Paragonimiasis

Paragonimiasis Bloody diarrhea

Last Updated December 20th, 2021

Overview

Care should always be taken to cook meat properly before consumption since it could be contaminated with disease-causing parasites. Processes such as sun-drying, smoke curing, pickling, salting, and marination do not achieve the same sterilizing effect as heat cooking methods. One should also avoid consuming partially cooked meats. The lung fluke is a parasite that infects freshwater crustaceans such as crabs and crayfish. When humans consume the undercooked or raw meat of such infected crustaceans, they may develop a potentially life-threatening infectious disease affecting the lungs and even the brain in extreme cases. The incidence of this disease, known as paragonimiasis, is particularly high in East Asia. It is also prevalent in countries such as Nigeria and Peru.

 

What Is Paragonimiasis?

Paragonimiasis Bloody diarrheaParagonimiasis is a food-borne infectious disease in humans that is caused by a parasitic organism known as the lung fluke (certain species of the genus Paragonimus). This organism is a kind of trematode or parasitic flatworm that goes through a complex life cycle involving multiple hosts. Its life begins in the form of eggs laid in the lungs of certain mammals. Subsequent stages of development take place within the bodies of freshwater snails, followed by crustaceans.

When humans consume the raw or undercooked meat of infected crustaceans, the parasite enters their bodies and initiates the final stages of its life cycle, ending up in the lungs and causing severe pulmonary symptoms. Sometimes the worm can affect other parts of the body. This is known as ectopic paragonimiasis. Fully mature lung flukes can live up to 20 years. Hence, the infection can persist for a considerable length of time if it is not effectively treated. Paragonimiasis is not, however, a contagious disease.

 

What Causes It?

The life cycle of the lung fluke involves seven stages of growth and maturation. In its adult form, this organism infects the lungs of carnivorous mammals that eat crustaceans. It lays eggs in the lungs and these are coughed up in sputum or swallowed and excreted along with feces. When the eggs enter freshwater bodies they hatch into free-swimming miracidia that invade aquatic snails. Here they undergo asexual reproduction, giving rise to larvae which then escape into the water where they come into contact with and infect crustaceans such as crabs and crayfish. Here, they exist in resting form (cysts containing larvae) until the contaminated crustaceans are consumed by humans.

PARAGONIMIASIS painDigestion of this meat releases parasite cysts into the small intestine. These then take the form of juvenile worms that can migrate to other parts of the body. Typically, the worms end up in the lungs. However, they can also travel to other parts of the body and give rise to what is known as ectopic paragonimiasis.

After reaching the lungs, the final stage of maturation into adulthood can take anywhere from one to three months or longer depending on the particular species. Once adult flukes are established in pairs in the lungs, they reproduce sexually and lay eggs which may be coughed out in the sputum. Sputum containing eggs may also be swallowed and passed out along with stools. Thus, humans can serve as substitutes for preferred primary hosts such as tigers, leopards, mongooses, and monkeys. Primary hosts are those in which the parasite is able to achieve sexual reproduction.

As many as 10 species of the genus Paragonimus are capable of infecting humans but only 8 of these can give rise to clinically significant symptoms of paragonimiasis. Each species is associated with a certain geographical range. Prevalent disease-causing species are:

  • Paragonimus westermani, P. heterotremus, and P. philippinensis in east, southeast and southwest Asia. The first of these is the most common cause for the disease in this region and, accordingly, it is referred to as the oriental lung fluke.
  • africanus and P. uterobilateralis in Africa.
  • kelicotti is endemic to North America.
  • mexicanus in central and South America.

Lung fluke infection can be acquired by the following means:

  • By consuming the raw or insufficiently cooked meat of freshwater crustaceans such as crabs and crayfish containing cysts of the parasite. Consumption of raw shellfish meat is connected with traditional medicinal practices in parts of Asia and Africa. Raw crustaceans also constitute part of the traditional diet in Asia and Peru.
  • Less often, the parasite is acquired by consuming pork from infected pigs and wild boar. In these animals, the fluke exists not in cyst form but as young worms.
  • Sometimes, infection is also transmitted by means of kitchen utensils or objects that come into contact with contaminated meats and juices.

 

What are the Signs and Symptoms of Paragonimiasis?

