Paragonimiasis: A continuing public health problem in northeast India

Abstract

Purpose: Trematode species belonging to the genus Paragonimus are the source of the food-borne parasitic zoonosis known as paragonimiasis. The disease has been identified as an outbreak in northeastern India since the early 1980s and is frequently diagnosed as tuberculosis because of similar clinical and radiological findings. This study is an attempt to update the clinic-radiological features and geographical distribution of the disease in recent times.

Methods: We retrospectively collected and analysed the data of 37 paragonimiasis suspected cases attending three healthcare facilities in Manipur from 2011 to 2023. Clinical data, history of food habits and geographical location, and laboratory data were retrieved and analysed. In the microbiology laboratory, sputum and pleural fluid examination were subjected to microbiological examination and serological testing using DIGFA, an immunochromatographic dot blot rapid test.

Results: Out of 37 cases, 32 cases were confirmed to be paragonimiasis. Clinical manifestations were pleural effusion (n = 11), cerebral with pulmonary (n = 1), cutaneous (n = 1), and pulmonary (n = 19). All patients had a history of consuming crabs. Thirteen cases were pediatric patients, representing 40.6 %. At the time of presentation, 22 cases (68.75 %) were clinically suspected to be TB, and 16 (50 %) of them were already receiving anti-TB drugs. The patients were treated with oral praziquantel, 25 mg/kg of body weight, three times a day.

Conclusions: The disease remains a public health concern in Manipur, as evidenced by the identification of new endemic foci. It continues to be misdiagnosed and mismanaged as tuberculosis. More awareness and a policy to examine AFB smear-negative sputum samples for paragonimiasis in patients with high eosinophil count is the need of the hour.

Keywords: Anti-TB misuse; DOTS challenge; Diagnostic overlap; Northeast India; Paragonimiasis.