• Archives of Plastic Surgery
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• v.37 no.4
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• pp.485-488
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• 2010

Purpose: Paragonimiasis is infectious disease occurred by Paragonimus Westermani, which invades into human body as a final host. Habitual eating the freshwater crab or crawfish unboiled is one of the reason of infection. Paragonimiasis raged in 1970s in Korea, Japan, China and other Asian countries but the incidence decreased rapidly. Once people eat infected second host, parasite penetrates the duodenal wall and migrates to the lung. During this migration period, the parasite can migrate to other organ, such as brain, spinal cord, liver and subcutaneous tissue, but the cases are rarely reported. The objective of our study is to present our experience of the ectopic migration of parasite to the subcutaneous tissue of the abdomen, which was easily treated with excision and Praziquantel medication. Methods: A 59-year-old woman who likes eating unboiled freshwater crab was diagnosed as Paragonimiasis 15 months ago. Her symptoms were fever and cough, and she was treated with Praziquantel medication. 3 months after discharge, she visited our hospital with left pleuritic chest pain, cough with fever, and palpable mass formation on left lower quadrant of the abdomen. Wedge resection of the left lung and Praziquantel medication was maintained for a week. Nevertheless, fever persisted after the treatment. The patient received total excision of the abdominal soft tissue mass, and the fever was relieved. Results: Pathologic findings of the mass showed multiple cyst and abscess formation with crystal structure which is suspicious parts of the parasite or calcified egg shells. Uncontrolled fever was relieved after the operation, and there was no evidence of recurrent Paragonimiasis and ectopic migration for 1 year follow up period. Conclusion: Ectopic migration of Paragonimus is rare, but multiple organ can be involved. Patient with Paragominiasis who was refractory in fever control after Praziquantel medication or surgical evaluation of the lung should be considered as ectopic migration of the Paragonimiasis.

• Parasites, Hosts and Diseases
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• v.55 no.3
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• pp.313-317
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• 2017

Paragonimiasis is a parasitic disease caused by Paragnonimus species. The primary site of infection is the lung, and extrapulmonary involvement is also reported. When infected with Paragonimus westermani, which is the dominant species in Korea, the central nervous system is frequently involved along with the liver, intestine, peritoneal cavity, retroperitoneum, and abdominal wall. Ectopic paragonimiasis raises diagnostic challenge since it is uncommon and may be confused with malignancy or other inflammatory diseases. Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain. The patient developed abdominal pain 3 times for the previous 3 years and the computed tomography (CT) of the abdomen revealed fluid collection with wall enhancement. Recurrent diverticulitis was initially suspected and part of the ascending colon was resected. However, the specimen showed intact colon wall without evidence of diverticulitis and multiple parasite eggs and granulomas were found instead. The size of about $70{\mu}m$, the presence of an operculum and relatively thick egg shell suggested eggs of Paragonimus species. With appropriate exposure history and a positive antibody test, the definitive diagnosis was made as peritoneal paragonimiasis.

• Parasites, Hosts and Diseases
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• v.50 no.4
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• pp.349-352
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• 2012

A 94-year-old female with end-stage renal disease presents with fever, fatigue, and hematochezia. She had previously resided in Hunan Province, China, and Myanmar, and she immigrated to Taiwan 30 years ago. Colonoscopy revealed a colonic ulcer. Biopsy of the colonic ulcer showed ulceration of the colonic mucosa, and many Paragonimus westermani-like eggs were noted. Serum IgG antibody levels showed strong reactivity with P. westermani excretory-secretory antigens by ELISA. Intestinal paragonimiasis was thus diagnosed according to the morphology of the eggs and serologic finding. After treatment with praziquantel, hematochezia resolved. The present case illustrates the extreme manifestations encountered in severe intestinal paragonimiasis.

• Parasites, Hosts and Diseases
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• v.31 no.3
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• pp.295-297
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• 1993

Pcrosonimr westermani is a lung fluke of humans that Is usually found in the lunes but may be fecund elsewhere in many unusual locations. A case of pelvic paragonimiasis was found incidentally by surgical intervention of inamatov disease and myoma uteri. She was a 51-year-old Korean woman complaining of lower abdominal pain and intermittent vaginal spotting. Numerous Porosonimus ova were observed in the reseated omentum in the pelvis after total abdominal hysterectomy. It is suggested that pelvic paragonimiasis may be one of causative agents of pelvic inflammatory disease.

