Paragonimiasis typically results from the consumption of raw or improperly cooked crustacea, especially crabs and crayfish. Although previously endemic in Korea, the prevalence of this disease decreased in the early 1970s because of educational campaigns and fewer intermediate hosts as a result of ecological changes. Recently, we were presented with a family where all members were infected with Paragonimus after ingestion of Kejang (= drunken crab). The mother was hospitalized for general myalgia and weakness first, followed by the father, who was hospitalized for dyspnea 2 month later. After the parents were diagnosed with paragonimiasis, we recommended their daughter to visit our hospital for a checkup, because they all had eaten freshwater crabs soaked in soybean sauce. She complained of generalized myalgia, fever, and pleuritic pain, and was also diagnosed with paragonimiasis. Peripheral blood of the 3 patients revealed hypereosinophilia, and computed tomography (CT) scans of their chests showed pleural effusion. The results of antibody tests by ELISA were positive for paragonimiasis. We report here the case series of familial paragonimiasis in a modern urban city, rather than in a typical endemic area.
Adult ; Animals ; Family ; Female ; Humans ; Korea ; Lung Diseases, Parasitic/*diagnosis/radiography ; Male ; Middle Aged ; Paragonimiasis/*diagnosis/radiography ; Paragonimus/isolation & purification

Though the incidence of paragonimiasis has been remarkably decreased since 1970, it is still not a rare disease in Korea. Major problems in the diagnosis of pulmonary paragonimiasis on chest radiography are its differentiation from pulmonary tuberculosis and lung cancer. Chest radiographic findings have been described in detail, but little have been reported on CT findings. We reviewed CT findings of 10 patients with pulmonary paragonimiasis. The characteristic CT findings were similar to those on chest radiography, such as air-space consolidation (70%), nodular mass (50%), pleural effusion (40%), cystic lesion (30%), small low density within the mass (30%), linear density (20%), pneumothorax(20%), and burrow track (20%). CT depicted the cystic lesions and the burrow tracks more clearly and showed the small worm-retaining cysts within the mass that were not detectable on chest radiography. In conclusion, all of these CT findings are useful in the diagnosis of pulmonary paragonimiasis especially when differentiation from tuberculosis or lung canceris difficult on chest radiography.
Diagnosis ; Humans ; Incidence ; Korea ; Lung ; Lung Neoplasms ; Paragonimiasis* ; Pleural Effusion ; Radiography ; Radiography, Thoracic ; Rare Diseases ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: It is important to diagnose paragonimiasis in early active stage because it can be dured by chemotherapy. However, it is difficult to make a correct diagnosis of cerebral paragonimiasis in the early active stage, and the radiographic findings of cerebral paragonimiasis have been rarely reported. Thus, this experimental study was designed to produce early active cerebral paragonimiasis and to demonstrate radiologic-pathologic correlations. MATERIALS AND METHODS: In 8 cats, 7-8 metacercariae of Paragonimus westerrnani were directly introduced into the brain parenchyma of each cat's after trephination of the skull. In anogher 16 cats, the juvenile worms and the adult worms that had developed for varying periods (2 weeks, 4 weeks, 6 weeks, 8 weeks and 12 weeks) in the lunges of another cats were introduced into the brain parenchyma of each cat's with the same procedures described above. Follw-up MR images and chest radiographs were obtained at 2 days, 1 weeks, 2 weeks, 4 weeks and 8 weeks after innoculation. The autopsies and histopathological examinations of the cat's brain were undertaken in 22 cats. In 9 cats that were suspected with pulmonary lesions on chest radiograph, the soft tissue radiographs of inflated-fixed lungs were obtained. RESULTS: In one cat with innoculation of adult worm, acute suppurative inflammation of the brain parenchyma was demonstrated. But the other cats with innoculction of adult worm or juvenile worm and the cats with innoulation of metacercaris did not reveal any evidence of acute cerebral paragonimiasis. More than half of the introduced metacercariae(5 out of 8 cats) were found in the lung parenchyma, while only 25%(4 out of 16 cats) of the adult worm innoculated cats were. CONCLUSION: Acute suppurative inflammation suggesting acute stage cerebral paragonimiasis was obtained in one case of adult worm innoculated cat. Most of the innoculated metacercariae and some of the juvenile worms or adult worms were migrated to the lungs.
Adult ; Animals ; Autopsy ; Brain ; Cats* ; Diagnosis ; Drug Therapy ; Humans ; Inflammation ; Lung ; Metacercariae ; Paragonimiasis* ; Paragonimus ; Radiography, Thoracic ; Skull ; Trephining

We describe a case of adrenal paragonimiasis with its computed tomographic and ultrasonographic findings. Computed tomogram showed a well enhancing oval mass at right adrenal gland and ultrasonogram showed a dumbbell-shaped hyperechoic mass saddling on the top of the right kidney. Surgical specimen was multicystic mass filled with creamy material.
Adrenal Gland Diseases/*diagnosis ; Adrenal Gland Neoplasms/*diagnosis ; Aged ; Case Report ; Human ; Male ; Paragonimiasis/*diagnosis/radiography/ultrasonography ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed

