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Section 3. Summaries of Infectious Diseases
Paragonimiasis
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: The disease has an insidious onset and a chronic course. The 2 major forms of paragonimiasis described are (1) classical paragonimiasis, which involves the lungs, and (2) nonclassical paragonimiasis, which results in a larval migrans syndrome. In classical infections, pulmonary disease is associated with chronic cough and dyspnea, but most infections probably are inapparent or result in mild symptoms. Heavy infestations cause paroxysms of coughing, which often produce blood-tinged sputum that is brown because of the presence of Paragonimus species eggs. Hemoptysis can be severe. Pleural effusion, pneumothorax, bronchiectasis, and pulmonary fibrosis with clubbing can develop. Extrapulmonary manifestations also may involve the abdominal cavity, skin, and uncommonly, the central nervous system, with meningoencephalitis and seizures attributable to invasion of the brain by adult flukes. Symptoms tend to subside after approximately 5 years but can persist for as many as 20 years.
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Nonclassical paragonimiasis is associated with migratory subcutaneous nodules containing juvenile worms, but hemoptysis does not occur. Pleural effusion is common, as is invasion of the brain.
ETIOLOGY: In Asia, classical paragonimiasis is caused by Paragonimus westermani and Paragonimus heterotremus adult flukes and their eggs. The adult flukes of
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Red Book 2003 2003: 744-770.