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Kang SA, Patel PK, Patil S, Bran-Acevedo A, Layfield L, Wiesemann S, Roland W. A case of spontaneous pneumothorax due to paragonimiasis in North America with literature review. IDCases 2023; 32:e01742. [PMID: 36968306 PMCID: PMC10034413 DOI: 10.1016/j.idcr.2023.e01742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023] Open
Abstract
The species, Paragonimus kellicotti , causes human paragonimiasis in North America. As a foodborne disease, human infection with P. kellicotti occurs after eating raw or undercooked crayfish containing metacercariae. Many risk factors have been described in the literature, including young adult age, male, alcohol consumption, outdoor activities involving rivers within Missouri, and ingesting raw or partially cooked crayfish. Here, we report a case of a 41-year-old male with a 5-year history of cough who presented with acute shortness of breath. Further workup showed mild eosinophilia and spontaneous pneumothorax. A definitive diagnosis was made with a lung biopsy, which showed P. kellicotti eggs. Further questioning revealed that the patient took a hunting and river rafting trip on a river in Missouri 5 years ago, though the history was negative for any crayfish consumption. Paragonimiasis should be considered in those with associated clinical features, including cough and eosinophilia, with a history of a river raft float trip in Missouri, even if the history is negative for crayfish ingestion or travel.
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Affiliation(s)
- Seung Ah Kang
- M4 Medical student, University of Missouri School of Medicine, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Parag Kumar Patel
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Sachin Patil
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Andres Bran-Acevedo
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Lester Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Sebastian Wiesemann
- Department of Cardiothoracic Surgery, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
| | - William Roland
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, USA
- University of Missouri Hospital and clinic, 1 Hospital Dr, Columbia, MO 65212, USA
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Dubey J. Endemic Paragonimus kellicotti infections in animals and humans in USA and Canada: Review and personal perspective. Food Waterborne Parasitol 2022; 30:e00184. [PMID: 36588917 PMCID: PMC9801091 DOI: 10.1016/j.fawpar.2022.e00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Infections with the lung fluke, Paragonimus kellicotti, have been diagnosed in a variety of domestic and wild animals and humans in USA and Canada. Although there are many species of Paragonimus in other parts of the world; P. kellicotti is the only species definitively diagnosed in USA and Canada. Fresh water snails (several species) and crayfish (mainly Orconectes spp.) are its intermediate hosts. Humans and animals become infected with P. kellicotti only by ingesting metacercariae encysted in the heart of crayfish. After ingestion, the fluke penetrates intestinal wall, enters peritoneal cavity, and reaches pleural cavity by direct penetration of diaphragm, 2-3 weeks post inoculation (p.i.). Young flukes penetrate lungs and become encysted in pulmonary tissue, often in pairs. Time to maturity is around 4-7 weeks p.i. Eggs are coughed up, swallowed, and are excreted in feces. Although the parasite has been known for more than a century, there has been an upsurge of human infections in the USA. Here, I review P. kellicotti infections in naturally infected hosts. Pathogenesis, diagnosis, and treatment in parasite-free cats and dogs experimentally infected P. kellicotti are reviewed to shed light on the pathogenesis of human paragonimiasis. Problems and challenges facing diagnosis of paragonimiasis, especially non-pulmonary infections, are discussed. Fluke stages are deposited in Smithsonian Museum.
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Coogle B, Sosland S, Bahr NC. A clinical review of human disease due to Paragonimus kellicotti in North America. Parasitology 2022; 149:1327-1333. [PMID: 35965058 PMCID: PMC9415338 DOI: 10.1017/s0031182021001359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/07/2022]
Abstract
Human autochthonous infections with the trematode Paragonimus kellicotti are increasingly being reported in North America, but the true prevalence and geographic distribution are unknown. Ingestion of raw crayfish is reported in most human cases, typically in the context of alcohol intoxication. Risk of infection varies depending on what part of the crayfish is ingested as metacercariae of P. kellicotti (>50% mature to adults) localize to the heart and pericardium of the crayfish. Reported human cases have manifested primarily in otherwise healthy young adults presenting with severe eosinophilic pneumonia, pleuritis, systemic symptoms, dermatologic lesions and cerebral involvement. However, it is likely that many infections go unreported due to lack of awareness, mild illness or the absence of rapid commercially available diagnostic tests. Promising advances have been made related to novel diagnostic targets. Conservation of these antigen targets among at least four Paragonimus species could make these antigens viable for diagnostic testing of P. kellicotti specifically as well as other Paragonimus species, but additional studies and funding investments are required. Public and physician awareness may have improved due to targeted education campaigns, but ongoing activities to raise awareness are needed, particularly in areas where cases have not been frequently reported to date.
