Paragonimiasis: A missed diagnosis from Nepal

Area of Science:

• Medical Parasitology
• Infectious Diseases
• Pulmonology

Background:

• Paragonimiasis, caused by the Oriental lung fluke, is a parasitic disease prevalent in Asia, Africa, and South America.
• Transmission occurs through consuming raw or undercooked crabs and crayfish harboring the parasite.
• Four cases of paragonimiasis had been previously reported in Nepal.

Observation:

• A young male from Nepal presented with prolonged fever, shortness of breath, and cough, initially treated for tuberculosis.
• High-Resolution Computerized Tomography (HRCT) revealed a cavitary lung lesion, leading to consideration of aspergillosis and subsequent lobectomy.
• Histological examination of the resected lung tissue identified parasitic structures and ova within foreign body granulomas.

Findings:

• The patient was diagnosed with paragonimiasis based on histological findings.
• Treatment with Praziquantel resulted in complete recovery and resolution of symptoms.

Implications:

• Paragonimiasis symptoms can closely resemble tuberculosis, potentially leading to misdiagnosis.
• Misdiagnosis can result in delayed appropriate treatment, prolonged patient morbidity, and resource wastage.
• This case highlights the importance of considering parasitic infections in differential diagnoses for respiratory illnesses, especially in endemic regions.