Paragonimus

Background
  • Parasitic lung fluke
  • Infectious species found mainly in East/Southeast Asia, Africa, and Central/South America. Rare reports of infection acquired in the Midwest US
  • Transmission via ingestion of undercooked crab or crayfish

Clinical Features
  • Onset 2-15 days
  • Diarrhea, abdominal pain
  • Followed by fever, chest pain, fatigue
  • Cough: sputum may be rusty or blood-tinged
  • Symptoms similar to TB or chronic bronchitis
  • CNS disease (found in 25% of hospitalized patients)
  • May also invade liver, spleen, intestinal wall, peritoneum, abdominal lymph nodes

Differential Diagnosis

Helminth infections

Cestodes (Tapeworms)

Trematodes (Flukes)

Nematodes (Roundworms)

Evaluation
  • Diagnosis made by sputum (though parasite is killed by acid-fast testing for TB)
  • CBC: may have marked eosinophilia
  • CXR: range of findings (lobar infiltrates, calcified nodules, coin lesions, pleural thickening) but characteristic finding is ring-shaped opacities of contiguous cavities that look like a bunch of grapes
  • CT head: may also see "bunch of grapes" type cavities if CNS involvement

Management
  • Praziquantel 25mg/kg q8h x 2 days
  • Add short course of corticosteroids if CNS involvement to reduce inflammatory response to dying flukes

Disposition


See Also



References
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