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Zhang Y, Xie Y, Luo Y, Xiang S, Zhong W, Wu N, Chen M, Zhou X, Peng S, Chen Q. Massive secretions in paragonimiasis pleural effusion: a new finding concerning clinical recognition and treatment. Eur J Clin Microbiol Infect Dis 2023; 42:493-501. [PMID: 36826718 DOI: 10.1007/s10096-023-04567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
Some paragonimiasis patients in Chongqing, southwest China, have recently exhibited pleural effusions (PEs) with massive viscous secretions. This study aimed to investigate their clinical characteristics, thereby promoting effective treatments. A 3-year retrospective review of paragonimiasis patients who were admitted for nonhomogeneous PEs at Chongqing University Three Gorges Hospital was conducted. Epidemiological data, symptoms, laboratory and imaging findings, treatments, and outcomes were analyzed. Twenty-eight patients were identified, of which 22 (78.6%) were males and 22 (78.6%) were rural residents. Respiratory (85.7%) and constitutional (57.1%) symptoms were common. Paragonimus-specific ELISA was positive in all patients. Eosinophilia was detected in all patients in peripheral blood and PEs. Irregular hyperdense signals were observed in PEs by chest CT scans (96.4%) and ultrasonography (100.0%). Thoracic closed drainage failed in 10 patients (conservative group) because of tube blockage and was eventually replaced by video-assisted thoracoscopic surgery (VATS). Eighteen patients (surgery group) initially underwent VATS, or thoracotomy surgery, without complications. Massive secretions, described as "bean-dregs" or "egg-floccule," were detected intraoperatively, which explained the imaging findings and tube blockage. All patients recovered well after 2-3 courses of postoperative praziquantel treatment. Viscous secretions in paragonimiasis patients warrant great concern. Irregular hyperdense signals in effusions are important characteristics in CT scans and ultrasonography. Treatments such as thoracic closed drainage may fail due to viscous secretions blocking the tube; therefore, surgeries should be considered. In-depth multidisciplinary research may help determine the optimal treatment strategy and reveal the origin of these secretions.
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Affiliation(s)
- Yunxuan Zhang
- Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, Chongqing, 404000, China
- Department of Burn and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yimin Xie
- Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, Chongqing, 404000, China
| | - Yarui Luo
- Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, Chongqing, 404000, China
| | - Shuang Xiang
- Department of Pathology, Chongqing University Three Gorges Hospital, Chongqing, 404000, China
| | - Wen Zhong
- Department of Medical Imaging, Chongqing University Three Gorges Hospital, Chongqing, 404000, China
| | - Na Wu
- Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, Chongqing, 404000, China
| | - Meng Chen
- Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, Chongqing, 404000, China
| | - Xiaojiao Zhou
- Department of Ultrasonography, Chongqing University Three Gorges Hospital, Chongqing, 404000, China
| | - Shulei Peng
- Department of Sleep Medicine Centre, Chongqing University Three Gorges Hospital, Chongqing, 404000, China.
| | - Qiang Chen
- Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, Chongqing, 404000, China.
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Lee S, Yu Y, An J, Lee J, Son JS, Lee YK, Song S, Kim H, Kim S. A Case of Delayed Diagnosis of Pulmonary Paragonimiasis due to Improvement after Anti-tuberculosis Therapy. Tuberc Respir Dis (Seoul) 2014; 77:178-83. [PMID: 25368664 PMCID: PMC4217034 DOI: 10.4046/trd.2014.77.4.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/09/2014] [Accepted: 06/30/2014] [Indexed: 11/24/2022] Open
Abstract
Here, we report a case of pulmonary paragonimiasis that was improved with initial anti-tuberculosis (TB) therapy but confused with reactivated pulmonary TB. A 53-year-old Chinese female presented with a persistent productive cough with foul smelling phlegm and blood streaked sputum. Radiologic findings showed subpleural cavitary consolidation in the right upper lobe (RUL). Bronchoscopic and cytological examination showed no remarkable medical feature. She was diagnosed with smear-negative TB, and her radiologic findings improved after receiving a 6-month anti-TB therapy. The chest CT scans, however, obtained at 4 months after completion of anti-TB therapy showed a newly developed subpleural consolidation in the RUL. She refused pathologic confirmation and was re-treated with anti-TB medication. Nevertheless, her chest CT scans revealed newly developed cavitary nodules at 5 months after re-treatment. She underwent thoracoscopic wedge resection; the pathological examination reported that granuloma caused by Paragonimus westermani. Paragonimiasis should also be considered in patients assessed with smear-negative pulmonary TB.
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Affiliation(s)
- Suhyeon Lee
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Yeonsil Yu
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Jinyoung An
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Jeongmin Lee
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Jin-Sung Son
- Department of Thoracic and Cardiovascular Surgery, Seoul Medical Center, Seoul, Korea
| | | | - Sookhee Song
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Hyeok Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Suhyun Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
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Ibrahim MG, Bunter R, Rajasooriar S, Thien F. Paragonimiasis: an unusual case of haemoptysis. Med J Aust 2008; 188:734-5. [DOI: 10.5694/j.1326-5377.2008.tb01866.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Accepted: 03/05/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Murad G Ibrahim
- Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC
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