Massive secretions in paragonimiasis pleural effusion: a new finding concerning clinical recognition and treatment.
Clinical recognition
Lung fluke disease
Paragonimiasis
Secretions
Species variations
Treatment
Journal
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
ISSN: 1435-4373
Titre abrégé: Eur J Clin Microbiol Infect Dis
Pays: Germany
ID NLM: 8804297
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
19
10
2022
accepted:
07
02
2023
pubmed:
25
2
2023
medline:
14
3
2023
entrez:
24
2
2023
Statut:
ppublish
Résumé
Some paragonimiasis patients in Chongqing, southwest China, have recently exhibited pleural effusions (PEs) with massive viscous secretions. This study aimed to investigate their clinical characteristics, thereby promoting effective treatments. A 3-year retrospective review of paragonimiasis patients who were admitted for nonhomogeneous PEs at Chongqing University Three Gorges Hospital was conducted. Epidemiological data, symptoms, laboratory and imaging findings, treatments, and outcomes were analyzed. Twenty-eight patients were identified, of which 22 (78.6%) were males and 22 (78.6%) were rural residents. Respiratory (85.7%) and constitutional (57.1%) symptoms were common. Paragonimus-specific ELISA was positive in all patients. Eosinophilia was detected in all patients in peripheral blood and PEs. Irregular hyperdense signals were observed in PEs by chest CT scans (96.4%) and ultrasonography (100.0%). Thoracic closed drainage failed in 10 patients (conservative group) because of tube blockage and was eventually replaced by video-assisted thoracoscopic surgery (VATS). Eighteen patients (surgery group) initially underwent VATS, or thoracotomy surgery, without complications. Massive secretions, described as "bean-dregs" or "egg-floccule," were detected intraoperatively, which explained the imaging findings and tube blockage. All patients recovered well after 2-3 courses of postoperative praziquantel treatment. Viscous secretions in paragonimiasis patients warrant great concern. Irregular hyperdense signals in effusions are important characteristics in CT scans and ultrasonography. Treatments such as thoracic closed drainage may fail due to viscous secretions blocking the tube; therefore, surgeries should be considered. In-depth multidisciplinary research may help determine the optimal treatment strategy and reveal the origin of these secretions.
Identifiants
pubmed: 36826718
doi: 10.1007/s10096-023-04567-z
pii: 10.1007/s10096-023-04567-z
doi:
Substances chimiques
Praziquantel
6490C9U457
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
493-501Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Yoshida A, Doanh PN, Maruyama H (2019) Paragonimus and paragonimiasis in Asia: an update. Acta Trop 199:105074. https://doi.org/10.1016/j.actatropica.2019.105074
doi: 10.1016/j.actatropica.2019.105074
pubmed: 31295431
Blair D (2019) Paragonimiasis. Adv Exp Med Biol 1154:105–138. https://doi.org/10.1007/978-3-030-18616-6_5
doi: 10.1007/978-3-030-18616-6_5
pubmed: 31297761
Shibahara T (1991) The route of infection of Paragonimus westermani (diploid type) cercariae in the freshwater crab, Geothelphusa dehaani. J Helminthol 65:38–42. https://doi.org/10.1017/s0022149x00010415
doi: 10.1017/s0022149x00010415
Kirk MD, Pires SM, Black RE, Caipo M, Crump JA, Devleesschauwer B et al (2015) World Health Organization estimates of the global and regional disease burden of 22 foodborne bacterial, protozoal, and viral diseases, 2010: a data synthesis. PLoS Med 12:e1001940. https://doi.org/10.1371/journal.pmed.1001940
doi: 10.1371/journal.pmed.1001940
pubmed: 26701262
pmcid: 4689409
Liu Q, Wei F, Liu W, Yang S, Zhang X (2008) Paragonimiasis: an important food-borne zoonosis in China. Trends Parasitol 24:318–323. https://doi.org/10.1016/j.pt.2008.03.014
doi: 10.1016/j.pt.2008.03.014
pubmed: 18514575