Not everybody who has lung fluke infection will necessarily experience symptoms. In fact, as many as one-fifth of all infections are asymptomatic. There are different phases in the progression of this disease. The acute phase is characterized by invasion and migration of the parasite through the intestine, into the abdominal wall or liver. Following the release of the cysts, this migration takes about 3 to 6 hours and produces symptoms such as:

A few days later, the patient will typically experience the following symptoms:

  • Fever.
  • Excessive sweating.
  • Cough.
  • Chest pain.
  • Difficulty in breathing.
  • Fatigue.

Pulmonary symptoms may take some months to manifest. Chronic pulmonary symptoms include dry cough and blood-tinged sputum.

 

Types of Paragonimiasis

paragonimiasis bloody sputumClinically, this disease can take three main forms as follows:

  • Pulmonary: Most often, symptomatic lung fluke infection is characterized by pulmonary symptoms. Apart from those listed above, the patient may also develop symptoms like anemia and lose weight in case of chronic infection.
  • Pleuropulmonary: This is characterized by involvement of the lungs as well as the protective pleural membranes surrounding the lungs and lining the chest cavity. Patients typically show signs of pleurisy and associated complications. Cardiovascular paragonimiasis is a rare complication associated with this form of the disease.
  • Extrapulmonary: When mature or immature worms or even eggs end up in other parts of the body and cause symptoms, this is known as extrapulmonary paragonimiasis. It can take multiple forms including the cerebral, abdominal, cutaneous and cardiovascular forms. Of these cerebral paragonimiases is the most common, accounting for as much as 50% of extrapulmonary cases although it is seen only in 1% of symptomatic patients. It is characterized by involvement of the brain. The parasite migrates to the central nervous system and, once there, it can cause meningitis. The patient will experience headaches, vomiting, double vision and even epileptic seizures. Other types of extrapulmonary involvement are less common. Areas affected include the eye, liver, spleen, kidney, lymph nodes, skin and even the ovaries and testes.

 

Clinical Complications

When infection is particularly severe and allowed to go untreated, it can progress into pneumonia and bronchitis. As a result of this, the patient may experience the following complications:

  • Pleural effusion: Accumulation of fluid between the pleura. This can make breathing difficult.
  • Empyema: The fluid between the pleural membranes becomes infected and thickens because of the formation of pus. This causes difficulty in breathing. Drainage of the pus helps relieve this problem.
  • Pneumothorax: Escape of air from the lungs into the space between the pleural membranes. This occurs when there is the perforation of lung tissue.
  • Lung abscess

The parasite or its eggs may cause the formation of cysts, abscesses or granulomas in various parts of the body including the intestinal wall, lymph nodes, liver, and spleen. This can lead to bloody diarrhea and abdominal pain. When the parasite invades the brain and spinal cord it can cause meningitis and severe neurological symptoms such as paraplegia and seizures. This can be fatal if it is not attended to in time.

 

Diagnosis

The symptoms of paragonimiasis tend to mimic those of more common pulmonary infections such as tuberculosis. However, when the patient does not respond to treatment intended for tuberculosis, the physician should suspect liver fluke infection.

  • Sputum, stool, urine or aspirated pleural fluid samples will be examined for the presence of ovoid, golden brown eggs.
  • Blood tests reveal signs of infection and antibodies specific to this parasite.
  • Diagnostic imaging helps to assess the condition of the lungs and other internal organs that may have been affected.
  • Tissue biopsy.

 

Treatment and prevention

Treatment 

  • Anti-parasite medications will be prescribed for those who have been diagnosed with paragonimiasis.
  • If the parasite has entered the brain, anti-seizure medications will be prescribed.
  • In case there is a swelling in the brain, a decompressive craniectomy will be performed to release the pressure.

Prevention 

  • Do not consume raw or semi-cooked shellfish and crab.
  • Do not consume any meat that may not have been cooked properly.
  • Maintain hygiene and sanitation.
  • Do not consume street food, especially when traveling to new places.
  • Maintain a safe distance from diseased animals.

 

Facts

  • There are more than 30 species of trematodes (flukes) of the paragonimus genus.
  • Out of these, 10 can cause infections in the human body.
  • The P.westermani species causes lung flu.

Facts

  • 20 million people are estimated to have been affected by this flu worldwide.
  • This flu was first noticed in Taiwan in 1879.
  • In Japan, this condition was caused due to the consumption of raw pork.

Facts

  • This condition is commonly found in East Asian regions include China, Japan, Philippines, South Korea, Taiwan, Vietnam and Thailand.

