As epidemiological parameters of human paragonimiasis, the positive rates of intradermal test and the sputum/stool examination have long been employed in population surveys. However, both the specificity of the intradermal test and the sensitivity of sputum/stool examination have been gradually declined as the endemicity was lowered; thus the gap between above two parameters widened. In such context, the development of a new epidemiological parameter or tool which makes it possible to accurately discriminate the active paragonimiasis cases was necessary. In the present study, the detection rate of Paragonimus-specific IgG antibody by micro-ELISA was evaluated as an indicator of epidemiologic status of human paragonimiasis in a population. A total of 4,285 students and inhabitants living in Bukpyeong Myeon and Bukil Myeon, Haenam Gun, Jeonlanam Do was surveyed in October 1983 by intradermal test first. Out of them, 244 case (5.7 percent) were found positively reacted to VBS antigen of P. wetermani. Out of 168 positive reactors, 7 cases (4.2 percent) were egg positive either by two times of sputum examination or by one stool examination. That indicated that only 0.16 percent of total surveyed were confirmed as active paragonimiasis by egg detection. When sera collected from 239 positive reactors of intradermal test were tested by micro-ELISA for their specific IgG antibody, 40 cases (16.7 percent) were found to be positive. All of 7 eggs positive cases were again positive for specific IgG antibody. Among remaining 232 intradermal test positive cases, 33 cases were positive for IgG antibody. In contrast to those, none of 42 positive reactors to intradermal test for Clonorchis and of 128 intradermal test negative cases showed positive for Paragonimus- specific IgG antibody. The rate of specific IgG antibody as detected by micro-ELISA appeared to be increased with the wheal size of the intradermal test. When the wheal size was over 13 mm in diameter, about 50 percent of them were positive for specific IgG antibody. Thirty-one specific antibody positive cases were clinically evaluated by laboratory examinations (repeated sputum examination, peripheral eosinophil count and chest roentgenogram) and by history taking. Out of them 24 cases were associated with one or more positive laboratory findings; thus considered as active paragonimiasis cases. Out of 7 lab. finding-free cases 3 revealed past history of typical paragonimiasis symptoms, suggesting that they were in chronic or in convalescent stages. The remaining 4 cases were considered as either mild or ectopic infection cases; the possibility of cross-reaction with other helminthiases could not be ruled out. From the above results, it was inferred that the detection of Paragonimus-specific IgG antibogy by micro-ELISA was very much helpful in detecting the active cases as well as in proper evaluation of the endemicity of human paragonimiasis in a population. The convenience of mass handling of sera in micro-ELISA was considered another superiority as an epidemiologic tool.
parasitology-helminth-trematoda ; Paragonimus westermani ; paragonimiasis ; ELISA ; immunology ; diagnosis ; IgG

Human paragonimiasis was endemic in Korea until the 1960's, and nowadays, the prevalence is decreasing. However, it is still one of the important helminthic diseases. Though it is essentially a pulmonary disorder, it may involve brain, muscle, mesentery, genital tract, pleura, peritoneum, spinal cord, spleen, and liver. We experienced two cases of paragonimiasis in a family who had ingested raw crabs together for 7 months. A 57-year-old female patient was admitted due to abdominal pain, diarrhea and tenesmus for 6 months. And, her 35-year-old son complained of cough, chest discomfort and dyspnea. The definite diagnosis for paragonimiasis could be made by the detection of the egg and adult worm from stool, sputum and involved lesion. Neither an egg or worm was detected. However, they were diagnosed based on the food history, laboratory data including serum eosinophilia, ELISA for specific IgG, pleural and peritoneal fluid examination, radiological findings, and intradermal tests. They were treated with praziquantel and their symptoms improved rapidly over 2 days. Both patients were asympromatic at a follow-up visit 2 months later.
Adult ; Animals ; Crustacea/parasitology ; Family Health ; Humans ; Male ; Paragonimiasis/complications/*diagnosis/transmission ; *Paragonimus westermani ; Peritonitis/*complications/diagnosis/parasitology ; Pleurisy/*complications/diagnosis/parasitology ; Shellfish/parasitology

Indirect fluorescent antibody tests were performed with sera of paragonimiasis patients and skin test positive sera against Paragonimus antigen. Paragonimus antigen was prepared from lyophilized adult worms of P. westermani by defatting with ethyl-ether before extracting with barbital buffered saline. Preparation of Paragonimus antigen for the indirect fluorescent antibody test was based upon Sato's method used for sero-diagnosis of anisakiasis, with Sephadex G-25 instead of Sepharose 4B. The results were as follows: The indirect fluorescent antibody titers of paragonimiasis patient's sera ranged from 1:64 to 1:512, whereas the control sera showed titers of less than 1:16. As controls, Clonorchis patient's sera and parasite-free healthy human sera were used. In indirect fluorescent antibody tests, the skin test positive human sera against Paragonimus antigen showed a positive rate of 41.5 per cent in the case of titers more than 1:40. On the other hand, complement fixation tests on the same sera showed a positive rate of 32.5 per cent in the case of titers more than 1:20.
parasitology-helminth-trematoda ; paragonimiasis ; Paragonimus westermani ; diagnosis ; indirect fluorescent antibody tests ; serum ; ethyl-ether

