Department of Molecular Parasitology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Korea.
Department of Biochemistry and Molecular Biology, Kyung Hee University College of Medicine, Seoul, Korea.
PLoS Negl Trop Dis. 2022 Mar 16;16(3):e0010240. doi: 10.1371/journal.pntd.0010240. eCollection 2022 Mar.
Cerebral paragonimiasis (CP), caused by aberrant migration of Paragonimus worms, frequently invokes serious illness. The causal relationship between the lesion characteristics and patients' symptoms has poorly been understood. CP serodiagnosis has not been properly evaluated to date. A total of 111 CP cases were diagnosed in our laboratory between 1982 and 2003. This study retrospectively assessed the clinical and imaging characteristics of the 105 patients along with the evaluation of diagnostic potentials of recombinant P. westermani yolk ferritin (rPwYF) by enzyme-linked immunosorbent assay (ELISA) employing patients' sera and cerebrospinal fluids (CSFs). We analyzed 60 male and 45 female patients; 50 early-stage patients with non-calcified enhancing nodule(s) (median age, 38 years; interquartile range [IQR], 24.75-52; median symptom duration, 0.75 years; IQR, 0.2-2) and 54 chronic cases having calcified lesion(s) (median age, 33 years; IQR, 25-41; median symptom duration, 10 years; IQR, 5-20). One patient showed a normal neuroimage. The patients were largely diagnosed in their 30s. The parietal lobe was most commonly affected, followed by occipital, frontal, and temporal lobes. Twenty-six patients had lesions encompassing ≥ two lobes. The patients complained mainly of seizures, headaches, hemiparesis, and focal neurologic deficits (P < 0.001). Seizures and visual defects were predominant in patients with calcified lesion(s) (P < 0.001). The diagnostic sensitivity and specificity of rPwYF against serum/CSF were 100%/97% and 97.2%/92.5%, respectively. The specific IgG antibody levels against rPwYF in sera and CSFs showed a positive correlation (r = 0.59). The clinical manifestations of the early-stage patients might be associated with cortical lesions or meningeal irritation, while those in the chronic stage were caused by conglomerated space-occupying lesions. rPwYF would be useful for the serodiagnosis of both early and chronic CP cases.
脑型并殖吸虫病（CP）是由并殖吸虫幼虫异常迁移引起的，常导致严重疾病。病变特征与患者症状之间的因果关系尚未得到很好的理解。迄今为止，CP 的血清学诊断尚未得到适当评估。1982 年至 2003 年期间，我们实验室共诊断了 111 例 CP 病例。本研究回顾性评估了 105 例患者的临床和影像学特征，并通过酶联免疫吸附试验（ELISA）评估了重组并殖吸虫卵铁蛋白（rPwYF）的诊断潜力，该方法使用了患者的血清和脑脊液（CSF）。我们分析了 60 名男性和 45 名女性患者；50 例早期患者有非钙化增强结节（中位数年龄 38 岁；四分位距[IQR] 24.75-52；中位症状持续时间 0.75 年；IQR 0.2-2）和 54 例慢性病例有钙化病变（中位数年龄 33 岁；IQR 25-41；中位症状持续时间 10 年；IQR 5-20）。1 例患者神经影像正常。患者主要在 30 多岁时被诊断。顶叶最常受累，其次是枕叶、额叶和颞叶。26 例患者的病变累及≥两个叶。患者主要抱怨癫痫发作、头痛、偏瘫和局灶性神经功能缺损（P < 0.001）。钙化病变患者以癫痫发作和视觉缺陷为主（P < 0.001）。rPwYF 对血清/CSF 的诊断敏感性和特异性分别为 100%/97%和 97.2%/92.5%。血清和 CSF 中针对 rPwYF 的特异性 IgG 抗体水平呈正相关（r = 0.59）。早期患者的临床表现可能与皮质病变或脑膜刺激有关，而慢性期患者则是由聚集的占位性病变引起的。rPwYF 可用于早期和慢性 CP 病例的血清学诊断。
