Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Pulmonary Paragonimiasis with Recurrent Pleural Effusion and Cured by Four Cycles of Chemotherapy

세 차례 재발하여 4회 약물 요법으로 치료한 폐흡충증 1예

  • Cho, Gye Jung (Department of Internal Medicine, Yeoung Gwang General Hospital) ;
  • Lim, Jung Hwan (Department of Internal Medicine, Stcarollo Hospital) ;
  • Chae, Dong Ryeol (Department of Internal Medicine, Stcarollo Hospital) ;
  • Chi, Su Young (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School) ;
  • Ban, Hee Jung (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School) ;
  • Yoon, Byeong Kab (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School) ;
  • Kwon, Yong Soo (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School) ;
  • Oh, In Jae (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School) ;
  • Kim, Kyu Sik (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School) ;
  • Kim, Yu Il (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School) ;
  • Lim, Sung Chul (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School) ;
  • Kim, Young Chul (Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chonnam National University Medical School)
  • 조계중 (영광종합병원 내과) ;
  • 임정환 (순천성가롤로병원 내과) ;
  • 채동렬 (순천성가롤로병원 내과) ;
  • 지수영 (전남대학교 의과대학 내과학교실) ;
  • 반희정 (전남대학교 의과대학 내과학교실) ;
  • 윤병갑 (전남대학교 의과대학 내과학교실) ;
  • 권용수 (전남대학교 의과대학 내과학교실) ;
  • 오인재 (전남대학교 의과대학 내과학교실) ;
  • 김규식 (전남대학교 의과대학 내과학교실) ;
  • 김유일 (전남대학교 의과대학 내과학교실) ;
  • 임성철 (전남대학교 의과대학 내과학교실) ;
  • 김영철 (전남대학교 의과대학 내과학교실)
  • Received : 2009.05.10
  • Accepted : 2009.05.25
  • Published : 2009.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Paragonimiasis is a parasitic infection that occurs following the ingestion of infectious Paragonimus metacercariae, which occurs as a result of eating raw or undercooked freshwater crabs or crayfish. Pulmonary paragonimiasis is the most common clinical manifestation of this infection. Human paragonimiasis occurs sporadically. We experienced a case of pulmonary paragonimiasis in a 35-year-old woman with left lower chest pain. The patient had hypereosinophilia and a pleural effusion. The diagnosis was confirmed by positive ELISA (Enzyme-linked immunosorbent assay) that detected Paragonimiasis westermani antibody in the serum. We treated the patient with praziquantel for two days at a daily dosage of 75 mg/kg. Left pleuritic pain and pleural effusion improved after treatment. However, similar symptoms and pleural effusion developed recurrently for the first 3 courses of treatment with praziquantel. Upon the fourth round of treatment, the patient made a full recovery.

폐흡충증은 예전에 비해서 발생 빈도가 감소 하였으나, 현재도 산발적으로 발생하고 있다. 폐흡충증은 민물 게나 민물 가재 등의 섭취력이 있고, 혈액검사상 호산구 증가증이 있는 경우 의심을 해보아야 한다. 객담이나 대변 검사상 충란을 발견할 경우 폐흡충증을 진단할 수 있으나 실제로 발견되는 경우는 40% 미만이므로 폐흡충증이 의심된다면 방사선학적 및 혈청학적 방법에 의해 폐흡충증을 확인하는 것이 필요하다. 치료로는 praziquantel 25 mg/kg 씩 1일 3회, 이틀간 투여하는 1회 치료 과정으로 비교적 좋은 예후를 보인다. 그러나 본 증례처럼 1회 치료로 불충분하여 재발하는 경우가 있으므로 치료 후에도 정기적인 추적 관찰이 필요하겠다. 또한 재발 및 재치료율을 낮추기 위한 연구와 재발 환자의 치료 기간 정립이 필요할 것으로 생각된다. 저자들은 좌측 흉수를 주소로 내원하여 폐흡충에 의한 흉수로 진단 받은 35세 환자에서 praziquantel 25 mg/kg씩 1일 3회, 2일간 투여하여 호전 보였으나, 이후에 3차례나 재발하여 총 4차례 치료 과정을 반복하여 호전된 증례를 경험하였기에 문헌과 함께 보고하는 바이다.