Qian M, Li F, Zhang Y, Qiao Z, Shi Y, Shen J (2021) A retrospective clinical analysis of pediatric paragonimiasis in a Chinese children’s hospital from 2011 to 2019. Sci Rep 11:12450. https://doi.org/10.1038/s41598-021-90897-x
doi: 10.1038/s41598-021-90897-x
pubmed: 34103553
pmcid: 8187660
Zhou XN (2018) Report on the national survey of important human parasitic disease in China (2015). People’s Medical Publishing House, Beiging
Zhang XL, Wang Y, Wang GX, Chen WB, He X, Niu H et al (2012) Distribution and clinical features of Paragonimiasis skrjabini in Three Gorges Reservoir Region. Parasitol Int 61:645–649. https://doi.org/10.1016/j.parint.2012.06.007
doi: 10.1016/j.parint.2012.06.007
pubmed: 22814214
Gong Z, Miao R, Shu M, Zhu Y, Wen Y, Guo Q et al (2017) Paragonimiasis in children in Southwest China: a retrospective case reports review from 2005 to 2016. Medicine (Baltimore) 96:e7265. https://doi.org/10.1097/MD.0000000000007265
doi: 10.1097/MD.0000000000007265
pubmed: 28640131
Peng X, Zhang J, Zhang J, Wang Y, Zhang X (2018) Incidence of paragonimiasis in Chongqing China: a 6-year retrospective case review. Parasitology 145:792–796. https://doi.org/10.1017/S003118201700172X
doi: 10.1017/S003118201700172X
pubmed: 29113601
Aboudara M, Maldonado F (2019) Update in the management of pleural effusions. Med Clin North Am 103:475–485. https://doi.org/10.1016/j.mcna.2018.12.007
doi: 10.1016/j.mcna.2018.12.007
pubmed: 30955515
Yeung C, Dawson J, Gilbert S (2019) Uniportal video-assisted thoracoscopy approach to the management of non-pulmonary diseases of the chest. J Thorac Dis 11(Suppl 16):S2062–S2068. https://doi.org/10.21037/jtd.2019.03.21
doi: 10.21037/jtd.2019.03.21
pubmed: 31637039
pmcid: 6783711
Xie Y, Luo YR, Chen M, Xie YM, Sun CY, Chen Q (2021) Pleural lump after paragonimiasis treated by thoracoscopy: a case report. World J Clin Cases 9:666–671. https://doi.org/10.12998/wjcc.v9.i3.666
doi: 10.12998/wjcc.v9.i3.666
pubmed: 33553406
pmcid: 7829717
Wu Y, Zhou Y, Jin X, Li Y, Li H, Dai J et al (2019) Diagnosis and surgical management of pericardial effusion due to paragonimiasis. Int J Infect Dis 83:102–108. https://doi.org/10.1016/j.ijid.2019.03.032
doi: 10.1016/j.ijid.2019.03.032
pubmed: 30930185
Nagayasu E, Yoshida A, Hombu A, Horii Y, Maruyama H (2015) Paragonimiasis in Japan: a twelve-year retrospective case review (2001–2012). Intern Med 54:179–186. https://doi.org/10.2169/internalmedicine.54.1733
doi: 10.2169/internalmedicine.54.1733
pubmed: 25743009
Das M, Doleckova K, Shenoy R, Mahanta J, Narain K, Devi K et al (2016) Paragonimiasis in tuberculosis patients in Nagaland, India. Glob Health Action 9:32387. https://doi.org/10.3402/gha.v9.32387
doi: 10.3402/gha.v9.32387
pubmed: 27667815
Choi WH, Chu JP, Jiang M, Lee YS, Kim BS, Kim DG, Park YK (2010) Analysis of parasitic diseases diagnosed by tissue biopsy specimens at KyungHee Medical Center (1984–2005) in Seoul, Korea. Korean J Parasitol 48:85–88. https://doi.org/10.3347/kjp.2010.48.1.85
doi: 10.3347/kjp.2010.48.1.85
pubmed: 20333293
pmcid: 2843854
Feng Y, Fürst T, Liu L, Yang GJ (2018) Estimation of disability weight for paragonimiasis: a systematic analysis. Infect Dis Poverty 7:110. https://doi.org/10.1186/s40249-018-0485-5
doi: 10.1186/s40249-018-0485-5
pubmed: 30342548
pmcid: 6196032
Doanh PN, Dung DT, Thach DT, Horii Y, Shinohara A, Nawa Y (2011) Human paragonimiasis in Viet Nam: epidemiological survey and identification of the responsible species by DNA sequencing of eggs in patients’ sputum. Parasitol Int 60:534–537. https://doi.org/10.1016/j.parint.2011.09.001
doi: 10.1016/j.parint.2011.09.001
pubmed: 21946337
Appleton CC (2014) Paragonimiasis in KwaZulu-Natal Province, South Africa. J Helminthol 88:123–128. https://doi.org/10.1017/S0022149X12000831
doi: 10.1017/S0022149X12000831
pubmed: 23253517
Tay NS, Ong KC, Tan SY, Kaw GJ (2005) Tuberculosis mimicry. Eur Respir J 26:554–556. https://doi.org/10.1183/09031936.05.00003505
