Clinical Characteristics of Pediatric Pleuropulmonary Paragonimiasis with Pleural Effusion: A Single-Center...

Paragonimiasis, a cause of pleuropulmonary disease, is a neglected etiology of pediatric pleural effusion. We retrospectively analyzed children with paragonimiasis-induced pleural effusion admitted to our center, aiming to summarize their diagnosis, treatment, and prognosis. A total of 103 children were included, with a mean age of 8.2 years, and 87.4% resided in rural areas. 81/91 (89.0%) were initially misdiagnosed with other infectious diseases including community-acquired pneumonia (43.9%; 40/91) and tuberculosis (16.5%; 15/91). The predominant blood test findings included hypereosinophilia (98.1%), leukocytosis (95.1%), thrombocytosis (42.7%), hyperglobulinemia (78.6%), and elevated immunoglobulin G levels (85.4%; 76/89). Multiple serous cavity effusions exhibited higher globulin levels (44.7 g/L versus 36.7 g/L) and lower albumin-globulin ratios (0.8 versus 1.0) than single pleural effusions, and loculation was more common in medium or large pleural effusions. After 3 days of praziquantel treatment at a dosage of 75-90 mg/(kg·day), with a median of four courses, all of the children improved, but no patients were cured with a single course of therapy. Almost half of the patients (44/99) continued to exhibit medium or small residual effusion on chest computed tomography scans. Additionally, various types of lung lesions remained, and the incidence of pleural lesions increased during the follow-up period. Unexplained pediatric pleural effusion with eosinophilia requires paragonimiasis evaluation. Early diagnosis and accurate treatment critically improve clinical prognosis, whereas post-paragonimiasis pulmonary injuries necessitate clinical attention.