• Parasites, Hosts and Diseases
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• v.32 no.2
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• pp.93-100
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• 1994

In order to know the species and frequency of human parasitic infection diagnosed by biopsy, 149 cases (0.18%) of parasitic infection were reviewed, which were selected from 80,947 biopsied materials submitted for routine histopathological examination during a period of 10 years from 1980 to 1989 at Department of Pathology, Chonnam National University Hospital. They consisted of 112 cases of cysticercosis, 17 paragonimiasis, 7 clonorchiasis, 4 amebiasis, 1 sparganosis, 1 enterobiasis, 1 anisakiasis, and 1 fascioliasis respectively Based on morphological preservation of cysticercus, they could be divided into mild (20.2%), moderate (40.4%), and severe (39.4%) degeneration. Except 2 cases biopsied at the lungs, 15 cases of ectopic paragonimiasis were located at abdominal cavity (8 cases) and central nervous system (7 cases). One case of intrahepatic fascioliasis was observed. This is the 13th human fasciollasis reported in Korea. From the above results, the frequency of parasitic infections found in biopsied specimens was on the decrease as the year passed by, but biopsy is very useful diagnostic method on tissue parasites such as cystlcercosis and ectopic paragonimiasis.

• Parasites, Hosts and Diseases
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• v.29 no.4
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• pp.407-410
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• 1991

A 35-year-old housewife living in Seoul complained of a recurrent palpable abdominal mass. Excisional biopsy was done. The cystic mass showed an immature worm of Paragonimus sp. in the cyst cavity. It measured $7{\times }4{\;}mm$ and showed well-developed oral and ventral sucker, uterus, 5-branched ovary and intestine after acetocarmine staining. But the testes and vitelline duct were not developed fully and there was no egg in the uterus. The patient has eaten raw fish. The case of ectopic paragonimiasis in the abdominal subcutaneous tissue was presented.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.760-765
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• 2008

Paragonimiasis is a parasitic infection that occurs following the ingestion of infectious Paragonimus metacercariae from crabs or crayfish. Pulmonary paragonimiasis is the most common clinical manifestation of this infection, but several ectopic paragonimiasis cases have also been reported. Among them, cases of subcutaneous paragonimiasis are rare, especially in children. We report a case of subcutaneous paragonimiasis of the right abdominal wall with pleural effusion with hepatic involvement and without abnormal pulmonary infiltration in a boy aged 2 years and 5 months. He had eaten soybean sauce-soaked freshwater crabs (kejang) 6 months prior to complaining of right abdominal wall distension. On evaluation, right pleural effusion without abnormal pulmonary infiltration was detected, as well as blood eosinophilia, an elevated serum IgE level, pleural fluid eosinophilia and a positive enzyme-linked immunosorbent assay that detected P. westermani antibody in the serum. Thoracentesis, praziquantel administration, and excision of subcutaneous lesions were performed. After treatment, the eosinophil count and serum IgE level were decreased, and the subcutaneous lesions did not recur. The frequency of paragonimiasis has decreased recently, but it is still prevalent in Korea. Paragonimiasis should be suspected if pleural fluid eosinophilia is associated with blood hypereosinophilia and a high level of serum IgE; however clinicians should obtain a thorough history of travel and food habits.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.553-556
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• 2010

A 55-year-old female presented to Pusan National University Yangsan Hospital with left neck and shoulder pain. An anterior mediastinal mass was detected on chest CT and there were no other specific lesions in the lung or pleural cavity. An infected pericardial cysts was suspected and excision was performed through a left-sided VATS approach. The patient was discharged on the second post-operative day with left diaphragm palsy and praziquantel was prescribed after paragonimaisis was confirmed on pathology. The patient has not shown any particular problems at my outpatient clinic.

