Esther Joanna J.

Ricamara BSN 4 Paragonimiasis

Sir Limon San Lazaro Hospital

Paragonimiasis is a chronic parasitic infection, w/c greatly reduces human productivity and quality of life. Spotty occurrence, it is frequently encountered in communities where eating of fresh or inadequately cooked crabs is a practice. The manifestations closely resemble PTB that most often it is misdiagnosed for this disease in endemic areas. Its presence in the country, especially in far flung places cannot be ignored. Loss of money, time and effort are the common consequences of the frequent misdiagnosis. Those with the disease are subject to prolonged and needless suffering from an ailment for which an effective treatment is available. Capability of health workers to recognize cases is still lacking. Endemic areas identified are: the provinces of Mindoro, Camarines Sur, Camarines Norte, Sorsogon, Samar, Leyte, Negros Islands, Albay, Cebu, Baslian and Island of Mindanao. Transmitted by eating fresh-water crabs or meat of parasitic hosts that harbor immature parasites. Endemicity is related with dietary habits, methods of food preparation and the presence of appropriate snail hosts, freshwater crustaceans and the reservoir hosts.

Etiology Lung Fluke Species in the Philippines Paragonimus westermani (Most common causative agent in asia) Paragonimus siamenses

Intermediate host in the Philippines Antemelania asperata (Brotia asperata, form dactylus) a fresh water snail, 1st intermediate host. Crabs, Sundathelpusa philippina (P. mistio or P. graspsiodes) and Varuna litterata small, fresh water crabs, 2nd intermediate hosts Crayfish

Mode of Transmission Ingestion of raw or insufficiency of cooked crabs. Contamination of food or utensils with metacecariae during food preparation. Consumption of inadequately cooked meat of animalreservoirs. Using meat of juice of infected animals for certain means. Accidental transfer of excysted metacercariae to the mouth during food preparation.

Drinking of water contaminated with infective larvae (METACERCARIAE). It may directly contaminate drinking water in a manner similar to food contamination. Pickling of crustaceans containing metacecariae in wine, brine, or vinegar does not kill the encysted larvae.

Reservoir Hosts Cats, Dogs, Rats, Pigs, other wild and domestic animals

Signs and Symptons Cough of long duration Coughing out of blood/blood streaked sputum Chest/back pain PTB like signs/symptoms not responding to anti-TB medications

Diagnosis Sputum Examination eggs in brown spots Immunology Cerebral Paragonimiasis eosinophilia in cerebrospinal fluid

Treatment Praziquantel Bithionol Surgical Removal for heterotopic cases Praziquantel (Biltrizide) is the treatment of choice. Description: It is pyrazinoisoquinolone derivative, which is structurally unrelated to their anthihelminthics. Dose: 25 mg./kg. Body Weight three times daily for three days. It is suitable for treatment of adults and children over four years of age, higher dose is needed for ectopic paragonimiasis. Adverse Reaction: Prazinquantel is exceptionally well tolerated. Occasional abdominal discomfort, nausea, headache and dizziness occur. Rarely, it may cause pyrexia and urticaria. Drowsiness and tachycardia have also been reported. Resistance: There have been no confirmed reports of parasite resistance to the therapeutic dose of praziquantel.

Preparation: Available in 600 mg. tablet Bithionol (BITIN) is the alternative dr7ug. Description: 2.2 thiobis (4.66 dichloropherol) Dose: 30 50 mg./kg. Body wight on alternate days for total of 10 -15 doses. Action: Mode of action is yet unclear. Adverse Reaction: Digestive disturbance, skin eruptions Prevention and Control - Treatment of Infected Person - Disinfection Sanitary disposal of excreta - Antimollusk campaigns - Education of the population - Avoid eating infected foods - Avoid bathing in infected water Transmission via food is the common denominator for understanding the health importance and strategies for prevention and control of paragonimiasis.