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Clinical Characteristics

Many individuals with heavy Paragonimus infections are entirely symptom free. They are unaware of their infection and suffer from no clinically recognizable ill health. In others, symptoms begin with chronic cough and chest pain. The sputum is chocolate colored or rusty brown, resembling that seen in pneumonia, but the patient remains remarkably healthy. The sputum at this stage is frequently loaded with eggs. Hemoptysis is irregular and seldom severe and may continue for years (endemic or benign hemoptysis), but occasionally is life threatening. There are seldom physical signs within the chest, although rales may occasionally be heard. There may be clubbing of the fingers and toes.

Cerebral paragonimiasis clinically resembles a brain tumor or vascular accident. In Oh's large series, the average age of onset was 15.7 years with a range from 1 to 45 years, and the average duration of symptoms was 5.5 years. Presenting symptoms may be convulsions, fever, headache, nausea, vomiting, and visual disturbances. Epilepsy may develop, often of the focal Jacksonian type. It is rare for cerebral symptoms to occur either without or before pulmonary symptoms (pulmonary symptoms precede cerebral symptoms in 70% of patients in most series). Almost any neurological abnormality may develop, such as homonymous hemianopsia, papilledema, optic nerve atrophy, other cranial nerve involvement, spastic hemiparesis, and mental deterioration.

Where the parasite is endemic, enlarged lymph nodes, skin nodules and ulceration, epididymitis, uterine infection and cirrhosis may occur. Abdominal pain and diarrhea are unusual symptoms except during occasional active larval migration stages. However, it must be emphasized that apart from the pulmonary and (to a lesser extent) cerebral symptoms, paragonimiasis at other sites is remarkably symptom free and only a small percentage of all those infected will have any significant symptoms at all.

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Copyright: Palmer and Reeder

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