• Parasites, Hosts and Diseases
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• v.21 no.2
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• pp.246-256
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• 1983

As epidemiological parameters of human paragonimiasis, the positive rates of intradermal test and the sputum/stool ekaminations have long been employed in population surveys. However, both the specificity of the intradermal test and the sensitivity of sputumjstool examination have been gradually declined as the endemicity was lowered; thus the gap between above two parameters widened. In such context, the development of a new epidemiologic parameter or tool which makes it possible to accurately discriminate the active paragonimiasis cases was necessary. In the present study, the detection rate of Paragonimus-speclac IgG antibody by micro-ELISA was evaluated as an indicator of epidemiologic status of human paragonimiasis in a population. A total of 4, 285 students and inhabitants living in Bukpyeong Myeon and Bukil Myeon, Haenam Gun, Jeonlanam Do was surveyed in October, 1983 by intradermal test first. Out of them, 244 cases (5.7%) were found positively reacted to VBS antigen of F. westermani. Out of 168 positive reactors, 7 cases (4.2%) were egg positive either by two times of sputum examination or by one stool examination. That indicated that only 0. 16% of total surveyed were confirmed as active paragonimiasis by egg detection. When sera collected from 239 positive reactors of Intradermal test were tested by micro-ELISA for their specific IgG antibody, 40 cases(16.7%) were found to be positive. All of 7 egg positive cases were again positive for specific IgG antibody. Among remaining 232 intradermal test positive cases, 33 cases were positive for IgG antibody. In contrast to those, none of 42 positive reactors to intradermal test for Cloncrchis and of 128 intradermal test negative cases showed positive for Paragcnimus-specIfic IgG antibody. The rate of specific IgG antibody as detected by micro-ELISA appeared to be increased with the wheal size of the intradermal test. When the wheal sixte was over 13mm in diameter, about 50% of them were positive for specific IgG antibody. Thirty-one specific antibody positive cases were clinically evaluated by laboratory examinations (repeated sputum examination, peripheral eosinophil count and chest roentgenogram) and by history taking. Out of them 24 cases were associated with one or more positive laboratory findings: thus considered as active paragonimiasis cases. Out of 7 lab. finding-free cases 3 revealed past history of typical paragonimiasis symptoms, suggesting that they were in chronic or in convalescent stages. The remaining 4 cases were considered as either mild or ectopic infection cases; the possibility of cross-reaction with other helminthiases could not be ruled out. From the above results, it was inferred that the detection of Paragonimus-specIfic IgG antibody by micro-ELISA was very much helpful in detecting the active cases as well as in proper evaluation of the endemicity of human paragonimiasis in a population. The convenience of mass haildling of sera in micro-ELISA was considered another superiority as an epidemiologic tool.

• Tuberculosis and Respiratory Diseases
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• v.56 no.5
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• pp.550-554
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• 2004

A paragonimiasis infestation is caused by the paragonimus species. It is commonly found in the lung but has also been found to exist extrapulmonary infestations including cerebral, spinal, subcutaneous, hepatic, splenic, abdominal, urinary, and gynecologic infestation. On the other hand, a cutaneous infestation is extremely rare. Human infestation is caused by ingesting raw or undercooked intermediate hosts. Because paragonimus westermani larva mature to an adult worm in the lung, the possibility of identifying the adult worm of paragonimus westermani at extrapulmonary region is very rare. Case : After ingesting a fresh-water crab 1 month prior to the hospital visit, a 45-year old female patient was suffering from right pleuritic chest pain during that 1 month. The patient also complained of a palpable mass that was movable and migrating, and it was localized at the right upper quadrant of the abdomen. The eosinophil fraction of the white blood cell of peripheral blood and pleural fluid was elevated to 55.1% and 90%, respectively. Parasite eggs were not found in her sputum and stool examination. By using the enzyme-linked immunosorbent assay (ELISA), the paragonimus-specific IgG antibody titer was elevated to 0.28. During incisional biopsy, we were able to find the young adult worm of paragonimus westermani. We experienced the rare case of ectopic paragonimiasis with pleural effusion that was confirmed by identifying the adult worm of paragonimus westermani within the abdominal subcutaneous tissue. We report a case with brief literature reviews.