Chinese Medical Journal

4 THE CHINESE MEDICAL JOURNAL

with the paragonimus antigen. Hence it appears that the test is more or less specific for the diagnosis of cerebral paragonimiasis.

Through the application of the three diagnostic procedures above outlined we were able to diagnose correctly many difficult cases of paragonimiasis which would have been missed otherwise. Six of these cases, two with summaries of autopsy findings, are especially instructive and are here reported.

REPORT OF CASES

CASE 1. Patient Chuan, a 9 year old Korean schoolboy was admitted to the - Central People’s Hospital on October 28, 1954 for fever, headache and vomiting for six months. In the spring of 1953 he had been sent to a convalescent home in the northeast for “infiltrated pulmonary tuberculosis.” In January 1954 he developed fever, mild headache, and vomiting. The symptoms became worse in May and the patient was occasionally in a state of coma. He was treated in a large hospital at Shenyang, where lumbar puncture showed the cerebrospinal fluid slightly turbid, and once “tubercle bacilli” were also said to have been found. His case was diagnosed as one of tuberculosis of the meninges. He was treated with 48 gm of streptomycin and rimifon of unknown dosage.

Physical examination showed that the patient was well developed and well nourished. The head organs, the heart and the lungs were normal. The neck was slightly stiff. The spleen and the liver were not palpable. Neurological findings were normal.

Laboratory findings. Erythrocytes 4,040,000. Hemoglobin 12 gm. Leukocytes 20,950. Eosinophils 20 per cent. Stool contained eggs of ascaris. Findings of cerebrospinal fluid were: appearance of ground glass, sugar positive for all five tubes —quantitatively 60 mg per cent, Pandy’s test 4 plus, leukocytes 238 per cu mm, polymorphonuclear neutrophils 81 per cent, and chloride 735 mg per cent. The erythrocytic sedimentation rate was 15 mm at the end of one hour. Electrocardiogram showed normal findings.

Roentgenograph of the chest taken after the patient’s admission showed no significant findings, and he was treated as a case of tuberculous meningitis. Rimifon orally and streptomycin intramuscularly and intrathecally were given. On November 19, the cerebrospinal fluid showed a reduction of leukocytes to 10 whereas Pandy’s test was still positive. He was twice subjected to the intradermal test for paragonimiasis during hospitalization, and the results were strongly positive. The complement fixation tests of the serum and.cerebrospinal fluid for paragonimiasis were also strongly positive. Repeated examinations of the cerebrospinal fluid, sputum, and gastric juice showed no paragonimus ova. A clinical diagnosis of paragonimiasis with cerebral involvement was finally made, and the patient was treated with chloroquine on November 18 at 0.225 gm daily by mouth gradually increasing to 0.45 gm. Eyeground examination on November 5 showed a bilateral edema of optic nerve head. However, re-examination made on November 31 showed normal findings. Roentgen examination of the chest made again on January 17, 1955 revealed a round, dense mass behind the cardiac shadow. Laminography of the chest on January 28 showed cavity formation not unlike that seen in paragonimiasis. By January 30, a total of 17.74 gm of chloroquine had been administered.

Beginning on January 30, 1955 the patient had headache and vomiting as well as conyulsion once. On the following day he went into coma. Neurological examination revealed enlargement of the pupils with the right larger than the left. Reaction