Paragonimiasis Treatment & Management

Updated: Oct 11, 2019
  • Author: Seth D Rosenbaum, MD; Chief Editor: Russell W Steele, MD  more...
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Treatment

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.

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Surgical Care

Extrapulmonary lesions should be surgically excised.

An intraventricular shunt may be needed to manage hydrocephalus.

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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
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Activity

Activity should be based on patient tolerance.

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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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Long-Term Monitoring

Follow up initial treatment after a few weeks.

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