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

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

BACKGROUND/AIMS: Pleuropulmonary paragonimiasis produces no specific symptoms or radiologic findings, allowing for the possibility of misdiagnosis. We evaluated the specific clinical and pleural fluid features of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis. METHODS: We retrospectively analyzed the clinical and radiologic characteristics of 20 patients diagnosed with pleuropulmonary paragonimiasis between 2001 and 2011. RESULTS: In total, 17 patients presented with respiratory symptoms, including dyspnea (30%), hemoptysis (20%), cough (20%), and pleuritic chest pain (15%). Chest radiographs revealed intrapulmonary parenchymal lesions, including air-space consolidation (30%), nodular opacities (20%), cystic lesions (15%), ground-glass opacities (10%), and pneumothorax (5%). A pleural f luid examination revealed eosinophilia, low glucose levels, and high lactate dehydrogenase (LDH) levels in 87%, 76%, and 88% of the patients, respectively. These traits helped to distinguish pleuropulmonary paragonimiasis from other pleural diseases such as parapneumonic effusion, malignancy, and pleural tuberculosis. CONCLUSIONS: Pleuropulmonary paragonimiasis is often initially misdiagnosed as other pleural diseases. Therefore, it is important to establish the correct diagnosis. In patients with unexplained pleural effusion living in paragonimiasis-endemic areas, pleural fluid obtained by thoracentesis should be examined to distinguish pleuropulmonary paragonimiasis. When marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid, physicians could consider a diagnosis of pleuropulmonary paragonimiasis.
Adolescent ; Adult ; Aged ; Animals ; Biological Markers/analysis ; Child ; Child, Preschool ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia/diagnosis/parasitology ; Female ; Glucose/analysis ; Humans ; L-Lactate Dehydrogenase/analysis ; Lung Diseases, Parasitic/*diagnosis/metabolism/parasitology/radiography ; Male ; Middle Aged ; Paracentesis ; Paragonimiasis/*diagnosis/metabolism/parasitology/radiography ; Paragonimus westermani/*isolation & purification ; Pleural Effusion/*diagnosis/metabolism/parasitology/radiography ; Predictive Value of Tests ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Pleural/*diagnosis ; Young Adult

In Korea, many people enjoy eating raw or underkooked freshwater crayfish and crabs which unfortunately may cause paragonimiasis. Here, we describe a case of pulmonary and abdominal paragonimiasis in a 9-year-old girl, who presented with a 1-month history of abdominal pain, especially in the right flank and the right inguinal area, with anorexia. A chest radiograph revealed pleural effusion in both lungs, and her abdominal sonography indicated an inflammatory lesion in the right psoas muscle. Peripheral blood analysis of the patient showed hypereosinophilia (66.0%) and an elevated total serum IgE level (>2,500 IU/ml). The pleural effusion tested by ELISA were also positive for antibodies against paragonimiasis. Her dietary history stated that she had ingested raw freshwater crab, 4 months previously. The diagnosis was pulmonary paragonimiasis accompanied by abdominal muscle involvement. She was improved after 5 cycles of praziquantel treatment and 2 times of pleural effusion drainage. In conclusion, herein, we report a case of pulmonary and abdominal paragonimiasis in a girl who presented with abdominal pain and tenderness in the inguinal area.
Abdominal Muscles/*parasitology/pathology/ultrasonography ; Animals ; Anthelmintics/therapeutic use ; Brachyura/*parasitology ; Child ; Drainage ; Female ; Humans ; Lung/parasitology/pathology ; Lung Diseases, Parasitic/*diagnosis/drug therapy/radiography ; Paragonimiasis/*diagnosis/drug therapy/radiography ; Paragonimus/isolation & purification ; Pleural Effusion/parasitology/therapy ; Praziquantel/therapeutic use ; Republic of Korea ; Shellfish/*parasitology ; Treatment Outcome

OBJECTIVE: To investigate the serial CT findings of Paragonimus westermani infected dogs and the microscopic structures of the worm cysts using Micro-CT. MATERIALS AND METHODS: This study was approved by the committee on animal research at our institution. Fifteen dogs infected with P. westermani underwent serial contrast-enhanced CT scans at pre-infection, after 10 days of infection, and monthly thereafter until six months for determining the radiologic-pathologic correlation. Three dogs (one dog each time) were sacrificed at 1, 3 and 6 months, respectively. After fixation of the lungs, both multi-detector CT and Micro-CT were performed for examining the worm cysts. RESULTS: The initial findings were pleural effusion and/or subpleural ground-glass opacities or linear opacities at day 10. At day 30, subpleural and peribronchial nodules appeared with hydropneumothorax and abdominal or chest wall air bubbles. Cavitary change and bronchial dilatation began to be seen on CT scan at day 30 and this was mostly seen together with mediastinal lymphadenopathy at day 60. Thereafter, subpleural ground-glass opacities and nodules with or without cavitary changes were persistently observed until day 180. After cavitary change of the nodules, the migratory features of the subpleural or peribronchial nodules were seen on all the serial CT scans. Micro-CT showed that the cyst wall contained dilated interconnected tubular structures, which had communications with the cavity and the adjacent distal bronchus. CONCLUSION: The CT findings of paragonimiasis depend on the migratory stage of the worms. The worm cyst can have numerous interconnected tubular channels within its own wall and these channels have connections with the cavity and the adjacent distal bronchus.
Animals ; Contrast Media/administration & dosage ; Cysts/*parasitology/*radiography ; Disease Progression ; Dogs ; Female ; Follow-Up Studies ; Hydropneumothorax/parasitology ; Iohexol/analogs & derivatives/diagnostic use ; Lung/parasitology/radiography ; Male ; Observer Variation ; Paragonimiasis/*diagnosis/parasitology ; Paragonimus westermani/growth & development/isolation & purification ; Pleural Effusion/parasitology ; Radiographic Image Enhancement/methods ; Time Factors ; Tomography, X-Ray Computed/*methods