Belizario V, Guan M, Borja L, Ortega A, Leonardia W
College of Public Health, University of the Philippines, Manila, Philippines.
Southeast Asian J Trop Med Public Health. 1997;28 Suppl 1:37-45.
The clinical epidemiology of pulmonary paragonimiasis and tuberculosis was investigated in a known endemic municipality of Sorsogon, Philippines. Records of diagnosed tuberculosis patients on treatment and follow up at the local Rural Health Unit over a two year period from 1993 to 1994 were reviewed to provide an overview of pulmonary tuberculosis in the area, specifically to describe the population at risk, the basis for diagnosis and the proportion of case notification who were sputum negative. Patients from the same group of individuals as well as undiagnosed tuberculosis patients with productive cough, fever with chest and/or back pain, or hemoptysis were examined to look into clinical manifestations, duration of symptoms, history of crab-eating and sputum examination results for acid-fast bacilli and Paragonimus. There was difficulty in determining the number of non-responders as the records did not have any provision for the recording of such. Annual tuberculosis case notification rates for the two years (374 and 401 per 100,000 population) were higher than the national figure in 1991 (325 per 100,000 population) indicating that tuberculosis is still a major health problem in the area and tuberculosis control efforts may have to be more aggressive to better contain the disease. Twenty-six out of 160 individuals surveyed were sputum smear positive for Paragonimus. Paragonimiasis rates were not significantly different in the two groups (15.6% vs 16.9%, respectively) indicating that there is a need for routine sputum examination for Paragonimus which is not available at present. Only six patients surveyed were sputum smear positive for acid-fast bacilli. A high index of suspicion is necessary to diagnose paragonimiasis and to be able to differentiate it from tuberculosis. The diagnosis may be suggested by a patient's place of origin being a known endemic area, a long period of chronic cough and the habit of eating raw or insufficiently cooked crabs or crayfish. Laboratories in endemic areas should have the capacity to differentiate between the two infections by being able to provide the routine laboratory procedures necessary for definitive diagnosis and treatment.
在菲律宾索索贡市一个已知的肺吸虫病流行地区，对肺吸虫病和结核病的临床流行病学进行了调查。回顾了1993年至1994年两年间当地农村卫生所确诊的结核病患者的治疗和随访记录，以概述该地区的肺结核情况，特别是描述高危人群、诊断依据以及痰涂片阴性的病例报告比例。对同一组个体以及有咳痰、发热伴胸痛和/或背痛或咯血症状但未确诊的结核病患者进行检查，以观察临床表现、症状持续时间、食蟹史以及痰涂片抗酸杆菌和肺吸虫检查结果。由于记录中没有关于记录无反应者数量的规定，因此难以确定无反应者的数量。这两年的年度结核病病例报告率（每10万人中分别为374例和401例）高于1991年的全国数字（每10万人中325例），这表明结核病在该地区仍然是一个主要的健康问题，可能需要采取更积极的结核病控制措施以更好地控制该疾病。在接受调查的160人中，有26人的痰涂片肺吸虫呈阳性。两组的肺吸虫病发病率无显著差异（分别为15.6%和16.9%），这表明需要对肺吸虫进行常规痰检，而目前尚无此项检查。接受调查的患者中只有6人的痰涂片抗酸杆菌呈阳性。诊断肺吸虫病并将其与结核病区分开来需要高度的怀疑指数。患者来自已知的流行地区、长期慢性咳嗽以及有食用生蟹或未煮熟蟹或小龙虾的习惯，这些情况可能提示诊断。流行地区的实验室应具备区分这两种感染的能力，能够提供明确诊断和治疗所需的常规实验室检查。
