PULMONARY PARAGONIMIASIS - A KOREAN PERSPECTIVE

Pulmonary paragonimiasis is a chronic, benign inflammatory disease. Symptoms develop insidiously and vary in degree with individual patients. Fatigue, blood-streaked sputum, cough, and chest pain due to pleural effusion are the most frequent. Because symptoms and radiologic findings overlap with pulmonary tuberculosis and other inflammatory lung diseases, differential diagnosis is frequently delayed even in endemic areas. Peripheral eosinophilia may be a clue leading to the diagnosis. Paragonimiasis needs specific chemotherapy, which results in immediate improvement. Correct differential diagnosis is therefore important. Of patients who resisted antituberculosis therapy, those with a history of eating inadequately cooked fresh water crabs or crayfish should be screened for paragonimiasis. People from Eastern and Southeast Asian countries, West Africa and Latin America may be infected. Diagnosis is confirmed by discovering characteristic eggs in sputum or stool, or both, on wet smear. In the chronic stage, the detection rate of the egg is low. The serum level of the anti-Paragonimus antibody (IgG), measured by antibody tests such as ELISA, is highly diagnostic. Once diagnosed, most patients are cured by a 2-day therapy with praziquantel in doses of 75 mg/kg/day. The cure may be delayed by pleural exudate and fibrosis, which sometimes needs surgical decortication. Pulmonary paragonimiasis may be associated with cerebral, spinal, and abdominal lesions or with migrating subcutaneous masses.