Agar-gel diffusion test (AGD), counterimmunoelectrophoresis (CIEP) and enzyme-linked immunosorbent assay(ELISA) were examined with the sera of skin test positives for paragonimiasis. The crude antigen(Paragonimus whole worm extracts: protein concentration, 7.56mg/ml) and human sera were used in AGD and CIEP. And in ELISA test, diluted antigen with 1:40,000 of crude antigen and diluted sera with 1:100, 1:200 were used in the test. The positive identical ratio between AGD and CIEP reactions is 98 percent and negative identical ratio is 100 percent. One or three precipitin bands are observed in AGD. One to seven precipitin bands are also revealed in CIEP. Especially, deeply stained bands are observed in CIEP than those of AGD. The positive identical ratios between AGD and ELISA tests are 96 percent in 1:100 diluted sera, and 94 percent in 1:200 diluted sera. But the negative identical ratios between AGD and ELISA tests are 97 percent and 99 percent respectively in 1:100 and 1:200 diluted sera. The positive identical ratios between CIEP and ELISA tests are 98 percent and 96 percent respectively in 1:100 and 1:200 diluted sera, but also 97 percent and 99 percent in 1:100 and 1:200. Control sera, such as clonorchiasis, amoebiasis and toxoplasmosis, revealed all negatives with Paragonimus antigen in AGD, CIEP and ELISA tests. By above results, ELISA was most sensitive, next CIEP and AGD. But AGD test appears to be more useful when used to crude antigen without cross reaction with other parasitic infections. CIEP test is basically equal in terms of precipitin reaction, but CIEP is able to be detected more sensitively and rapidly though less simple in handiwork than AGD. Consequently, three methods for immunological tests of paragonimiasis have good correlations with one another. Also, each of these has both merits and demerits in immunological test for paragonimiasis. But the ELISA test was proved to be the most sensitive and convenient tool for mass screening test, especially in case of using purified antigen.
parasitology-helminth-trematoda ; Clonorchis sinensis ; clonorchiasis ; ELISA ; immunology ; diagnosis ; paragonimiasis ; Paragonimus westermani ; agar-gel diffusion ; counterimmunoelectrophoresis

In order to obtain more specific antigenic preparation for the diagnosis of human paragonimasis, crude saline extract of whole worm (=PwWWE), secretory-excretory components (PwSEC) and secretion-excretion-free somatic extract (PwSM) of 12 week-old Paragonimus westermani were filtrated through Sephadex G-200 gel column. The adult Paragonimus worms were obtained from experimentally infected dogs. A total of 11 antigenic solutions was lyophilized or diluted to adjust protein content of 1 mg/ml. To evaluate the antigenicity of crude antigens and fractions, micro-ELISA was done with the sera from P. westermani infected cases, C. sinensis infected cases and non-infected control cases to detect Paragonimus specific IgG antibody. The results were as follows: When the PwWWE was filtrated through Sephadex G-200 gel, it was separated into three fractions; PwWWE Fr. 1, PwWWE Fr. 2 and PwWWE Fr. 3. The percentage of protein content was 28.0 percent, 21.6 percent and 50.4 percent respectively. The PwSM was also separated into three fractions; PwSM Fr. 1, PwSM Fr. 2, PwSM Fr. 3 and their percentage of protein content was 41.3 percent, 38.6 percent and 20.1 percent. However, the PwSEC showed different fractionation pattern; i.e. fraction 1 (=PwSEC Fr. 1) and 3 (PwSEC Fr. 3) without fraction 2. The percentage of protein content was 14.0 percent in PwSEC Fr. 1 and 86.0 percent in PwSEC Fr. 3. When the antigenicity of each Paragonimus crude antigen and fractionated antigen was evaluated for specific IgG antibody by micro-ELISA in 10 human paragonimiasis sera, PwSEC Fr. 1 was the most potent antigen showing the mean absorbance 1.98. The PwWWE Fr. 1, PwSEC, PwWWE were next to that; their mean absorbance were 1.72, 1.38 and 0.83, respectively. The antigenicity of fractions 2 and 3 was much weaker in binding specific IgG antibody. When the antigens were reacted in micro-ELISA with 10 human clonorchiasis sera, most antigens showed weak reactivity. Each fraction 1 of crude antigens reacted higher than other fractions or crude antigens; the mean absorbance was 0.17 in fraction 1, but in others the absorbances were about 0.06. With non-infected control sera, the result of micro-ELISA revealed almost same pattern with those of the clonorchiasis sera. From the above results, it became apparent that PwWWE Fr. 1, especially PwSEC Fr. 1 was the most potent antigen reacted with Paragonimus specifc IgG antibody.
parasitology-helminth-trematoda ; Paragonimus westermani ; paragonimiasis ; ELISA ; immunology ; diagnosis ; IgG ; purification

