Paragonimiasis is an infection with parasitic worms. It is caused by eating undercooked crab or crayfish.
Paragonimiasis can cause illness resembling pneumonia or stomach flu. The infection can last for years.
Paragonimiasis is caused by infection with a flatworm. That's a parasitic worm also called a fluke or lung fluke because it commonly infects the lungs. Usually, infection comes after eating undercooked crab or crayfish that carry immature flukes.
Once swallowed by a person, the worms mature and grow inside the body. Over months, the worms spread through the intestines and belly (abdomen). They penetrate the diaphragm muscle to enter the lungs. Once inside the lungs, the worms lay eggs and can survive for years, causing chronic (long-term) paragonimiasis.
Paragonimiasis is rare in the U.S. Most cases occur in Asia, West Africa, and South and Central America.
Paragonimiasis causes no symptoms during initial infection. Many people with paragonimiasis never experience any symptoms. When paragonimiasis symptoms do occur, they result from the worms’ location and activity in the body, which change over time.
In the first month or so after someone is infected, paragonimiasis worms spread through the abdomen, sometimes causing symptoms that can include:
Worms then travel from the belly into the chest. There they can cause respiratory symptoms, such as:
Without treatment, paragonimiasis becomes chronic. It can continue for decades.
- Belly pain
- Bloody diarrhea
- Lumps or bumps on the skin of the belly or legs that come and go over time
Some people with chronic paragonimiasis have no noticeable symptoms.
In up to 25% of people hospitalized with paragonimiasis, the worms infect the brain. Symptoms can include:
Diagnosing paragonimiasis can be difficult or delayed. That's because its symptoms are often mild and overlap with more common conditions.
Most often, a person with symptoms has multiple tests before a doctor makes the diagnosis of paragonimiasis. Exams and tests used to make a diagnosis include:
Patient History. Your doctor will get clues about possible paragonimiasis by looking at the pattern in which your symptoms appeared. Your doctor will ask about your past eating of undercooked crab or crayfish.
Physical examination. Abnormal breath sounds or belly tenderness observed with a doctor’s examination of the chest or belly can suggest a problem and direct further testing.
Sputum microscopy. Fluke eggs may be detected during examination of coughed-up sputum under a microscope.
Chest X-ray. Nodules (spots) in the lungs, hollowed-out areas (cysts or cavities), or fluid around the lungs (pleural effusions) may be present.
Bronchoscopy. A doctor can put an endoscope (flexible tube with a camera on its tip) through the nose or mouth into the lungs. Flukes or their eggs are collected from lung fluid samples. The flukes or eggs may be seen under a microscope.
Thoracentesis. A doctor puts a needle through the chest wall to sample fluid around the lungs (pleural effusion).
Stool studies. Fluke eggs may be seen in stool samples when examined under a microscope.
A definite diagnosis of paragonimiasis is made when fluke eggs are detected in an infected person’s sputum or stool. But the flukes may not lay eggs until two months after you are infected. That makes early diagnosis difficult.
In most people, paragonimiasis can be cured with oral anti-parasite medications. Both praziquantel (Biltricide) and triclabendazole (Egaten) are approved for treatment. Praziquantel is taken three times daily for two days, while triclabendazole is taken twice a day, 12 hours apart.
In the rare cases of paragonimiasis with brain involvement, other treatments may be necessary, such as anti-seizure medications or surgery to reduce brain swelling.