Lung Flukes As Lung Cancer?

Differential diagnosis includes tuberculosis of the lungs, pulmonary abscess, chronic bronchitis, melioidosis, lung carcinoma and lung metastases.

11.6 Trematodes: lung flukes – Paragonimus sp.

11.6.1 Trematodes: Paragonimus sp., summary

  1. Transmission via eating infected crabs and crayfish
  2. Symptoms resembling pulmonary tuberculosis or chronic bronchitis
  3. Rarely located ectopically
  4. Diagnosis via detection of eggs in sputum

11.6.2 Trematodes: Paragonimus sp., general

The parasite occurs in Southeast Asia and the Far East, in Central and West Africa. In America its distribution is limited to Central America and the north of South America. Usually P. westermani is reported, but there are a number of other species which can cause infection in humans (Paragonimus africanus, P. bangkokensis, P. heterotremus, P. hueitungensis, P. kellicotti, P. mexicanus, P. miyazakii, P. ohirae, P. philippinensis, P. sadoensis, P. skrjabini, P. uterobilateralis).

 

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Paragonimus westermani egg in sputum. Such eggs can also be found in the faeces if the patient swallowed his/her sputum. Copyright ITM

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Adult Paragonimus westermani. Photo ITM

Paragonimus westermani, life cycle. Courtesy of CDC, Division of Parasitic Diseases.

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Paragonimus westermani eggs in sputum. Such eggs can also be found in the faeces if the patient swallowed his/her sputum. Copyright ITM
11.6.3 Trematodes: Paragonimus sp., life cycle

Adult worms live in the lungs. Eggs pass to the outside with the sputum. If sputum is swallowed, eggs may also be found in faeces. Once in the outside world and in water, miracidia (first-stage larvae) emerge from the eggs. They penetrate snails, where they undergo a transformation. After 3 to 5 months cercariae (second-stage larvae) leave the snail and penetrate crabs. Here the cercariae develop into metacercariae (third-stage larvae). It is this form which is infectious for the definitive host. Paragonomiasis is a zoonosis of carnivorous animals. Humans are only an exceptional host. They become infected by eating raw fresh-water crabs and river crayfish which contain infectious metacercariae. Excystation occurs in the duodenum. The larvae bore through the intestinal wall and migrate via the abdominal cavity to the lungs. There they develop into adult worms. The worms form a cavity 1 to 4 cm in diameter. Egg-laying begins 8 to 10 weeks after infection. The worms rarely migrate to ectopic sites.
11.6.4 Trematodes: Paragonimus sp., symptoms

Mild infections are asymptomatic. In the acute stage (invasion and migration of the larvae) there may be diarrhoea, abdominal pain, urticaria and eosinophilia. This is followed by fever, thoracic pain, cough, dyspnoea and malaise. The chronic illness resembles chronic bronchitis and TB. There is spasmodic cough (especially after exertion) with expectoration of blood stained sputum, as well as dyspnoea sometimes with wheezing and pleural pain. When the parasite is located in an ectopic site (brain, subcutis, etc.) the symptoms depend on the place where the worms are.
11.6.5 Trematodes: Paragonimus sp., diagnosis

Diagnosis is by detecting the eggs. The eggs often need to be concentrated (e.g. mix sputum + water + potassium hydroxide, then centrifuge and examine the sediment). Differential diagnosis includes tuberculosis of the lungs, pulmonary abscess, chronic bronchitis, melioidosis, lung carcinoma and lung metastases. If sputum is swallowed, eggs may also be found in the faeces.
11.6.6 Trematodes: Paragonimus sp., treatment

Praziquantel 75 mg/day for 3 days is very effective. In cases of cerebral localisation higher doses must be given but only under the protection of steroids due to the risk of epileptic fits secondary to perilesional oedema.

http://www.scribd.com/doc/24119752/Parasitic-disease-Paragonomiasis

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