Case series of paragonimiasis from Nepal

Abstract

Paragonimiasis is an important food-borne parasitic zoonosis caused by trematodes of genus Paragonimus. We report case series of paragonimiasis with common symptoms of cough with blood tinged sputum, shortness of breath, chest pain with occasional fever, eosinophilia and radiological findings mimicking pulmonary tuberculosis and had taken anti-tubercular drug despite all investigation negative for tuberculosis without improvement. They all had common history of consumption of raw/undercooked crab. There is a local belief in remote villages of Nepal that eating raw crab helps in healing bone fracture and cure jaundice. Microscopic examination of sputum sample revealed the ova of Paragonimus species. All patients were treated with praziquantel and got improved. Pulmonary paragonimiasis is endemic in Southeast Asia including Nepal. So, it has to be differentiated from pulmonary tuberculosis in the patient with symptoms of cough, chest pain and hemoptysis with eosinophilia and having history of consumption of raw/undercooked crabs or crayfish.

Figure 1:

chest X-ray of case 3 showing pericardial effusion and left sided pleural effusion

Figure 2:

chest X-ray of case 4 showing right middle and lower lobe opacity

Figure 3:

CT scan of case 4

Figure 4:

ova of Paragonimus species with Charcot Leyden crystal seen in case 1

Figure 5:

ova of Paragonimus species seen in case 2

Figure 6:

ova of Paragonimus species seen in case 3

Fagure 7:

ova of Paragonimus species seen in case 4

Figure 8:

measurement of the ova (77 μm by 50 μm) using cell sensation software version 1.12 for DP73 camera installed to the Olympus BX53 microscope used for the microscopy