Studies on Paragonimus and paragonimiasis in the Philippines. II. Prevalence of pulmonary paragonimiasis in wild rats Rattus norvegicus in Jaro, Leyte, Philippines.
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Serum IgE concentrations of patients with paragonimiasis were determined by a radioimmunosorbent test. The mean concentration was 3,462.3 IU/ml in a group of 13 cases of paragonimiasis miyazakii in which patients showed clinical symptoms and/or positive immunological diagnostic tests, and 1,026.6 IU/ml in a control group of 13 individuals who had eaten uncooked freshwater crabs, Potamon dehaani, but had been found to be free from the infection. Moreover, the IgE level of the pleural exudates obtained from four patients with paragonimiasis miyazakii on the day of bleeding or within several days after was significantly higher than that of their sera, ranging between 4,200 IU/ml and 10,000 IU/ml. This was true also in a case of paragonimiasis westermani. Sera and pleural exudates of patients with both forms of paragonimiasis were applied to immunosorbent columns of Sepharose 4B beads coupled with saline extracts of Paragonimus miyazakii, P. weetermani, or P. ohirai. IgE eluted from the corresponding column was considered to be specific, being around 5% to 10% of the total IgE.
The first case of cerebral paragonimiasis was reported by Otani in Japan in 1887. This was nine years after Kerbert's discovery of the fluke in the lungs of Bengal tigers and seven years after a human pulmonary infection by the fluke was demonstrated by Baelz and Manson. The first case was a 26-year-old man who had been suffering from cough and hemosputum for one year. The patient developed convulsive seizures with subsequent coma and died. The postmortem examination showed cystic lesions in the right frontal and occipital lobes. An adult fluke was found in the occipital lesion and another was seen in a gross specimen of normal brain tissue around the affected occipital lobe. Two years after Otani's discovery, at autopsy a 29-year-old man with a history of Jacksonian seizure was reported as having cerebral paragonimiasis. Some time later, however, it was confirmed that the case was actually cerebral schistosomiasis japonica. Subsequently, cases of cerebral paragonimiasis were reported. However, the majority of these cases were not confirmed histologically. It was pointed out that some of these early cases were probably not Paragonimus infection. After World War II, reviews as well as case reports were published. Recently, investigations have been reported from Korea, with a clinicla study on 62 cases of cerebral paragonimiasis seen at the Neurology Department of the National Medical Center, Seoul, between 1958 and 1964. In 1971 Higashi described a statistical study on 105 cases of cerebral paragonimiasis that had been treated surgically in Japan.
Paragonimiasis is a benign parasitic disease caused by Paragonimus westermani and endemic in Japan, mostly in south-western area. Although the lung is the primary site of infection, ectopic involvement of the brain is not uncommon. Over 300 cases of cerebral paragonimiasis have been reported since the first case of this disease described by Ohtani in Japan in 1887. The patient with paragonimiasis in the lung and the brain were though to be decreasing because of the introduction of Bithionol treatment (Yokogawa in 1961) and public health instruction. However, about 20 cases of cerebral paragonimiasis have been reported for 10 years past in Kyushu.
96% of the P. uterobilateralis patients and 86.5% of the P. africanus patients showed a positive reaction with the homologous antigen in the passive haemagglutination test (PA). Common antigens of the two species were demonstrated by cross reactions. About 75% of the Paragonimus sera reacted also with the heterologous antigen with titres greater than or equal to 1:160. The PA test can be useful in the evaluation of the efficacy of treatment and is well suited for seroepidemiologic purposes. The complement fixation (CF) test was not suitable for serodiagnostic or seroepidemiologic studies nor for the assessment of the cure of African Paragonimiasis since antibodies persisted for at least one year after treatment. Comparative studies on levels of IgA, IgE, IgG and IgM seems to be of no diagnostic value in African paragonimiasis because no significant correlation between immunoglobulin concentration and paragonimiasis could be recognized. Very high IgE levels--up to 100 times higher than in Europeans--were found in nearly all sera. Shipment of filter papers blood specimens collected from P. africanus patient resulted in a significant decrease of antibody reactivity in all sera, the loss being about 30% in the parasitologically proven patients.
A research programme on African paragonimiasis was carried out in eastern Nigeria, which included the epidemiology, parasitology and clinical and radiological studies. The radiological pulmonary changes are described in detail and differentiated from tuberculosis.
A 2 1/2-year-old girl recently arrived from eastern Nigeria presented with a soft tissue swelling of the infraclavicular region. Subsequent investigation revealed a cavity in the left lung associated with a small pleural effusion and leucocytosis with pronounced eosinophilia. Clinical and serological findings were compatible with the diagnosis of paragonimiasis. After a course of Bitin-S the chest x-ray returned to normal, the soft tissue changes disappeared, and the eosinophil count fell.
Menichlopholan, biphenyl compound, in a single dose of 2 mg/kg body weight, gave a 73%-90% cure rate in the treatment of pulmonary infections due to Paragonimus uterobilateralis at two centers in Nigeria. Ninety-five patients were followed up for 4 months, and 58 for 1 year. Side effects of the drug included sweating and body pains, but there was no significnat biochemical or hematological evidence of damage to the internal organs. The advantages of single dose therapy are likely to make menichlopholan the treatment of choice for paragonimiasis in Africa, and probably elsewhere.
The clinical and epidemiological features of pulmonary paragonimiasis are first described. Then, a brief and localized survey is reported in which 19 cases were detected. The disease has probably a higher prevalence than generally estimated. Eating raw or insufficiently cooked crab meat is the main cause of infection. Treatment is easy and so should be the prophylaxis.
During 1972 and 1976 316 cases of human paragonimiasis were stated in the following provinces of Ecuador: 19 cases in El Oro, 16 cases in Los Rios, 74 cases in Pichincha, and 206 cases in Manabi. 153 patients were males and 163 females. For localization of the probable origin of the infections the data of 192 patients could be utilized. The home villages and towns of these persons have been marked on a map. The majority of the patients were between 10 and 29 years of age. The youngest case was 4 years, the oldest 75 years old.
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