title: Severe Pleuropulmonary Paragonimiasis Caused by Paragonimus mexicanus Treated as Tuberculosis in Ecuador.
abstract: A 30-year-old male, from a subtropical region of Ecuador, was hospitalized with a 5-year history of persistent cough with rusty brown sputum, chest pain, and progressive dyspnea. The patient underwent thoracic surgery 3 years ago for pleural effusion and subsequently received a 9-month regimen treatment of tuberculosis. However, there was no clinical resolution and symptoms became progressively worse. A chest radiograph and computerized tomography scan showed several small nodules in both lungs. Eggs of Paragonimus spp. were observed in sputum smears, but the smears were negative for acid-fast bacilli. Molecular characterization of eggs by the internal transcribed spacer-2 regions identified them as Paragonimus mexicanus The patient was treated with praziquantel and tested negative parasitologically for 12 months. There was clinical resolution of the cough and expectoration, but dyspnea and chest pain persisted.
authors.affiliation: Unidad de Parasitología Molecular y Medicina Tropical, Carrera de Medicina, Universidad De Las Américas (UDLA), Quito, Ecuador. manuelcalvopina@gmail.com manuel.calvopina@udla.edu.ec.
authors.forename: Manuel
authors.initials: M
authors.lastname: Calvopina
authors.affiliation: Unidad de Parasitología Molecular y Medicina Tropical, Carrera de Medicina, Universidad De Las Américas (UDLA), Quito, Ecuador.
authors.forename: Daniel
authors.initials: D
authors.lastname: Romero-Alvarez
authors.affiliation: Hospital Carlos Andrade Marín, Instituto Ecuatoriano de Seguridad Social, Quito, Ecuador.
authors.forename: Rubén
authors.initials: R
authors.lastname: Macias
authors.affiliation: Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D000818:Animals; D004484:Ecuador / Q000453:epidemiology; D006801:Humans; D008174:Lung Diseases, Parasitic / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology*; D008297:Male; D010237:Paragonimiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D010238:Paragonimus / Q000145:classification / Q000302:isolation & purification*; D010995:Pleural Diseases / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology*; D011223:Praziquantel / Q000627:therapeutic use
chemical_list: D011223:Praziquantel