DOI QR코드

DOI QR Code

Pleural fluid characteristics of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis

  • Hwang, Ki-Eun (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Song, Hyo-Yeop (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Jung, Jae-Wan (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Oh, Su-Jin (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Yoon, Kwon-Ha (Department of Radiology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Park, Do-Sim (Department of Laboratory Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Jeong, Eun-Taik (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine) ;
  • Kim, Hak-Ryul (Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine)
  • Received : 2014.03.24
  • Accepted : 2014.07.10
  • Published : 2015.01.01

Abstract

Background/Aims: Pleuropulmonary paragonimiasis produces no specific symptoms or radiologic findings, allowing for the possibility of misdiagnosis. We evaluated the specific clinical and pleural fluid features of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis. Methods: We retrospectively analyzed the clinical and radiologic characteristics of 20 patients diagnosed with pleuropulmonary paragonimiasis between 2001 and 2011. Results: In total, 17 patients presented with respiratory symptoms, including dyspnea (30%), hemoptysis (20%), cough (20%), and pleuritic chest pain (15%). Chest radiographs revealed intrapulmonary parenchymal lesions, including air-space consolidation (30%), nodular opacities (20%), cystic lesions (15%), ground-glass opacities (10%), and pneumothorax (5%). A pleural f luid examination revealed eosinophilia, low glucose levels, and high lactate dehydrogenase (LDH) levels in 87%, 76%, and 88% of the patients, respectively. These traits helped to distinguish pleuropulmonary paragonimiasis from other pleural diseases such as parapneumonic effusion, malignancy, and pleural tuberculosis. Conclusions: Pleuropulmonary paragonimiasis is often initially misdiagnosed as other pleural diseases. Therefore, it is important to establish the correct diagnosis. In patients with unexplained pleural effusion living in paragonimiasis-endemic areas, pleural fluid obtained by thoracentesis should be examined to distinguish pleuropulmonary paragonimiasis. When marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid, physicians could consider a diagnosis of pleuropulmonary paragonimiasis.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

