Diaz James H
Environmental and Occupational Health Sciences School of Public Health, Louisiana State University Health Sciences Center, New Orleans, USA.
J La State Med Soc. 2011 Sep-Oct;163(5):261-6.
Paragonimiasis is a parasitic infection of the lungs caused by zoonotic lung flukes of the genus Paragonimus. Most cases are reported from Asia and caused by P. westermani following consumption of raw crustaceans. With the exception of imported cases, human paragonimiasis was rarely described prior to 1984 in the United States (US), which has only one indigenous lung fluke species, P. kellicotti. Between 1984 and 2010, 15 cases of P. kellicotti paragonimiasis were reported in the United States. This study will analyze all US cases and compare an earlier series of six cases reported during the period 1984-2005 with a recently reported cluster of nine cases from Missouri during the period 2006-2010 in order to determine any significant behavioral and/ or recreational risk factors for paragonimiasis and to recommend early diagnostic, treatment and preventive strategies. Significant behavioral and recreational risk factors included eating raw crayfish while on canoeing trips on local rivers (p = 0.002), eating raw crayfish while on canoeing trips in Missouri (p = 0.002), and eating raw crayfish while intoxicated (p = 0.007). The male:female case ratio was 9.3:1.0 and more than 80% of cases presented with fever, cough, pleural effusions and peripheral eosinophilia. One patient developed cerebral paragonimiasis, and one patient died of pneumonic sepsis. Clinicians should inquire about consumption of raw or undercooked crayfish in all patients with unexplained fever, cough, eosinophilia and pleural effusions returning from camping or canoeing adventures in P. kellicotti-endemic areas of the Mississippi River Drainage Basin; institute diagnostic evaluation by specific parasitological and serological methods and treat all cases as soon as possible to avoid the pulmonary and cerebral complications of paragonimiasis.
肺吸虫病是由肺吸虫属的人畜共患肺吸虫引起的肺部寄生虫感染。大多数病例报告来自亚洲，由食用生甲壳类动物后感染卫氏并殖吸虫所致。除输入性病例外，1984年之前在美国（美国）很少描述人体肺吸虫病，美国只有一种本土肺吸虫物种，即北美肺吸虫。1984年至2010年期间，美国报告了15例北美肺吸虫病病例。本研究将分析所有美国病例，并将1984 - 2005年期间报告的较早的6例病例系列与2006 - 2010年期间密苏里州最近报告的9例病例群进行比较，以确定肺吸虫病的任何显著行为和/或娱乐风险因素，并推荐早期诊断、治疗和预防策略。显著的行为和娱乐风险因素包括在当地河流上乘独木舟旅行时食用生小龙虾（p = 0.002）、在密苏里州乘独木舟旅行时食用生小龙虾（p = 0.002）以及在醉酒时食用生小龙虾（p = 0.007）。病例的男女比例为9.3:1.0，超过80%的病例出现发热、咳嗽、胸腔积液和外周嗜酸性粒细胞增多。1例患者发生脑型肺吸虫病，1例患者死于肺炎败血症。临床医生应询问所有来自密西西比河流域北美肺吸虫流行地区露营或独木舟探险归来且有不明原因发热、咳嗽、嗜酸性粒细胞增多和胸腔积液的患者是否食用了生的或未煮熟的小龙虾；通过特定的寄生虫学和血清学方法进行诊断评估，并尽快治疗所有病例，以避免肺吸虫病的肺部和脑部并发症。
