Paragonimiasis Acquired in the United States

Blackburn, Brian
March 2011
Infectious Disease Alert;Mar2011, Vol. 30 Issue 6, p66
Paragonimiasis is caused by lung flukes of the genus Paragonimus, of which P. westermani is the best described. Humans acquire paragonimiasis primarily by eating undercooked crabs or crayish infested with the parasite. Shortly after ingestion, patients may develop diarrhea, abdominal pain, fever, chest pain, eosinophilia, and cough. Subsequently, patients may develop eosinophilic pleural effusions, or bronchiectatic and cavitary lung disease with cough and hemoptysis, sometimes mimicking tuberculosis. Less commonly, lesions develop in the brain, skin, or other ectopic sites. Paragonimiasis is most highly endemic to East and Southeast Asia, but transmission occurs in Peru, Ecuador, Nigeria, Cameroon, and other areas. While imported cases occasionally occur in the United States, infection acquired within the United States has been described only six times in the literature to 2 date. In North America, P. kellicotti causes infections among animals, but rarely humans. In Missouri, nine people who had developed paragonimiasis between 2006 and 2010 were identified by public-health oficials. The patients were aged 10-32 years, and all had eaten raw or undercooked crayish from rivers in Missouri (during the months of May-August) four months or less before illness onset. Seven (78%) patients were serologically positive for paragonimiasis (two of whom were also positive for P. kellicotti eggs in respiratory secretions), and two (22%) were clinically defined (but seronegative) cases. The patients presented with fever (100%), cough (100%), eosinophilia (100%), weight loss (56%), chest pain (44%), dyspnea (44%), and night sweats (44%). Five had eosinophilic pleural effusions, and other radiologic abnormalities included pulmonary nodules (44%), pulmonary iniltrates (33%), and pneumothorax (11%). Four patients noted migratory skin nodules, one had cardiac tamponade, and one had cerebral lesions. All patients were treated with praziquantel and noted prompt resolution of their symptoms subsequently.


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