affected by a wide spectrum of respiratory diseases caused by tropical pathogens. Asian patients with community-acquired pneumonia differ from their Western counterparts in microbiological aetiology, in particular the prominence of Gram-negative organisms, Mycobacterium tuberculosis, Burkholderia pseudomallei and Staphylococcus aureus. In addition, the differences in socioeconomic and health-care infrastructures limit the usefulness of Western management guidelines for pneumonia in Asia. The importance of emerging infectious diseases such as severe acute respiratory syndrome and avian influenza infection remain as close concerns for practising respirologists in Asia. Specific infections such as melioidosis, dengue haemorrhagic fever, scrub typhus, leptospirosis, salmonellosis, penicilliosis marneffei, malaria, amoebiasis, paragonimiasis, strongyloidiasis, gnathostomiasis, trinchinellosis, schistosomiasis and echinococcosis occur commonly in Asia and manifest with a prominent respiratory component. Pulmonary eosinophilia, endemic in parts of Asia, could occur with a wide range of tropical infections. Tropical eosinophilia is believed to be a hyper-sensitivity reaction to degenerating microfilariae trapped in the lungs. This article attempts to address the key respiratory issues in these respiratory infections unique to Asia and highlight the important diagnostic and management issues faced by practising respirologists.
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PMID:Respiratory infections unique to Asia. 1894 21

Infections caused by the parasite Paragonimus westermani are endemic to Southeast Asia. Most infections reported in the United States are among immigrants who acquired the disease abroad. Due to the nonspecific nature of its presentation and rarity in the United States, the diagnosis may first be suggested by the pathologist on biopsy review. Definitive diagnosis may need serologic testing for confirmation. We report 4 cases of pleuropulmonary disease caused by United States-acquired P. westermani, which were identified in the consultation files of the authors. Patients (3 men and 1 woman; aged, 20 to 66 y) presented with pulmonary complaints and chest imaging abnormalities including cavitary infiltrates (2), lung mass (1), pleural effusion (1), and pneumothorax (1). Biopsies showed chronic eosinophilic pneumonia and organizing pneumonia in all cases. Other pathologic findings included granulomatous inflammation with geographic necrosis (3), vasculitis (3), and pleuritis (3). Paragonimus organisms and/or eggs were identified in 2 cases. Serologic studies were positive for P. westermani in 3 cases (2 enzyme-linked immunosorbent assay and 1 immunoblot). Three patients ate live crabs at sushi bars (including crabs in martinis, a previously unreported mechanism for infection). In 1 patient, the source of infection was uncertain. Paragonimiasis should be considered in the differential diagnosis of patients with eosinophilic pleuropulmonary disease in the United States. Although eosinophilic pneumonia was a consistent finding, the biopsies may be nonspecific as the organisms and/or eggs are not always visualized. Unusual features include marked pleuritis, foci of geographic necrosis and granulomatous vasculitis. A history of ingestion and targeted serologies are the keys to diagnosis.
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PMID:Pleuropulmonary infection by Paragonimus westermani in the United States: a rare cause of Eosinophilic pneumonia after ingestion of live crabs. 2141 2

Organizing pneumonia by paragonimiasis and coexistent aspergilloma as a pulmonary nodule is a rare case of lung disease. Its radiographic or CT feature has not been described before in the radiologic literature. We present organizing pneumonia by paragonimiasis and coexistent aspergilloma manifested as a pulmonary irregular nodule on CT.
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PMID:Organizing pneumonia by paragonimiasis and coexistent aspergilloma manifested as a pulmonary irregular nodule. 2260 55

We report a rare case of pulmonary paragonimiasis caused by Paragonimus miyazakii that showed pulmonary manifestations and a long-term clinical course after infection. A 45-year-old Japanese male developed cough and dyspnea in 2004 and was diagnosed with eosinophilic pneumonia. He had been treated with low-dose oral corticosteroid for 7 years. He recalled that he had consumed a large amount of raw freshwater crab (Geothelphusa dehaani) several weeks before he had been admitted for the first time, and that had been the only occasion when he had eaten this meat. The patient was referred to our hospital due to persistent hemoptysis, and his chest computed tomography scan showed pulmonary nodules and cavities, and his serum total IgE level was elevated. Bronchoscopy was performed, and ova were detected in the bronchoalveolar lavage fluid. The morphological examination of the ova and immunoserological examination yielded typical findings of P. miyazakii. Treatment with praziquantel improved his chest radiographic findings and a decrease of serum total IgE, as well as the values of immunoserological examination for P. miyazakii. The clinical course of this patient indicated that he had been infected with P. miyazakii for 7 years at least, which is unusual for paragonimiasis miyazakii.
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PMID:A rare case of paragonimiasis miyazakii with lung involvement diagnosed 7 years after infection: A case report and literature review. 2577 Oct 73

Pulmonary paragonimiasis is a food-borne zoonosis with a wide variety of radiologic findings, which sometimes can be confused with tuberculosis and carcinoma. Therefore, differential diagnosis is always warranted. A 43-year-old male farmer, with productive cough, blood-tinged sputum and chest pain, as well as patchy consolidation and pleural effusions in chest computer tomography, was misdiagnosed of community-acquired pneumonia and tuberculosis. Complete blood cell count, sputum smear and culture, chest computer tomography, thoracoscopy, and biopsy. The diagnosis of pulmonary paragonimiasis was established due to the finding of Charcot-Leyden crystals in the pleural necrosis, and antibodies against Paragonimus westermani in enzyme-linked immunosorbent assay. Paragonimiasis should be considered as a possibility in the differential diagnosis of tuberculosis. Thoracoscopy is an effective and valuable technology that can help make an accurate diagnosis.
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PMID:Pulmonary Paragonimiasis Mimicking Tuberculous Pleuritis: A Case Report. 2708 24

Paragonimiasis is a zoonosis caused by many species of Paragonimus commonly P. westermani. Human get infected by eating raw, salted, pickled, smoked, partially cooked crustaceans (crayfish or crabs). Clinical manifestations ranges from non-specific symptoms like pain abdomen, diarrhea, urticarial rashes, fever to pleuropulmonary symptoms like cough, hemoptysis, chest pain and dyspnea. A 48 years, female presented at TUTH emergency with fever on and off for nine months, cough and shortness of breath for three months, lethargy, malaise and urticaria with history of raw crab intake one month prior to the onset of symptoms. Blood and pleural fluid analysis revealed raised total counts with eosinophilia and x-ray showed bilateral infiltration of lower lobes with pleural effusion. Diagnosis was confirmed by microscopic examination of sputum for Paragonimus. She responded well to Praziquantel. Pulmonary paragonimiasis must be considered in the differential diagnosis of unresolving pneumonia and unexplained hypereosinophilia.
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PMID:Unresolving Pneumonia with Pleural effusion: Pulmonary Paragonimiasis. 2874 28

Bacterial pneumonia is a common lung disorder, and the pathogenesis remain elusive. Parasitic infections of the lung are able to affect the respiratory system, and the clinical features could mimic tuberculosis and malignancy. Therefore, it is essential to identify parasitic pneumonia at early stage, and most cases are curable with medical intervention. In this study, one case of parasitic pneumonia was misdiagnosed as bacterial infection, revealing the importance of pathological biopsy and MDT, especially when clinical features are not typical and routine tests are not specific. Therefore, more paragonimiasis cases can be diagnosed more effectively by the clinicians and misdiagnose should be avoided in future clinical practice.
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PMID:Parasitic Infection Misdiagnosed As Bacterial Pneumonia: A Case Report. 3282 8


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