Cerebral paragonimiasis: a retrospective analysis of 27 cases.
OBJECTIVE
The authors retrospectively analyzed the clinical characteristics, existing problems, and treatment experiences in recently diagnosed cerebral paragonimiasis (CP) cases and sought to raise awareness of CP and to supply reference data for early diagnosis and treatment.


METHODS
Twenty-seven patients (22 male and 5 female; median age 20.3 years, range 4-47 years) with CP were diagnosed between September 2008 and September 2013. These diagnoses were confirmed by IgG enzyme-linked immunosorbent assays. Follow-up was performed in 24 cases for a period of 6-56 months.


RESULTS
Cerebral paragonimiasis accounted for 21.6% of paragonimiasis cases (27 of 125). The average duration from onset to praziquantel treatment was 69 days. All patients resided in rural areas. Twenty patients had positive lung results, which included visible lung lesions in 14 cases. The lesions were surgically removed in 8 of these cases. Twenty-four patients had high eosinophil counts (≥ 0.08 × 10(9)/L), and eosinophilic meningitis was noted in 17 cases. The rate of misdiagnosis and missed diagnosis was 30.4%. Most symptoms were markedly improved after treatment, but mild movement disorders combined with impaired memory and personality changes remained in a small number of patients.


CONCLUSIONS
Clinicians should be alert to the possibility of CP in young patients (4-16 years) with the primary symptoms of epilepsy and hemorrhage. Early diagnosis and timely treatment can reduce the need for surgery and further impairments to brain function. Liquid-based cytological examination of CSF and peripheral blood eosinophil counts can aid in differentiating CP from similar lesions.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
Yong
Y
Xia
Yan
Y
Ju
Jing
J
Chen
Chao
C
You
D000293:Adolescent; D000328:Adult; D000871:Anthelmintics / Q000627:therapeutic use; D020807:Central Nervous System Parasitic Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002681:China; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004797:Enzyme-Linked Immunosorbent Assay; D004827:Epilepsy / Q000469:parasitology*; D005260:Female; D006801:Humans; D008174:Lung Diseases, Parasitic / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010237:Paragonimiasis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D010784:Photomicrography; D011223:Praziquantel / Q000627:therapeutic use; D012189:Retrospective Studies; D012424:Rural Population; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D000871:Anthelmintics; D011223:Praziquantel
CP = cerebral paragonimiasis; ELISA = enzyme-linked immunosorbent assay; Paragonimus skrjabini; Paragonimus westermani; cerebral paragonimiasis; infection; praziquantel; surgery