Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon 16419, Korea.
Department of Internal Medicine, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul 06973, Korea.
J Infect. 2021 Jan;82(1):150-158. doi: 10.1016/j.jinf.2020.09.037. Epub 2020 Oct 2.
Paragonimiasis is a global foodborne zoonosis. Overlapping clinical and imaging features with other lung pathologies hamper correct diagnosis and require differential diagnosis.
During 1982-2003, 49,012 samples were referred for immunodiagnosis of helminthiases. We detected paragonimiasis cases by enzyme-linked immunosorbent assay (ELISA). We assessed clinical, radiographical and laboratory characteristics, and diagnostic dilemmas associated with delayed diagnosis.
We analyzed 685 pleuropulmonary paragonimiasis cases. ELISA-positive was 665. Eggs were detected in 50. Symptom duration correlated well with the appearance of chest radiographs; 359 pleural, 33 pleuroparenchymal, and 264 parenchymal lesions (P < 0.001). Twenty-nine had normal chest images. Eosinophilia, seen in 304, was common in pleural and pleuroparenchymal patients (P < 0.05). Chest pain and dyspnea were characteristic for pleurisy patients. Sputum (odds ratios [OR]: 6.79; 95% CI: 4.41-10.47), blood-tinged sputum (OR: 5.62; 95% CI: 3.75-8.42), and foul-odor (OR: 2.70; 95% CI: 1.42-5.16) were significant in parenchymal patients. Delayed diagnosis (119) for ≥ 25 weeks was attributed mainly to misdiagnosis as tuberculosis, malignancy, or chronic obstructive pulmonary disease (COPD) (OR: 111.75; 95% CI: 43.25-288.74).
Variable symptoms and radiographs of pleuropulmonary paragonimiasis depended on the stage of infection. Suspicion of tuberculosis, malignancy, or COPD was major cause of delayed diagnosis.
肺吸虫病是一种全球性食源性人畜共患寄生虫病。与其他肺部病变重叠的临床和影像学特征阻碍了正确诊断，需要进行鉴别诊断。
1982 年至 2003 年期间，我们对 49012 份样本进行了寄生虫病免疫诊断检测。我们使用酶联免疫吸附试验（ELISA）检测肺吸虫病病例。我们评估了临床、影像学和实验室特征，以及与延迟诊断相关的诊断难题。
我们分析了 685 例胸膜肺吸虫病病例。ELISA 阳性的有 665 例。50 例患者检测到虫卵。症状持续时间与胸部 X 线表现密切相关；359 例胸膜病变、33 例胸膜-实质病变和 264 例实质病变（P<0.001）。29 例患者胸部 X 线图像正常。304 例患者存在嗜酸性粒细胞增多症，胸膜和胸膜实质病变患者中常见（P<0.05）。胸膜炎患者有胸痛和呼吸困难的特征。咳痰（比值比[OR]：6.79；95%置信区间[CI]：4.41-10.47）、痰中带血（OR：5.62；95% CI：3.75-8.42）和恶臭（OR：2.70；95% CI：1.42-5.16）在实质病变患者中具有显著意义。119 例（≥25 周）的延迟诊断主要归因于误诊为肺结核、恶性肿瘤或慢性阻塞性肺疾病（COPD）（OR：111.75；95% CI：43.25-288.74）。
胸膜肺吸虫病的症状和影像学表现因感染阶段而异。怀疑肺结核、恶性肿瘤或 COPD 是导致延迟诊断的主要原因。
