eMedicine Specialties > Pediatrics: General Medicine > Parasitology
Paragonimiasis: Treatment & Medication
Updated: Apr 10, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Antiparasitic therapy is the mainstay of paragonimiasis treatment.
- Therapy may also be required for seizures caused by an inflammatory reaction to dying worms in the setting of cerebral paragonimiasis.
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.
- Pulmonologist
- Neurologist
- Surgeon
- Neurosurgeon
Activity
- Activity should be based on patient tolerance.
Medication
Antiparasitic agents
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
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%.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).7 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.7
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.
Praziquantel (Biltricide)
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.
Adult
25 mg/kg PO tid for 2 d
Pediatric
Administer as in adults
Hydantoins may reduce serum praziquantel concentrations, possibly leading to treatment failures
Documented hypersensitivity; ocular cysticercosis
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Destruction of parasite within eyes can cause irreparable lesions (do not treat ocular cysticercosis with praziquantel); caution while driving or performing other tasks requiring alertness on day of and day following treatment; minimal increases in liver enzymes reported; when schistosomiasis or fluke infection associated with cerebral cysticercosis occurs, hospitalize patient for duration of treatment; use during pregnancy only if clearly indicated; do not breastfeed during or 72 h after treatment; seizures and coma have been observed because of an inflammatory reaction that accompanies worm death (add corticosteroids when treating cerebral paragonimiasis to reduce this reaction); frequent adverse effects include abdominal pain, diarrhea, malaise, dizziness, and headache; other adverse effects include fever, nausea, rash, and pruritus
More on Paragonimiasis |
| Overview: Paragonimiasis |
| Differential Diagnoses & Workup: Paragonimiasis |
 Treatment & Medication: Paragonimiasis |
| Follow-up: Paragonimiasis |
| Multimedia: Paragonimiasis |
| References |
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References
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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. Jan 29 2009;[Medline].
Rosen MJ. Chronic cough due to tuberculosis and other infections: ACCP evidence-based clinical practice guidelines. Chest. Jan 2006;129(1 Suppl):197S-201S. [Medline].
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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. Sep-Oct 1998;92(5):566-9. [Medline].
Anonymous. Drugs for parasitic infections. Med Lett Drugs Ther. Aug 2004;46(1189):1-12.
Blair D, Xu ZB, Agatsuma T. Paragonimiasis and the genus Paragonimus. Adv Parasitol. 1999;42:113-222. [Medline].
Christie JD, Garcia LS. Emerging parasitic infections. Clin Lab Med. Sep 2004;24(3):737-72. [Medline].
Dainichi T, Nakahara T, Moroi Y, et al. A case of cutaneous paragonimiasis with pleural effusion. Int J Dermatol. Sep 2003;42(9):699-702. [Medline].
Hawn TR, Jong EC. Update on Hepatobiliary and Pulmonary Flukes. Curr Infect Dis Rep. Dec 1999;1(5):427-433. [Medline].
Kagawa FT. Pulmonary paragonimiasis. Semin Respir Infect. Jun 1997;12(2):149-58. [Medline].
Maguire JH. Trematodes (Schistosomes and other Flukes). In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Vol 2. 6th ed. Philadelphia, PA: Churchill Livingstone; 2004:3283-4.
Nakamura-Uchiyama F, Mukae H, Nawa Y. Paragonimiasis: a Japanese perspective. Clin Chest Med. Jun 2002;23(2):409-20. [Medline].
Further Reading
Keywords
paragonimiasis, Paragonimus, Paragonimus westermani, P westermani, Oriental lung fluke, parasitic infection, trematodes, paragonimiasis, inflammation of the lung, treatment, diagnosis, pneumonia, bronchitis, bronchiectasis, bronchitis, bronchiectasis, pleural effusion, empyema, abdominal pain, diarrhea, urticaria, facial palsy, seizures, optic atrophy, hematuria, hernia
