The patient is a 19-year-old athletic male with no prior medical history presenting to an urgent care clinic with dyspnea, wheezing, and an intermittent cough. The patient also reports that on occasion he coughs up blood-tinged sputum. The hemoptysis was first noticed about two weeks ago. His dyspnea is especially worsened during his workouts as a college soccer player.. Intermittent diarrhea for the last month is also noted.
He has no prior or present history of smoking or working where he could possibly be exposed to any hazardous fumes/chemicals. There is no history of lung cancer in his family. He is a soccer player for the local university and until this considered himself in excellent condition.
His travel history was significant for a rafting trip taken that down the Missouri River with five other soccer teammates this past summer. While on the rafting trip he recalled a night where he and his teammates were drinking, and a dare was made of consuming raw crayfish that were in abundance at the camp location. He also noted that two of his teammates had been complaining of a chronic non-productive cough and weakness upon exertion the past two weeks. Practices had been difficult for them to finish.
His physical examination is unremarkable. Lung sounds were normal. Laboratory blood work was unremarkable except for a curiously elevated eosinophil count of 10% in his complete blood cell count. The history of intermittent diarrhea triggered a stool pathogen multiplex PCR test which subsequently came back negative. Because of the travel history a sputum ova & parasite examination was ordered. The Microbiologist saw occasional objects in the ova & parasite examination as seen in the image below.
What is the identification of the parasite seen in the image?
What other species is related, much better known, and produces a similar pulmonary infection but is more common in Asian countries?
What are the symptoms of this parasitic infection many times confused with?
What is the treatment of choice for this parasitic infection?
What complications can occur due to an infection with this parasite?
The identification of this parasite is Paragonimus westermani. Another species within this genus that is more commonly known and prevalent in Asian countries is Paragonimus skrjabini. Paragonimus skrjabini is a trematode parasite that also infects the lungs of humans. It causes a similar pulmonary infection characterized by symptoms such as such as cough, wheezing, hemoptysis, and chest pain. Paragonimus skrjabini is primarily found in countries across East Asia, including China, Japan, Korea, and parts of Southeast Asia. It is commonly associated with the consumption of raw or undercooked crustaceans, such as crabs and crayfish, which act as intermediate hosts for the parasite. Ingesting these infected crustaceans can lead to the transmission of Paragonimus skrjabini to humans.
Paragonimus infection, caused by parasites such as Paragonimus westermani or Paragonimus skrjabini, can present with symptoms that are often confused with other respiratory conditions. Some of the symptoms associated with this parasitic infection include:
Chronic cough: The patient may experience a persistent cough that is often productive, meaning they may cough up sputum or mucus.
Hemoptysis: Coughing up blood-tinged sputum can occur in some cases.
Chest pain: The infection may cause chest discomfort or pain, which can be localized or generalized.
Dyspnea: Shortness of breath or difficulty breathing, particularly during physical exertion, may be present.
Wheezing: The infected individual may exhibit wheezing sounds during breathing.
Fever: In some cases, a low-grade fever may be present.
The treatment of choice for Paragonimus infection is the administration of specific antiparasitic medications. The most commonly used drug is praziquantel, which is effective against Paragonimus species.