Paragonimiasis is a parasitic disease caused by the lung fluke, Paragonimus spp. Lung flukes may be found in various organs, such as the brain, peritoneum, subcutaneous tissues, and retroperitoneum, other than the lungs. Abdominal paragonimiasis raises a considerable diagnostic challenge to clinicians, because it is uncommon and may be confused with other abdominopelvic inflammatory diseases, particularly peritoneal tuberculosis, and peritoneal carcinomatosis. Also, subcutaneous paragonimiasis does not easily bring up clinical suspicion, due to its rarity. We herein report 2 cases of abdominal paragonimiasis and 1 case of subcutaneous paragonimiasis in Korea.
Abdominal Cavity/*parasitology ; Animals ; Biopsy, Fine-Needle ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Paragonimiasis/parasitology/*pathology/radiography ; Paragonimus/cytology/*isolation & purification ; Republic of Korea ; Subcutaneous Tissue/*parasitology

Abdominal Neoplasms ; diagnosis ; secondary ; Adult ; Animals ; Female ; Humans ; Liver Diseases, Parasitic ; diagnosis ; Liver Neoplasms ; diagnosis ; parasitology ; pathology ; Neoplasm Metastasis ; Paragonimiasis ; diagnosis

Pulmonary paragonimiasis is a relatively rare cause of lung disease revealing a wide variety of radiologic findings, such as air-space consolidation, nodules, and cysts. We describe here a case of pulmonary paragonimiasis in a 27-year-old woman who presented with a 2-month history of cough and sputum. Based on chest computed tomography (CT) scans and fluorodeoxyglucose positron emission tomography (FDG-PET) findings, the patient was suspected to have a metastatic lung tumor. However, she was diagnosed as having Paragonimus westermani infection by an immunoserological examination using ELISA. Follow-up chest X-ray and CT scans after chemotherapy with praziquantel showed an obvious improvement. There have been several reported cases of pulmonary paragonimiasis mimicking lung tumors on FDG-PET. However, all of them were suspected as primary lung tumors. To our knowledge, this patient represents the first case of paragonimiasis mimicking metastatic lung disease on FDG-PET CT imaging.
Adult ; Animals ; Diagnostic Errors ; Female ; Humans ; Lung Diseases, Parasitic/*diagnosis/*parasitology/radiography/radionuclide imaging ; Lung Neoplasms/*diagnosis ; Paragonimiasis/*diagnosis/*parasitology/radiography/radionuclide imaging ; Paragonimus westermani/isolation & purification ; Positron-Emission Tomography ; Tomography, X-Ray Computed

As a part of a broader effort to determine the status of Paragonimus species infection in Lao PDR, an epidemiological survey was conducted on villagers and schoolchildren in Namback District between 2003 and 2005. Among 308 villagers and 633 primary and secondary schoolchildren, 156 villagers and 92 children evidenced a positive reaction on a Paragonimus skin test. Only 4 schoolchildren out of 128 skin test-positive cases had Paragonimus sp. eggs in their sputum, all of which was collected on 1 day. Several types of crabs, which were identified as the second intermediate host of the Paragonimus species, were collected from markets and streams in a paragonimiasis endemic area for the inspection of metacercariae. Among the examined crabs, only "rock crabs" (Indochinamon ou) harbored Paragonimus sp. metacercariae, and it is speculated that the life cycle of Paragonimus sp. was maintained via rock crabs in Namback District, Lao PDR.
Adolescent ; Adult ; Aged ; Animals ; Brachyura/parasitology ; Child ; Female ; Humans ; Laos/epidemiology ; Male ; Middle Aged ; Paragonimiasis/*diagnosis/*epidemiology ; Population Surveillance ; *Skin Tests

No abstract available.
Abdomen/pathology ; Animals ; Anthelmintics/therapeutic use ; Bronchi/pathology ; Humans ; Male ; Middle Aged ; Paragonimiasis/*diagnosis/drug therapy/parasitology ; Paragonimus westermani/isolation & purification ; Praziquantel/therapeutic use ; Tomography, X-Ray Computed