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Affiliation(s)
- Brianna Coogle
- Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Samuel Sosland
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nathan C. Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Beatty NL, Forsyth CJ, Gilman RH, Hamer DH, Henao-Martínez AF, Hochberg NS, Manne-Goehler J, Marcus R, Meymandi S, Reich MR, Showler A, Stigler Granados PE. Neglected Testing for Neglected Tropical Diseases at the CDC. Am J Trop Med Hyg 2022; 106:tpmd220222. [PMID: 35413685 PMCID: PMC9209921 DOI: 10.4269/ajtmh.22-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Norman L. Beatty
- Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, Florida
| | | | - Robert H. Gilman
- Johns Hopkins Bloomberg Boston Medical Center. School of Public Health, Baltimore, Maryland
| | - Davidson H. Hamer
- Boston University School of Medicine. Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Natasha S. Hochberg
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jen Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachel Marcus
- Latin American Society of Chagas, Bristow, Virginia
- Medstar Union Memorial and Good Samaritan Hospitals, Baltimore, Maryland
| | - Sheba Meymandi
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
- Olive View-UCLA Medical Center, Los Angeles, California
| | - Michael R. Reich
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Adrienne Showler
- Division of Infectious Disease, Georgetown University Hospital, Washington, District of Columbia
| | - Paula E. Stigler Granados
- Division of Global Health and Environmental Health, School of Public Health, San Diego State University, San Diego, California
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Curtis KC, Fischer K, Choi YJ, Mitreva M, Weil GJ, Fischer PU. Characterization and localization of antigens for serodiagnosis of human paragonimiasis. Parasitol Res 2021; 120:535-545. [PMID: 33415393 PMCID: PMC7854406 DOI: 10.1007/s00436-020-06990-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/25/2020] [Indexed: 10/28/2022]
Abstract
Paragonimiasis is a foodborne trematode infection that affects 23 million people, mainly in Asia. Lung fluke infections lead frequently to chronic cough with fever and hemoptysis, and are often confused with lung cancer or tuberculosis. Paragonimiasis can be efficiently treated with praziquantel, but diagnosis is often delayed, and patients are frequently treated for other conditions. To improve diagnosis, we selected five Paragonimus kellicotti proteins based on transcriptional abundance, recognition by patient sera, and conservation among trematodes and expressed them as His-fusion proteins in Escherichia coli. Sequences for these proteins have 76-99% identity with amino acid sequences for orthologs in the genomes of Paragonimus westermani, Paragonimus heterotremus, and Paragonimus miyazakii. Immunohistology studies showed that antibodies raised to four recombinant proteins bound to the tegument of adult P. kellicotti worms, at the parasite host interface. Only a known egg antigen was absent from the tegument but present in developing and mature eggs. We evaluated the diagnostic potential of these antigens by Western blot with sera from patients with paragonimiasis (from MO and the Philippines), fascioliasis, and schistosomiasis, and with sera from healthy North American controls. Two recombinant proteins (a cysteine protease and a myoglobin) showed the highest sensitivity and specificity as diagnostic antigens, and they detected antibodies in sera from paragonimiasis patients with early or mature infections. In contrast, antibodies to egg yolk ferritin appeared to be specific marker for patients with adult fluke infections that produce eggs. Our study has identified and localized antigens that are promising for serodiagnosis of human paragonimiasis.
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Affiliation(s)
- Kurt C Curtis
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO, 63110, USA
| | - Kerstin Fischer
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO, 63110, USA
| | - Young-Jun Choi
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Makedonka Mitreva
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO, 63110, USA.,McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Gary J Weil
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO, 63110, USA
| | - Peter U Fischer
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO, 63110, USA.
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