Medical Care
Antiparasitic therapy is the mainstay of paragonimiasis treatment.
Triclabendazole was approved by the FDA in 2019 for fascioliasis after being available for many years from the CDC. The CDC recommends triclabendazole off-label for the treatment of paragonimiasis. [13] In areas where triclabendazole is available, it is becoming first-line therapy for the treatment of paragonimiasis. Triclabendazole has been administered at a dose of 10 mg/kg/d for 3 days or 20 mg/kg/d divided in 2 doses for 1 day for paragonimiasis. Cure rates have been as high as 98.5%. [1]
A study done in Ecuador randomized 62 patients with confirmed pulmonary paragonimiasis to one of four groups (praziquantel or one of three groups with differing doses of triclabendazole). [14] This study found improved clinical response and quicker decreases in sputum production in patients treated with triclabendazole. Parasitological response was found to be more rapid in those individuals treated with triclabendazole. The study suggested that triclabendazole may achieve a more rapid killing of adult flukes, but the mechanism of action remains unknown.
Older therapies (eg, bithionol, niclofolan), despite their effectiveness (cure rates ≥ 90%), have unacceptable adverse effect profiles compared with praziquantel and are not available in the United States for human use.
Therapy may also be required for seizures caused by an inflammatory reaction to dying worms in the setting of cerebral paragonimiasis. Patients with cerebral paragonimiasis may require care in an ICU for seizures and/or coma.
Surgical Care
Extrapulmonary lesions should be surgically excised.
An intraventricular shunt may be needed to manage hydrocephalus.
Consultations
In addition to consultation with an infectious diseases specialist, the following may be helpful, depending on the particular manifestations of disease:
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Pulmonologist
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Neurologist
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Surgeon
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Neurosurgeon
Activity
Activity should be based on patient tolerance.
Prevention
In endemic areas, avoid eating uncooked or insufficiently cooked crustaceans and raw pork. Individuals should also refrain from using uncooked crustacean juice medicinally and for seasoning.
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This micrograph depicts an egg from the trematode parasite Paragonimus westermani. Eggs range in size from 68-118 µm x 39-67 µm. They are yellow-brown and ovoidal or elongated, with a thick shell. They are often asymmetrical, with one end slightly flattened. At the large end, the operculum (ie, lid or covering) is visible. Photo courtesy of The Centers for Disease Control and Prevention.
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This is an illustration of the life cycle of Paragonimus westermani, one of the causal agents of paragonimiasis. Photo courtesy of The Centers for Disease Control and Prevention.