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Dos and Don'ts

Dos
  • Visit the doctor if you continue to have a cough after 3 days, to determine if you have paragonimaisis.
  • Take your medications as prescribed; this can help in speeding up your recovery process.
  • Maintain proper hygiene, ensure that you wash your hands before every meal and after you use the washroom. Cough or sneeze into a tissue and dispose it immediately.
Don'ts
  • Consume any raw shellfish from freshwater areas, they contain the parasite.
  • Go near any animal that may look sick or unwell, they may already be contaminated by the parasite and could pass it on to you.
  • Forget to visit the doctor for follow-up check-ups, to monitor your condition and the treatment progress.

 

 

 

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25-Hydroxy Vitamin D test 25-hydroxy Vitamin D test is a blood test used to measure the level of vitamin D in the…
apolipoprotein a1 test
Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
lose weight fast
12 easy and instant steps to successful weight loss Do you want to lose weight without losing your mind? Does weight loss always mean saying goodbye to…
nutritional yeast bread
Nutritional Yeast : How can a fungi culture be good for your body? Nutritional yeast: How a simple culture of fungi can transform your skin, digestion, immunity , and much more.…
Epley maneuver: Why is this the best protection from the symptoms of vertigo? Epley maneuver is an exercise that can treat the symptoms of benign paroxysmal positional vertigo (BPPV).  It was…
What to eat, what not to eat in the South Beach Diet? The South Beach Diet is one among the most popular weight loss programs that have been the talk…
Erythritol: A healthy sugar substitute or yet another marketing ploy? Erythritol is a popular choice of a healthy alternative sweetening agent in foods. But how healthy can a…
Carb Cycling: Weighing the pros vs the cons of this diet routine Completely discarding carbs from your life will do you more harm than good. Read more about carb cycling,…
Ear pain model
Easy and safe tips for ear wax removal you can do at home Cerumen impaction generally occurs when an external object like cotton swabs are used to remove the ear wax.…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
HSV-1_IGG
Herpes Simplex Virus I (HSV)-IgG Test Herpes simplex virus I(HSV)-IgG is an Immunoglobulin protein that acts as an antibody & stays in the blood…
Thyroid disorders
Thyroid Profile Thyroid profile is a panel of blood tests performed to check if an individual is suffering from any…
AUTOIMMUNE HEPATITIS liver
Hepatitis Profile A hepatitis profile or a hepatitis panel is a blood test that checks for markers of hepatitis infection…
Hepatitis A virus infected liver
Hepatitis A Virus (HAV) Total Blood test to look for IgM antibodies to know if you are infected with Hepatitis A virus (HAV),…
carrageenan seaweed
Carrageenan: How a simple seaweed extract could better your gut health & immunity Eat more ice cream to prevent cold and flu? –With carrageenan you get one simple seaweed extract that…
dance health benefits
5 unbelievable effects of dance on your overall health! You enjoy dancing, but did you know what else it does to your body? Dancing is not only…
Jack in the box fast food
Jack In the Box : The perils of surging fast food culture in the USA Jack in the Box - How a culture of fast-food can clog your arteries, weaken your heart, fatten…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
How seitan proved to be a blessing in disguise for vegans worldwide Can only meat-eaters enjoy delicious juicy steaks and burgers? With seitan, the best meat substitute available today,even vegans…
Appendix pain: Recent findings on this not-so vestigial organ The exact function of the appendix is still not clear. Some consider it as an organ that once…
Surgery or home-remedy; what is the right way to treat a burn The treatment of a burn injury depends on its severity. You can save a life by offering the…
liver cleanse detox
14 go-to foods that are best for a complete natural liver detox Liver cleanse can be achieved by just choosing or avoiding certain types of food. Liver itself is a detoxifying…
Chest X-Ray A chest x-ray is a diagnostic test that uses x-rays to visualize the structures inside your chest. It…
Strep throat pain
Anti-Streptolysin-O Test The ASO or Anti-Streptolysin-O is a blood test designed to check for the presence of streptococcus bacterial infection…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
AHBC Igm
Anti-Hepatitis B Core Antigen (AHBc) IgM Anti-hepatitis B core antigen (AHBC) IgM is an investigative procedure to detect the presence of IgM antibodies in…
ureteroscopy
Ureteroscopy Ureteroscopy is the diagnostic procedure which is used for the detection of the kidney stones in addition to…
Unbelievable health benefits of gooseberries (and a few tasty recipes) Gooseberries are antioxidant-rich tasty fruits that can be easily added in daily diet to improve overall health and…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
cancer facts
8 hard-hitting truths no one tells you about cancer Did you know that 1.5 million new cases of cancer are reported every year? Can second-hand smoking kill…