Keywords

References

  1. Kagawa FT. Pulmonary paragonimiasis. Semin Respir Infect 1997;12:149-58
  2. Im JG, Whang HY, Kim WS, Han MC, Shim YS, Cho SY. Pleuropulmonary paragonimiasis: radiologic findings in 71 patients. AJR Am J Roentgenol 1992;159: 39-43 https://doi.org/10.2214/ajr.159.1.1609718
  3. Mukae H, Taniguchi H, Matsumoto N, Iiboshi H, Ashitani J, Matsukura S, et al. Clinicoradiologic features of pleuropulmonary Paragonimus westermani on Kyusyu Island, Japan. Chest 2001;120:514-20 https://doi.org/10.1378/chest.120.2.514
  4. Sumitani M, Mikawa T, Miki Y, Nisida K, Tochino Y, Kamimori T, et al. A case of chronic pleuritis by Paragonimus Westermani infection resistant to standard chemotherapy and cured by three additional cycles of chemotherapy. Nihon Kokyuki Gakkai Zasshi 2005;43: 427-31
  5. Choi DW. Paragonimus and paragonimiasis in Korea. Korean J Parasitol 1990;28:79-102
  6. Lee CT, Yeon TC, Woo JH, Nam SH, Shim YS, Kim KY. Familial infestation of Paragonimus Westermani diagnosed by ELISA: report of two families. Tuberc Respir Dis 1985;32:124-8
  7. Cho SY, Kong Y, Kang SY. Epidemiology of paragonimiasis in Korea. Southeast Asian J Trop Med Public Health 1997;28 Suppl 1:32-6
  8. Nakamura-Uchiyama F, Mukae H, Nawa Y. Paragonimiasis: a Japanese perspective. Clin Chest Med 2002;23: 409-20 https://doi.org/10.1016/S0272-5231(01)00006-5
  9. Jeon K, Koh WJ, Kim H, Kwon OJ, Kim TS, Lee KS, et al. Clinical features of recently diagnosed pulmonary paragonimiasis in Korea. Chest 2005;128:1423-30 https://doi.org/10.1378/chest.128.3.1423
  10. Cho SY, Hong ST, Rho YH, Choi SY, Han YC. Application of micro-ELISA in serodiagnosis of human paragonimiasis. Korean J Parasitol 1981;19:151-6 https://doi.org/10.3347/kjp.1981.19.2.151
  11. Cho SY, Kim SI. Detection of Paragonimus-specific IgG antibody in CSF and pleural effusion by micro-ELISA. Korean J Parasitol 1983;21:286-8 https://doi.org/10.3347/kjp.1983.21.2.286
  12. Johnson RJ, Jong EC, Dunning SB, Carberry WL, Minshew BH. Paragonimiasis: diagnosis and the use of pra ziquantel in treatment. Rev Infect Dis 1985;7:200-6 https://doi.org/10.1093/clinids/7.2.200
  13. Udonsi JK. Clinical field trials of praziquantel in pulmonary paragonimiasis due to Paragonimus uterobilateralis in endemic populations of the Igwun Basin, Nigeria. Trop Med Parasitol 1989;40:65-8
  14. Vidamaly S, Choumlivong K, Keolouangkhot V, Vannavong N, Kanpittaya J, Strobel M. Paragonimiasis: a common cause of persistent pleural effusion in Lao PDR. Trans R Soc Trop Med Hyg. Forthcoming 2009
  15. Rim HJ, Chang YS, Lee JS, Joo KH, Suh WH, Tsuji M. Clinical evaluation of praziquantel (Embay 8440; Biltricide) in the treatment of Paragonimus westermani. Korean J Parasitol 1981;19:27-37 https://doi.org/10.3347/kjp.1981.19.1.27