Paragonimiasis is a food-borne parasitic infection

caused by the lung fluke which can cause a

sub-acute to chronic inflammatory disease of
the lung. These flukes are larger than liver
flukes and infect meat- or fish-eating animals as
well as humans. Their life cycle is similar to that
of liver flukes except that their encysted larvae
infect crabs and crayfish rather than plants or
fish. Humans can ingest the encysted
metacercariae from drinking contaminated
water or eating raw or undercooked crabs and
crayfish.
Acute Symptoms:
-from period of invasion and migration of flukes
-abdominal pain, diarrhea and urticaria, followed
roughly 1 to 2 weeks later by fever, pleuritic chest pain,
cough and/or dyspnea.

Chronic Symptoms:
-pulmonary manifestations include cough,
expectoration of discolored sputum, hemoptysis, and
chest radiographic abnormalities.
-Chronic pulmonary paragonimiasis, the most common
clinical pattern, is frequently mild, with chronic
cough, brown-tinged sputum (the color being caused
by expectorated clusters of reddish brown eggs rather
than by blood) and true hemoptysis.
Causative Agent
Kingdom: Animalia
Phylum: Platyhelminthes
Class: Trematoda
Family: Paragonimidae
Genus: Paragonimus
Species: P. westermani

More than 30 species of trematodes (flukes) of the genus

Paragonimus have been reported to infect animals and humans.
Among them, more than 10 species reported to infect humans,
the most common is P. westermani, the oriental lung fluke.
Lung fluke is most commonly
encountered in parts of Asia,
Africa and South America.
Southeast Asia is more
predominately more infected
because of lifestyles. Raw
seafood is popular in these
countries.
Paragonimus westermani eggs range from
80 to 120 µm long by 45 to 70 µm wide.
They are yellow-brown, ovoid or elongate,
with a thick shell, and often asymmetrical
with one end slightly flattened. At the large
end, the operculum is clearly visible. The
opposite (abopercular) end is thickened.
The eggs are unembryonated when
passed in sputum or feces.
Cercariae are often indistinguishable
between species. There is a large
posterior sucker, and the exterior is
spined.
Metacercaria: Metacercariae are
usually encysted in tissue. The
exterior is spined and has two suckers
Adult flukes are typically reddish brown
and ovoid, measuring 7 to 16 mm by
4 to 8 mm, similar in size and
appearance to a coffee bean.They are
hermaphroditic, with a lobed ovary
located anterior to two branching
testes. Like all members of the
Trematoda, they possess oral and
ventral suckers.
1. The eggs are excreted unembryonated in the
sputum, or alternately they are swallowed and
passed with stool.
2. In the external environment, the eggs become
embryonated,
3. Miracidia hatch and seek the first intermediate
host, a snail, and penetrate its soft tissues.
4. Miracidia go through several developmental
stages inside the snail : sporocysts , rediae ,
with the latter giving rise to many cercariae ,
which emerge from the snail.
5. The cercariae invade the second intermediate host, a
crustacean such as a crab or crayfish, where they encyst and
become metacercariae. This is the infective stage for the
mammalian host.
6. Human infection with P. westermani occurs by eating
inadequately cooked or pickled crab or crayfish that harbor
metacercariae of the parasite.
7. The metacercariae excyst in the duodenum, penetrate through
the intestinal wall into the peritoneal cavity, then through the
abdominal wall and diaphragm into the lungs, where they
become encapsulated
8. Develop into adults[8] (7.5 to 12 mm by 4 to 6 mm).

The worms can also reach other organs and tissues, such as the
brain and striated muscles, respectively. However, when this
takes place completion of the life cycles is not achieved,
because the eggs laid cannot exit these sites.
Transmission of the parasite P. westermani to humans and
mammals primarily occurs through the consumption of raw or
undercooked seafood.
In Asia, an estimated 80% of freshwater crabs carry P.
westermani. In preparation, live crabs are crushed and
metacercariae may contaminate the fingers/utensils of the
person preparing the meal. Accidental transfer of infective
cysts can occur via food preparers who handle raw seafood
and subsequently contaminate cooking utensils and other
foods.
Consumption of animals which feed on crustaceans can also
transmit the parasite
Food preparation techniques such as pickling and salting do not
exterminate the causative agent. For example, in Chinese
study eating “drunken crabs” was shown to be particularly
risky because the infection rate was 100% when crabs are
immersed in wine for 3–5 minutes and fed to cats/dog.
Animals such as pigs, dogs, and a variety of feline
species can also harbor P. westermani. Humans
only become infeted after eating raw fresh water
crabs that have been encysted with the
metacerciaria.

Time from infection to oviposition (laying eggs) is 65 to 90

days. Infections may persist for 20 years in humans.
Once in the lung or ectopic site, the worm
stimulates an inflammatory response that allows
it to cover its self in granulation tissue forming a
capsule. These capsules can ulcerate and heal
over time. The eggs in the surrounding tissue
become pseudotubercles. If the worm becomes
disseminated and gets into the spinal chord, it
can cause paralysis; capsules in the heart can
cause death. The symptoms are localized in the
pulmonary system, which include a bad cough,
bronchitis, and blood in sputum (hemoptysis).
Praziquantel is the drug of choice to treat
paragonimiasis. It works by paralyzing the flukes'
suckers, forcing them to drop away from the walls of
the host's blood vessels.
Bithionol is an alternative drug for treatment of this
disease but is associated with skin rashes and
urticaria.
Depending on the species of fluke and the severity of
infection, the course of treatment can vary from
several days to several weeks. Cure rates vary from
50-95%. Most patients experience mild temporary side
effects from these drugs, including diarrhea, dizziness,
or headache.
No vaccines have been developed that are effective
against lung or liver fluke infections. Prevention of
these infections includes the following measures:
boiling or purifying drinking water
avoiding raw or undercooked fish or salads made from
fresh aquatic plants; all food eaten in areas with fluke
infestations should be cooked thoroughly; pickling or
smoking will not kill fluke cysts in fish or shellfish
control or eradication of the snails that serve as the
flukes' intermediate hosts