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A Persistent Parasite
October 2015, Vol 148, No. 4_MeetingAbstracts
Signs and Symptoms of Chest Diseases | October 2015
A Persistent Parasite Aaron Glucksman, MD; Antranik Mangardich, MD; Premkumar Padmanabhan, MD; Booth Wainscoat, DO University of Connecticut, Hartford, CT Chest. 2015;148(4_MeetingAbstracts):1026A. doi:10.1378/chest.2246660
Abstract SESSION TITLE: Signs and Symptoms of Chest Diseases Student/Resident Case Report Posters SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: A 23 year-old Ghanaian woman with recurrent pneumonias for 4 years and latent tuberculosis (TB) as a child who presents with 2 weeks of productive cough and hemoptysis is found to have a Paragonimiasis positive antibody titer with resolution of symptoms and no recurrence after a threeday course of Praziquantal. CASE PRESENTATION: A 23 year-old Ghanaian woman presents with 2 weeks of productive cough and hemoptysis. She has a history of recurrent pneumonias for 4 years and childhood latent TB treated with Isoniazid. She also complains of shortness of breath, pleuritic chest pain, fevers, weight loss, and night sweats. Her mother had active TB and she loves eating crayfish. A low-grade fever and right basilar rales were appreciated on physical exam. Chest x-ray displayed a right basilar consolidation with normal laboratory investigations. Intravenous antibiotics were started and the patient was cultured. Additional workup including HIV serology, immunoglobulin testing, streptococcal pneumonia vaccine response, and an underlying autoimmune disorder were all non-diagnostic. Active TB was ruled out. Prior investigations were obtained yielding negative pathology for underlying infectious or inflammatory processes. Bronchoscopy revealed purulent and bloody secretions in the right lower lobe with negative serological and culture testing. As a result, parasitic infectious etiologies were entertained resulting in ova and parasite smears with Strongyloides and Paragonimiasis antibody titers. After a ten-day hospital course with IV antibiotics the patient had improved and her microbiological investigations revealed only a Paragonimiasis positive antibody titer with resolution of symptoms and no recurrence after a three-day course of Praziquantal. DISCUSSION: The encysted parasite is transmitted to humans by the ingestion of inadequately cooked crayfish or crab. Symptoms are various with the most common being chronic cough, hemoptysis, and fever. Early diagnosis and proper treatment is essential as this pathogen can present with TB resembling symptoms resulting in repetitive investigations, hospital readmissions, prolongation of hospital stays, and potential adverse effects of anti-tuberculosis medications. The presence of ova and parasites in sputum is specific yet sensitivity is low (28-38%), stool examination is insensitive, and pleural fluid positivity usually does not occur. Serological testing with ELISA can be useful to establish a diagnosis (Sensitive 96%, Specific 99%). CONCLUSIONS: Recurrent bacterial pneumonias in the appropriate clinical setting with a negative work up for common infectious etiologies may require entertaining parasitic etiologies particularly Paragonimiasis as a possible causative entity. Serological testing is useful to establish a diagnosis when sputum, stool, and pleural fluid cultures are negative.
Reference #1: Lane MA. Human paragonimiasis in north america following ingestion of raw crayfish. Clin Infect Dis. 2009;49(6):e55-61. DISCLOSURE: The following authors have nothing to disclose: Aaron Glucksman, Antranik Mangardich, Premkumar Padmanabhan, Booth Wainscoat No Product/Research Disclosure Information
Signs and Symptoms of Chest Diseases | October 2015
A Persistent Parasite Aaron Glucksman, MD; Antranik Mangardich, MD; Premkumar Padmanabhan, MD; Booth Wainscoat, DO University of Connecticut, Hartford, CT Chest. 2015;148(4_MeetingAbstracts):1026A. doi:10.1378/chest.2246660
Abstract SESSION TITLE: Signs and Symptoms of Chest Diseases Student/Resident Case Report Posters SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: A 23 year-old Ghanaian woman with recurrent pneumonias for 4 years and latent tuberculosis (TB) as a child who presents with 2 weeks of productive cough and hemoptysis is found to have a Paragonimiasis positive antibody titer with resolution of symptoms and no recurrence after a threeday course of Praziquantal. CASE PRESENTATION: A 23 year-old Ghanaian woman presents with 2 weeks of productive cough and hemoptysis. She has a history of recurrent pneumonias for 4 years and childhood latent TB treated with Isoniazid. She also complains of shortness of breath, pleuritic chest pain, fevers, weight loss, and night sweats. Her mother had active TB and she loves eating crayfish. A low-grade fever and right basilar rales were appreciated on physical exam. Chest x-ray displayed a right basilar consolidation with normal laboratory investigations. Intravenous antibiotics were started and the patient was cultured. Additional workup including HIV serology, immunoglobulin testing, streptococcal pneumonia vaccine response, and an underlying autoimmune disorder were all non-diagnostic. Active TB was ruled out. Prior investigations were obtained yielding negative pathology for underlying infectious or inflammatory processes. Bronchoscopy revealed purulent and bloody secretions in the right lower lobe with negative serological and culture testing. As a result, parasitic infectious etiologies were entertained resulting in ova and parasite smears with Strongyloides and Paragonimiasis antibody titers. After a ten-day hospital course with IV antibiotics the patient had improved and her microbiological investigations revealed only a Paragonimiasis positive antibody titer with resolution of symptoms and no recurrence after a three-day course of Praziquantal. DISCUSSION: The encysted parasite is transmitted to humans by the ingestion of inadequately cooked crayfish or crab. Symptoms are various with the most common being chronic cough, hemoptysis, and fever. Early diagnosis and proper treatment is essential as this pathogen can present with TB resembling symptoms resulting in repetitive investigations, hospital readmissions, prolongation of hospital stays, and potential adverse effects of anti-tuberculosis medications. The presence of ova and parasites in sputum is specific yet sensitivity is low (28-38%), stool examination is insensitive, and pleural fluid positivity usually does not occur. Serological testing with ELISA can be useful to establish a diagnosis (Sensitive 96%, Specific 99%). CONCLUSIONS: Recurrent bacterial pneumonias in the appropriate clinical setting with a negative work up for common infectious etiologies may require entertaining parasitic etiologies particularly Paragonimiasis as a possible causative entity. Serological testing is useful to establish a diagnosis when sputum, stool, and pleural fluid cultures are negative.
Reference #1: Lane MA. Human paragonimiasis in north america following ingestion of raw crayfish. Clin Infect Dis. 2009;49(6):e55-61. DISCLOSURE: The following authors have nothing to disclose: Aaron Glucksman, Antranik Mangardich, Premkumar Padmanabhan, Booth Wainscoat No Product/Research Disclosure Information