Minh V D, Engle P, Greenwood J R, Prendergast T J, Salness K, St Clair R
Am Rev Respir Dis. 1981 Aug;124(2):186-8. doi: 10.1164/arrd.1981.124.2.186.
We report a Laotian patient with pleural paragonimiasis who did not have the usual diagnostic triad for this parasitic disease. He did not have chronic hemoptysis (considered by many to be an "invariable" finding), there were no pulmonary infiltrations, and stool and sputum examinations did not yield Paragonimus ova. The diagnosis was made on the basis of ova found in the pleural fluid. Paragonimiasis pleural effusion did not resolve with bithionol, the drug of choice for pulmonary paragonimiasis, and, as a result, chest tube drainage was required. The difference between pleural paragonimiasis and pulmonary paragonimiasis is that the classic clinical presentation of the latter (hemoptysis, ova in sputum and stools, lung infiltration, etc.) requires an intrapulmonary location on the parasite. A search for ova in the pleural fluid may be the only diagnostic tool for patients suspected of pleural paragonimiasis. With the influx of Southeast Asia refugees, this case report may be of relevance to U.S. physicians involved in the care of patients in whom not all chronic pleuropulmonary diseases are tuberculous.
我们报告了一名老挝胸膜肺吸虫病患者，他没有这种寄生虫病常见的诊断三联征。他没有慢性咯血（许多人认为这是一个“不变”的表现），没有肺部浸润，粪便和痰液检查也未发现肺吸虫卵。诊断是基于在胸腔积液中发现虫卵做出的。胸膜肺吸虫病胸腔积液用治疗肺吸虫病的首选药物硫双二氯酚治疗无效，因此需要进行胸腔闭式引流。胸膜肺吸虫病与肺吸虫病的不同之处在于，后者的典型临床表现（咯血、痰液和粪便中有虫卵、肺部浸润等）表明寄生虫位于肺内。对于疑似胸膜肺吸虫病的患者，在胸腔积液中查找虫卵可能是唯一的诊断方法。随着东南亚难民的涌入，本病例报告可能对美国那些负责诊治并非所有慢性胸膜肺部疾病都是结核病患者的医生有参考价值。
