Analysis of the misdiagnosis of 8 adult cases of paragonimiasis with lung masses as the main manifestation in Xishuangbanna, Yunnan

Abstract

Objective To summarize the clinical characteristics of adult cases of paragonimiasis with lung masses as the main manifestation in Xishuangbanna, Yunnan Province, analyze the causes of misdiagnosis, and improve the levels of clinical diagnosis and treatment. Method We conducted a retrospective analysis of the clinical data and diagnosis and treatment of 8 adult cases of paragonimiasis with lung masses as the main manifestation that were diagnosed in the Oncology Department of People’s hospital of Xishuangbanna Dai Autonomous Prefecture from July 2014 to July 2019. Result All 8 patients were from epidemic paragonimiasis areas and had a confirmed history of consuming uncooked freshwater crabs. The clinical manifestations were mainly fever, dry cough, and chest pain. The disease durations were long, and peripheral blood eosinophil counts were elevated. The cases had been misdiagnosed as pneumonia or pulmonary tuberculosis. After years of anti-inflammatory or anti-tuberculosis treatment, the symptoms had not improved significantly. Patients eventually sought treatment from the oncology department for hemoptysis. Chest computed tomography showed patchy consolidation in the lungs, with nodules, lung masses, and enlarged mediastinal lymph nodes. Conclusion Paragonimiasis is a food-borne parasitic disease. Early clinical manifestations and auxiliary examination results are nonspecific. The parasite most often invades the lungs, and the resulting disease is often misdiagnosed as pneumonia, pulmonary tuberculosis, or lung cancer (Acta Trop 199: 05074, 2019). To avoid misdiagnosis, clinicians should inquire, in detail, about residence history and history of unclean food and exposure to infected water and make an early diagnosis based on the inquired information and imaging examination results. For patients who have been diagnosed with pneumonia or pulmonary tuberculosis and whose symptoms do not improve significantly after anti-inflammatory or anti-tuberculosis treatments, their epidemiological history should be traced to further conduct differential diagnosis and avoid misdiagnosis.

Current status of the treatment of paragonimiasis

“…For instance, in areas where tuberculosis and paragonimiasis overlap and patients are treated with antibiotics for long periods, the efficacy of the treatment of paragonimiasis may be impaired [46] . Rifampicin, for example, induces degrading enzymes and thereby reduces the plasma level of praziquantel to zero [8] .…”

“…In the latter case eggs are released into bronchioles, coughed up, mixed with sputum, and are either expectorated or swallowed for later excretion via feces. The clinical picture (cough, hemophthysis, fever, asthenia, pleura effusions, pulmonary masses, lung cavernae) is very similar to tuberculosis (TB) [8] . Therefore, paragonimiasis in Vietnam is also called "eosinophilic TB" (Richter 2002, personal observation, unpublished).…”

“…Therefore, paragonimiasis in Vietnam is also called "eosinophilic TB" (Richter 2002, personal observation, unpublished). In endemic areas paragonimiasis may also be associated with TB or it may be confused with lung cancer [8][9][10] .…”

Morphological and Molecular Characterization of Paragonimus Species Isolated from Freshwater Crabs in Southern Yunnan, China

“…Previous literature on the identification of Paragonimus species among individuals consuming freshwater crabs is scarce. A recent study reported that 8 adult humans were infected with P. heterotremus, which were recovered from their lung masses on examination in Xishuangbanna, Yunnan [28]. In such a case, phylogenetic analysis is helpful in the identification of various species of organisms.…”

What Findings on Chest CTs Can Delay Diagnosis of Pleuropulmonary Paragonimiasis?

“…Hwang et al reported [14] that they observed clinical cases of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis. Moreover, Shu et al [15] found that eight pleuropulmonary paragonimiasis patients experienced delayed diagnosis due to symptoms shared with lung masses, six were misdiagnosed as having pneumonia, and two were misdiagnosed as having pulmonary tuberculosis.…”