C-231. North American Paragonimiasis: A Review of Five Patients Infected by P. kellicotti

G. W. Procop;
Cleveland Clin., Cleveland, OH.

Introduction: North American paragonimiasis is caused by a Paragonimus kellicotti, a species that is unique to North America. Five patients with North American paragonimiasis have been reported in the medical literature. Materials and Methods: The reports of five patients diagnosed with North American that appeared in the medical literature since the mid 1980s were reviewed. The histologic slides from two of these patients and the cytologic preparation from a third patient were also reviewed. Patient demographics and medical findings were reviewed.Results: The ages of the patients ranged from 18-71 years. Four had acute, active disease, whereas one, the 71 y/o man, had a remote infection. Infections were acquired in Oklahoma (2), Missouri (1), Michigan (1), and Iowa/Nebraska (1). All the patients ate crayfish; two ate a raw crayfish. Early manifestations included none (3), watery diarrhea (1), and a flu-like illness (1). Later manifestations included cough and hemoptysis (3). All had leukocytosis; eosinophila was documented in three. All patients had some type of pulmonary radiologic finding. Pleural effusions (4), pneumothoracies (2), bilateral pleural thickening (1), linear streaking (1), a pulmonary infiltrate (1) and a cavitary lesion (cyst) (1) were noted. All were diagnosed by morphologic methods, which included sputum cytology (1), bronchoalveolar lavage cytology (1), histologic examination of a pleural peel removed at decortication (2), or cytology of pleural fluid (1). Serologic studies were not performed (2), were positive (2), or were negative (1); the negative serology occurred in the one patient with remote disease. All of the patients with active, acute infections were treated and cured with praziquantel, but two required surgery. The patient with remote disease died from an unrelated bacterial infection.Conclusion: North American paragonimiasis is similar in many respects to paragonimiasis elsewhere. Patients are likely to be young men who have eaten crayfish. Pleural involvement is a prominent component of North American paragonimiasis. Cure may be achieved with praziquantel, but surgery may be necessary if extensive pleural fibrosis is present.

230/C. Diagnostic Virology

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