Paragonimus Westermani - Confusion With Tuberculosis

Confusion With Tuberculosis

Practitioners should always consider about tuberculosis in patients with fevers, cough, weight loss. However, it is prudent to consider paragonamiasis in endemic areas. Flukes occasionally invade and reside in the pleural space without parenchymal lung involvement.

“In contrast to tuberculosis, pulmonary paragonimiasis is only rarely accompanied by rales or other adventitious breath sounds. Many patients are asymptomatic, and symptomatic patients frequently look well despite a prolonged course.”

In pleural paragonimiasis, symptoms may be minimal and diagnosiss complicated, since ova are not coughed or spit out or swallowed and there is frequently no cough. Such patients may develop pleural effusions and, because of the coendemicity with Mycobacterium tuberculosis (and co-infection in some patients), such effusions are often misdiagnosed as isolated tuberculosis.

• Adapted from Heath, Harley W & Susan G Marshall. "Pleural Paragonimiasis In A Laotian Child.*

Extra-pulmonary locations of the adult worms result in more severe manifestations, especially when the brain is involved. Extra-pulmonary paragonimiasis is rarely seen in humans, as the worms nearly exclusively migrate to the lungs. Despite this, cysts can develop in the brain and abdominal adhesions resulting from infection have been reported. Cysts may contain living or dead worms; a yellow-brownish thick fluid (occasionally hemorrhagic). When the worm dies or escapes, the cysts gradually shrink, leaving nodules of fibrous tissues and eggs which can calcify.

Worldwide the most common cause of hemoptysis is paragonamiasis.

Other case studies: 1. Pachucki, CT, Levandowski, RA, Brown, VA, Sonnenkalb, BH, Vruno, MJ. American paragonimiasis treated with Praziquantel. New Eng J Med 1984; 311:582-3 2. Procop, GW, Marty, AM, Scheck, DN, Mease, DR, Maw, GM. North American Paragonimiasis: A case report. Acta Cytol 2000; 44: 75-80.