References

  1. Yokogawa M. Paragonimus and paragonimiasis. Adv Parasitol 1965;3:99-158. https://doi.org/10.1016/S0065-308X(08)60364-4
  2. Kagawa FT. Pulmonary paragonimiasis. Semin Respir Infect 1997;12:149-158.
  3. Choi DW. Paragonimus and paragonimiasis in Korea. Kisaengchunghak Chapchi 1990;28 Suppl:79-102.
  4. 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
  5. Mukae H, Taniguchi H, Matsumoto N, et al. Clinicoradiologic features of pleuropulmonary Paragonimus westermani on Kyusyu Island, Japan. Chest 2001;120:514-520. https://doi.org/10.1378/chest.120.2.514
  6. Chang HT, Wang CW, Yu CF, Hsu CF, Fang JC. Paragonimiasis: a clinical study of 200 adult cases. Chin Med J 1958;77:3-9.
  7. Im JG, Kong Y, Shin YM, et al. Pulmonary paragonimiasis: clinical and experimental studies. Radiographics 1993;13:575-586. https://doi.org/10.1148/radiographics.13.3.8316665
  8. Singh TN, Kananbala S, Devi KS. Pleuropulmonary paragonimiasis mimicking pulmonary tuberculosis: a report of three cases. Indian J Med Microbiol 2005;23:131-134. https://doi.org/10.4103/0255-0857.16056
  9. Johnson JR, Falk A, Iber C, Davies S. Paragonimiasis in the United States: a report of nine cases in Hmong immigrants. Chest 1982;82:168-171. https://doi.org/10.1378/chest.82.2.168
  10. Singh TS, Mutum SS, Razaque MA. Pulmonary paragonimiasis: clinical features, diagnosis and treatment of 39 cases in Manipur. Trans R Soc Trop Med Hyg 1986;80:967-971. https://doi.org/10.1016/0035-9203(86)90275-0
  11. Song JU, Um SW, Koh WJ, et al. Pulmonary paragonimiasis mimicking lung cancer in a tertiary referral centre in Korea. Int J Tuberc Lung Dis 2011;15:674-679. https://doi.org/10.5588/ijtld.10.0494
  12. Lee JJ, Choi CM, Kwon HH, et al. Case of pulmonary paragonimiasis mimicking lung cancer diagnosed by EBUS-TBNA. Korean J Med 2013;84:423-427. https://doi.org/10.3904/kjm.2013.84.3.423
  13. Cho SY, Kong Y, Kang SY. Epidemiology of paragonimiasis in Korea. Southeast Asian J Trop Med Public Health 1997;28 Suppl 1:32-36.
  14. Jeon K, Koh WJ, Kim H, et al. Clinical features of recently diagnosed pulmonary paragonimiasis in Korea. Chest 2005;128:1423-1430. https://doi.org/10.1378/chest.128.3.1423
  15. Miller FL, Walker R. The roentgen characteristics of pulmonary paragonimiasis. Radiology 1955;65:231-235. https://doi.org/10.1148/65.2.231
  16. Nakamura-Uchiyama F, Onah DN, Nawa Y. Clinical features of paragonimiasis cases recently found in japan: parasite-specific immunoglobulin M and G antibody classes. Clin Infect Dis 2001;32:e151-e153. https://doi.org/10.1086/320516
  17. Narain K, Devi KR, Mahanta J. Pulmonary paragonimiasis and smear-negative pulmonary tuberculosis: a diagnostic dilemma. Int J Tuberc Lung Dis 2004;8:621-622.
  18. Raviglione MC, O'Brien RJ. Tuberculosis. In: Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill Medical, 2012:1340-1359.
  19. Pettersson T, Ojala K, Weber TH. Adenosine deaminase in the diagnosis of pleural effusions. Acta Med Scand 1984;215:299-304.
  20. Gakis C. Adenosine deaminase (ADA) isoenzymes ADA1 and ADA2: diagnostic and biological role. Eur Respir J 1996;9:632-633. https://doi.org/10.1183/09031936.96.09040632
  21. Taniguchi H, Mukae H, Matsumoto N, et al. Elevated IL-5 levels in pleural fluid of patients with paragonimiasis westermani. Clin Exp Immunol 2001;123:94-98. https://doi.org/10.1046/j.1365-2249.2001.01425.x
  22. Romeo DP, Pollock JJ. Pulmonary paragonimiasis: diagnostic value of pleural fluid analysis. South Med J 1986;79:241-243. https://doi.org/10.1097/00007611-198602000-00024
  23. Minh VD, Engle P, Greenwood JR, Prendergast TJ, Salness K, St Clair R. Pleural paragonimiasis in a Southeast Asia refugee. Am Rev Respir Dis 1981;124:186-188.

Cited by

  1. North American paragonimiasis: epidemiology and diagnostic strategies vol.13, pp.6, 2015, https://doi.org/10.1586/14787210.2015.1031745
  2. Demographic characteristic and analysis of pulmonary paragonimiasis in patients attending RIMS, Manipur vol.33, pp.2, 2015, https://doi.org/10.4103/0970-2113.177436
  3. Paragonimiasis in Children in Southwest China : A retrospective case reports review from 2005 to 2016 vol.96, pp.25, 2017, https://doi.org/10.1097/md.0000000000007265
  4. Pulmonary Diseases in Refugees and Migrants in Europe vol.95, pp.4, 2018, https://doi.org/10.1159/000486451
  5. Pulmonary larval paragonimiasis mimicking lung cancer vol.80, pp.2, 2015, https://doi.org/10.17116/patol201880260-63
  6. 만성 복통과 발진을 주소로 내원한 6세 여아에서 진단된 폐흡충증 1예 vol.25, pp.1, 2018, https://doi.org/10.14776/piv.2018.25.1.54
  7. Bronchodilator Reversibility Occurring during the Acute Phase of Paragonimiasis westermani Infection vol.58, pp.2, 2015, https://doi.org/10.2169/internalmedicine.0401-17
  8. Retrospective study of pleural parasitic infestations: a practical diagnostic approach vol.19, pp.None, 2015, https://doi.org/10.1186/s12879-019-4179-9
  9. Identification of pulmonary paragonimiasis using Ziehl-Neelsen stain vol.8, pp.1, 2015, https://doi.org/10.4168/aard.2020.8.1.36