doi: 10.1183/09031936.05.00003505
pubmed: 16135739
Jeon K, Koh WJ, Kim H, Kwon OJ, Kim TS, Han LKS, J (2005) Clinical features of recently diagnosed pulmonary paragonimiasis in Korea. Chest 128:1423–1430. https://doi.org/10.1378/chest.128.3.1423
doi: 10.1378/chest.128.3.1423
pubmed: 16162738
Fiorentini LF, Bergo P, Meirelles GSP, Capobianco J, Mohammed TL, Verma N et al (2020) Pictorial review of thoracic parasitic diseases: a radiologic guide. Chest 157:1100–1113. https://doi.org/10.1016/j.chest.2019.12.025
doi: 10.1016/j.chest.2019.12.025
pubmed: 31978430
Kim TS, Han J, Shim SS, Jeon K, Koh WJ, Lee I et al (2005) Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR Am J Roentgenol 185:616–621. https://doi.org/10.2214/ajr.185.3.01850616
doi: 10.2214/ajr.185.3.01850616
pubmed: 16120908
Oh IJ, Kim YI, Chi SY, Ban HJ, Kwon YS, Kim KS et al (2011) Can pleuropulmonary paragonimiasis be cured by only the 1st set of chemotherapy? Treatment outcome and clinical features of recently developed pleuropulmonary paragonimiasis. Intern Med 50:1365–1370. https://doi.org/10.2169/internalmedicine.50.5093
doi: 10.2169/internalmedicine.50.5093
pubmed: 21720054
Olden AM, Holloway R (2010) Treatment of malignant pleural effusion: PleuRx catheter or talc pleurodesis? A cost-effectiveness analysis. J Palliat Med 13:59–65. https://doi.org/10.1089/jpm.2009.0220
doi: 10.1089/jpm.2009.0220
pubmed: 19839739
pmcid: 2939851
Qaqish TR, Cox S, Carr R, Katlic M (2020) Treatment of pleural effusions with nonintubated video-assisted thoracoscopic surgery. Thorac Surg Clin 30:25–32. https://doi.org/10.1016/j.thorsurg.2019.08.003
doi: 10.1016/j.thorsurg.2019.08.003
pubmed: 31761281
Yang W, Zhang B, Zhang ZM (2017) Infectious pleural effusion status and treatment progress. J Thorac Dis 9:4690–4699. https://doi.org/10.21037/jtd.2017.10.96
doi: 10.21037/jtd.2017.10.96
pubmed: 29268539
pmcid: 5720994
Caffrey CR, Goupil L, Rebello KM, Dalton JP, Smith D (2018) Cysteine proteases as digestive enzymes in parasitic helminths. PLoS Negl Trop Dis 12:e0005840. https://doi.org/10.1371/journal.pntd.0005840
doi: 10.1371/journal.pntd.0005840
pubmed: 30138310
pmcid: 6107103
Chung YB, Kita H, Shin MH (2008) A 27 kDa cysteine protease secreted by newly excysted Paragonimus westermani metacercariae induces superoxide anion production and degranulation of human eosinophils. Korean J Parasitol 46:95–99. https://doi.org/10.3347/kjp.2008.46.2.95
doi: 10.3347/kjp.2008.46.2.95
pubmed: 18552546
pmcid: 2532610
Temkin V, Kantor B, Weg V, Hartman ML, Levi-Schaffer F (2002) Tryptase activates the mitogen-activated protein kinase/activator protein-1 pathway in human peripheral blood eosinophils, causing cytokine production and release. J Immunol 169:2662–2669. https://doi.org/10.4049/jimmunol.169.5.2662
doi: 10.4049/jimmunol.169.5.2662
pubmed: 12193739
Liu H, Lazarus SC, Caughey GH, Fahy JV (1999) Neutrophil elastase and elastase-rich cystic fibrosis sputum degranulate human eosinophils in vitro. Am J Physiol 276:L28–L34. https://doi.org/10.1152/ajplung.1999.276.1.L28
doi: 10.1152/ajplung.1999.276.1.L28
pubmed: 9887052
Devi KR, Narain K, Mahanta J, Nirmolia T, Blair D, Saikia SP, Agatsuma T (2013) Presence of three distinct genotypes within the Paragonimus westermani complex in northeastern India. Parasitology 140:76–86. https://doi.org/10.1017/S0031182012001229
doi: 10.1017/S0031182012001229
Wu B, Wu Y (2019) Large pericardial effusion due to paragonimiasis in a 4-year-old Chinese boy. Open Forum Infect Dis 6:ofz145. https://doi.org/10.1093/ofid/ofz145
doi: 10.1093/ofid/ofz145
pubmed: 31041346
pmcid: 6483802
Zhang X, Peng L, Liu W, Fan L, Zhang Q, Chen G et al (2014) Response of primary vectors and related diseases to impoundment by the Three Gorges Dam. Trop Med Int Health 19:440–449. https://doi.org/10.1111/tmi.12272
doi: 10.1111/tmi.12272
pubmed: 24684420