- Author: Seth D Rosenbaum, MD; Chief Editor: Russell W Steele, MD more...
Praziquantel and triclabendazole are the 2 agents that the World Health Organization (WHO) recommended to treat paragonimiasis. Praziquantel is the most commonly used and has a cure rate of 80-90%.[1, 13]
Triclabendazole is currently not approved for use in the United States but is available on a compassionate care protocol from the Centers for Disease Control and Prevention Drug Services at (404) 639-3670. In areas where triclabendazole is available, it is becoming first-line therapy for treatment of paragonimiasis. Triclabendazole is administered at a dose of 10 mg/kg/d for 3 days or 20 mg/kg/d divided in 2 doses for 1 day. Cure rates have been as high as 98.5%.
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). 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 have more rapid killing of adult flukes but the mechanism of action remains unknown.
Older therapies (eg, bithionol [30-50 mg/kg qod for 10-15 doses] or niclofolan), despite their effectiveness (cure rates ≥ 90%), have unacceptable adverse effect profiles compared with praziquantel.
Increases cell membrane permeability in susceptible worms, resulting in loss of intracellular calcium, massive contractions, and paralysis of musculature. Produces vacuolization and disintegration of schistosome tegument, followed by attachment of phagocytes to parasite and death.
Tab should be swallowed whole with some liquid during meals. Keeping tab in mouth may reveal bitter taste, which can produce nausea or vomiting.
Liu Q, Wei F, Liu W, Yang S, Zhang X. Paragonimiasis: an important food-borne zoonosis in China. Trends Parasitol. 2008 Jul. 24(7):318-23. [Medline].
Boe DM, Schwarz MI. A 31-year-old man with chronic cough and hemoptysis. Chest. 2007 Aug. 132(2):721-6. [Medline].
Vidamaly S, Choumlivong K, Keolouangkhot V, Vannavong N, Kanpittaya J, Strobel M. Paragonimiasis: a common cause of persistent pleural effusion in Lao PDR. Trans R Soc Trop Med Hyg. 2009 Jan 29. [Medline].
Fischer PU, Weil GJ. North American paragonimiasis: epidemiology and diagnostic strategies. Expert Rev Anti Infect Ther. 2015 Jun. 13 (6):779-86. [Medline].
Rosen MJ. Chronic cough due to tuberculosis and other infections: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan. 129(1 Suppl):197S-201S. [Medline].
Robertson KB, Janssen WJ, Saint S, Weinberger SE. Clinical problem-solving. The missing piece. N Engl J Med. 2006 Nov 2. 355(18):1913-8. [Medline].
Cho AR, Lee HR, Lee KS, Lee SE, Lee SY. A case of pulmonary paragonimiasis with involvement of the abdominal muscle in a 9-year-old girl. Korean J Parasitol. 2011 Dec. 49(4):409-12. [Medline]. [Full Text].
Nakamura-Uchiyama F, Mukae H, Nawa Y. Paragonimiasis: a Japanese perspective. Clin Chest Med. 2002 Jun. 23(2):409-20. [Medline].
Xia Y, Ju Y, Chen J, You C. Cerebral paragonimiasis: a retrospective analysis of 27 cases. J Neurosurg Pediatr. 2014 Nov 7. 1-6. [Medline].
Diaz JH. Boil before eating: paragonimiasis after eating raw crayfish in the Mississippi River Basin. J La State Med Soc. 2011 Sep-Oct. 163(5):261-6. [Medline].
Tsang KW, File TM Jr. Respiratory infections unique to Asia. Respirology. 2008 Nov. 13(7):937-49. [Medline].
Xia Y, Chen J, Ju Y, You C. Characteristic CT and MR imaging findings of cerebral paragonimiasis. J Neuroradiol. 2016 Jun. 43 (3):200-6. [Medline].
Doanh PN, Dung do T, Thach DT, Horii Y, Shinohara A, Nawa Y. Human paragonimiasis in Viet Nam: epidemiological survey and identification of the responsible species by DNA sequencing of eggs in patients' sputum. Parasitol Int. 2011 Dec. 60(4):534-7. [Medline].
Kyung SY, Cho YK, Kim YJ, Park JW, Jeong SH, Lee JI, et al. A paragonimiasis patient with allergic reaction to praziquantel and resistance to triclabendazole: successful treatment after desensitization to praziquantel. Korean J Parasitol. 2011 Mar. 49(1):73-7. [Medline]. [Full Text].
Anonymous. Drugs for parasitic infections. Med Lett Drugs Ther. 2004 Aug. 46(1189):1-12.
Blair D, Xu ZB, Agatsuma T. Paragonimiasis and the genus Paragonimus. Adv Parasitol. 1999. 42:113-222. [Medline].
Calvopina M, Guderian RH, Paredes W, Chico M, Cooper PJ. Treatment of human pulmonary paragonimiasis with triclabendazole: clinical tolerance and drug efficacy. Trans R Soc Trop Med Hyg. 1998 Sep-Oct. 92(5):566-9. [Medline].
Christie JD, Garcia LS. Emerging parasitic infections. Clin Lab Med. 2004 Sep. 24(3):737-72. [Medline].
Dainichi T, Nakahara T, Moroi Y, et al. A case of cutaneous paragonimiasis with pleural effusion. Int J Dermatol. 2003 Sep. 42(9):699-702. [Medline].
Hawn TR, Jong EC. Update on Hepatobiliary and Pulmonary Flukes. Curr Infect Dis Rep. 1999 Dec. 1(5):427-433. [Medline].
Kagawa FT. Pulmonary paragonimiasis. Semin Respir Infect. 1997 Jun. 12(2):149-58. [Medline].
Maguire JH. Trematodes (Schistosomes and other Flukes). Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2004. Vol 2: 3283-4.