Cerebral paragonimiasis: A retrospective analysis of 89 cases
Introduction
Paragonimiasis is caused by consumption of the food or water contaminated with Paragonimus westermani. There are approximately 2.9 million paragonimiasis patients [1] distributed in eastern Asia, southern Asia, central and northern Africa and America from Peru to Canada [1], [2]. Because of the migration, paragonimiasis patients or food contamination with Paragonimus are also reported in Europe and Australia [3], [4]. With the advancement of public health after World War II, the incidence of paragonimiasis has declined. However, since the 1990s, the incidence of paragonimiasis was rising again [5].
For some species, humans are not very suitable hosts and juvenile worms may wander in the body. In cases of extrapulmonary paragonimiasis, the central nervous system (CNS) is the most common locus of involvement [5], where they can cause serious problems (headache, epilepsy, paralysis, behavioral change, disturbed vision, etc.). Because of the high incidence in the 1960s and 1970s, there have been some clinical case reports with individual or small number of cases, but the limited treatment means resulted in a higher rate of misdiagnosis. Standard diagnosis and treatment of cerebral paragonimiasis, particularly epilepsy, have not been established [7], [8], [9], [10]. With the increases of the incidence and advancement in imaging examination (e.g., MRI), neuroscientists have noticed the lack of clinical data of this disease [11]. In this study, we retrospectively analyzed the clinical and follow-up data of 89 cases with cerebral paragonimiasis and summarized the disease characteristics, diagnostic strategies and treatment experience, with an expectation of helping to establish standard diagnosis and treatment of cerebral paragonimiasis.
Section snippets
Case information
In the past 10 years, our hospital treated 287 cases of paragonimiasis, among which 89 patients (31%) including 56 males and 33 females (ages: 2–64; average: 16.57, Standard Deviation: 10.60) had cerebral involvement (Table 1). All the patients came from southwest China including Sichuan, Chongqing and Hunan Provinces. Consumption of undercooked crustaceans was confirmed in 49 cases in the recent 2 years. The clinical manifestations of 37 cases included speech disorders and limb movement or
Result
Seventy-three cases were followed up for 6–48 months and the original symptoms improved markedly without recurrence (Fig. 6, Fig. 7). Fifteen cases were lost to follow-up after discharge. One patient died of difficult-to-control epilepticus seizures, high fever and convulsions. Epilepticus insults occurred in 4 cases within 6 months of treatment, but the frequency was significantly reduced. These cases were continuously provided with carbamazepine treatment until the epilepsy did not attack
Discussion
The pathological basis of cerebral paragonimiasis is the migration of lung fluke to the brain, catabolism of brain tissue, mechanical damages, toxicity, and defense reactions. The main pathological changes include invasive inflammation, cerebral hemorrhage or cerebral infarction. According to the quantity, size, location of lesions, cerebral paragonimiasis may be manifested by a variety of neurological symptoms, e.g., epilepsy, hemiplegia, aphasia and headache. In the past 10 years, our hospital
Conclusions
Patients with an age of younger than 18 years old are more likely to be complicated with cerebral hemorrhage. SWI imaging contributes to the diagnosis of hemorrhage in the lesions. Cerebral paragonimiasis can cause seizures, especially grand mal epilepsy, which can be controlled by antiepileptic drugs.
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2022, Travel Medicine and Infectious DiseaseCitation Excerpt :Symptoms of cerebral paragonimiasis usually manifest after the onset of the pulmonary symptoms and can include headaches, seizures, blurred visions, gait disturbance, and paralysis. Pathological changes to the cerebrum include invasive inflammation and cerebral hemorrhage or infarction [19,20]. Furthermore, brain cysts secondary to infection can occasion increased intracranial pressure, epilepsy, and paralysis [13,21].
Paragonimiasis presenting as an acute hemorrhagic stroke
2021, IDCasesCitation Excerpt :Had it not been for the atypical changes seen on the CT chest, paragonimiasis would not have come up on the differential diagnosis. CNS paragonimiasis is treatable and has a fairly good prognosis [4]. Due to the rarity of this disease, it can often be missed.
Intracranial Pseudoaneurysm Caused by Cerebral Paragonimiasis in Pediatric Patients
2020, Pediatric NeurologyParasites and epilepsy: Understanding the determinants of epileptogenesis
2019, Epilepsy and BehaviorCitation Excerpt :Cerebral paragonimiasis is the most common form of extrapulmonary paragonimiasis and accounts for over 50% of such cases [54]. It is also a great mimic of cerebrovascular disorders [55–57]. Sparganosis was associated with epilepsy in one Korean case–control study, reporting an odds ratio of 1.3 [58].
- 1
Drs. J. Chen and Z. Chen contributed equally to this work.