Humans are infected on ingestion of parasites in raw or undercooked freshwater crabs or crayfish, or uncooked wild boar meat. The flukes then traverse the intestinal wall into the peritoneal cavity. Within 2-3 weeks after the initial ingestion, the parasites migrate through the diaphragm into the pleural space and/or lungs as well as other organs including the central nervous system and skin.
Children and adults of all ages are affected by paragonimiasis.
Typical symptoms of acute paragonimiasis include fever, abdominal pain, and diarrhea within 2-15 days of ingesting undercooked or raw crustaceans. Urticaria and eosinophilia may also occur in this early phase.
On migration of flukes into the lungs, patients can experience fevers, cough productive of brownish sputum, and occasionally hemoptysis as early signs of chronic pulmonary infection. Profuse expectoration, pleuritic chest pain, dyspnea, chronic cough, and intermittent hemoptysis collectively comprise symptoms of chronic pleuropulmonary paragonimiasis (typically 6 months after exposure).
A commonly identified form of ectopic paragonimiasis involves parasite migration into the brain (typically causes meningoencephalitis or neurological deficits / seizures due to space occupying lesions / cysts, typically 12-16 months after exposure). Migration into the skin (subcutaneous nodular migratory mass lesion with or without associated pruritus, hyperpigmentation) has also been reported.
B66.4 – Paragonimiasis
30369007 – Infection by Paragonimus
Differential Diagnosis & Pitfalls
- Viral gastroenteritis (eg, noroviruses)
- Bacterial gastroenteritis (eg, Salmonella, Shigella, Escherichia coli, Campylobacter, Vibrio)
- Parasitic (eg, Giardia)
- Tuberculosis (eosinophilia and lack of fever suggest paragonimiasis)
- Nontuberculous mycobacterial infections
- Fungal pneumonia (blastomycosis, histoplasmosis, coccidioidomycosis)
- Parapneumonic effusion
- Cutaneous larva migrans – Serpiginous skin lesions with migration of up to several centimeters per day.
- Dracunculiasis – Movement of worms just under skin and blisters at site of worm exiting the skin.
- Fascioliasis – Ingestion of water plants, antecedent jaundice, and/or liver function test abnormalities; serologic testing.
- Gnathostomiasis – Rapid migration of 1 cm/hour of immature larva.
- Hookworm – Acute exposure to contaminated soil; local skin symptoms 1-2 days after exposure.
- Loiasis – Central and Western Africa; serologic testing.
- Strongyloidiasis – Serpiginous skin lesions; larva currens, can migrate up to 5-10 cm/hour.
- Myiasis – Visible movement of maggots or larvae.