Can Pleuropulmonary Paragonimiasis be Cured by Only the 1st Set of Chemotherapy? Treatment Outcome and Clinical Features of Recently Developed Pleuropulmonary Paragonimiasis

Abstract

Purpose Most patients with pleuropulmonary paragonimiasis can be cured by the initial single set of Praziquantel (PZQ) treatment. However, several cases have been reported to have unsatisfactory responses to the initial PZQ treatment. The objective of this study was to evaluate the clinical findings of patients with pleuropulmonary paragonimiasis who needed additional PZQ treatment after the 1st set chemotherapy. Patients and Methods Thirty-two patients who were diagnosed with pleuropulmonary paragonimiasis at our institution between 2003 and 2008 were retrospectively reviewed. Results All patients were treated initially with PZQ for 3 days (1st set chemotherapy). Twenty-four patients (75.0%) showed improvement in respiratory symptoms and pulmonary involvements. However, eight patients (25.0%) suffered from relapsed respiratory symptoms and pleural effusion. For these patients, an additional 2nd set PZQ treatment resulted in the resolution of the symptoms and pulmonary involvements. The characteristics of patients who needed multi-set treatments were as follows; longer duration of respiratory symptoms (single vs multi-set treatment group; 6.67 ± 8.08 vs 17.86 ± 11.84 weeks, p=0.009), higher IgG titer (optical density, O.D.) for Pargonimus westermani (ELISA O.D. for PW, 0.54 ± 0.19 vs 0.88 ± 0.16 O.D., p=0.001) and higher frequency of multiple pulmonary lesions (% of patients with multiple lesions; 16.7% vs 50.0%, p=0.059). Conclusion The patients who had a longer duration of respiratory symptoms, higher ELISA titer for PW and/or multiple pulmonary lesions needed an additional PZQ treatment after the 1st set of chemotherapy. Close follow-up after the initial treatment is necessary especially for such patients.

Paragonimiasis in Children in Southwest China

“…However, a recent report showed that patients with effusion and had longer duration of respiratory symptoms, higher ELISA titers for pulmonary paragonimiasis, and/or multiple pulmonary lesions needed additional PZQ treatment. [10] Obara et al [11] reported that 16.7% (3/18) of patients needed additional PZQ treatment. We found that 29 (23.6%) patients needed more than 1 course of PZQ.…”

“…Additionally, it has been recently reported that paragonimiasis associated with effusions have unsatisfactory response to the initial praziquantel (PZQ) treatment in adults. [10,11] Paragonimiasis has been rarely reported in children and usually was misdiagnosed as tuberculosis (TB), pneumonia, liver abscess, or carcinoma. [12–14] Better diagnostic methods should be developed for paragonimiasis to enable rapid treatment.…”

Vesical Paragonimiasis Diagnosed by Histopathology: A Case Report

“…Praziquantel is the most commonly used antiparasitic drug for Paragonimus , with an overall effective rate approaching 100% [10]. In our case, we prescribed 1.5 g of oral praziquantel, 3 times a day, for 3 days, and our patient experienced a stable recovery.…”

A Case of Delayed Diagnosis of Pulmonary Paragonimiasis due to Improvement after Anti-tuberculosis Therapy

“…Nevertheless, the lesion was still maintained as same state in 1-year follow-up CT scans and there were no findings of exacerbation. Most papers have mentioned cure rates of around 90%-100% and even untreated, the prognosis with paragonimiasis is good15. The recent series, however, have reported some treatment failure after an initial set praziquantel medication and cure rate of only 75.0% after the first set of praziquantel and pleural drainage15.…”

“…Most papers have mentioned cure rates of around 90%-100% and even untreated, the prognosis with paragonimiasis is good15. The recent series, however, have reported some treatment failure after an initial set praziquantel medication and cure rate of only 75.0% after the first set of praziquantel and pleural drainage15. Our patient suffered surgical resection and succeeding treatment with praziquantel, and she had not shown any symptom or interval aggravation of chest radiograph and CT scans during 1-year follow-up period after the treatment.…”