Chinese Medical Journal

a THE CHINESE MEDICAL JOURNAL

little sputum. He had not been treated previously with either antimony preparations or emetine hydrochloride.

Physical examination on admission. Body temperature 37.3 C. Body weight 64 pounds. Moderately developed and nourished. The patient was mentally clear but depressed. Skin normal. No general.edema of lymph glands. Pupils were equal with normal reaction to light. Mild trachoma O.U. Ears, nose, and throat were all normal. Neck slightly stiff. No cardiac enlargement. No murmurs. Blood pressure 100/56 mm of mercury. Lungs clear. Abdomen flat without tenderness. Liver and spleen were not palpable. No fluid was found in the abdomen. The spine, the extremities, the rectum, the genitalia, and the tendon reflexes were all normal.

Neurological findings. Cranial nerves ineluding visual field and eyeground examinations were normal. The deep and superficial sensations in general were also normal. The right upper and lower limbs showed a weakness of muscular tone without atrophy. Chaddock’s and Babinski’s signs were positive on both sides.

Laboratory findings. Hemoglobin 14 gm. Erythrocytes 4,410,000. Leukoeytes 5,850. Neutrophils 40 per cent. Lymphocytes 38 per cent. Hosinophils 16 per cent. Monocytes 6 per cent. Urine normal. The thymol turbidity test showed a reading of 8 Maclagan units. Non-protein nitrogen 26 mg per cent. Cholesterol 218 mg per cent. Plasma albumin 4.62 gm per cent and plasma globulin 2.32 9m per cent. Blood sedimentation rate normal.

On the second day of admission roentgenography revealed a normal skull. A chest film showed a few nodular shadows with irregular calcified spots in the upper region of the right hilum. Cardio-diaphragmatic angle also showed irregular nodular shadows. Electrocardiogram showed normal findings. Cerebrospinal fluid was clear and colorless. Pandy’s test negative. Sugar positive in all five tubes. Total cells 4. Leukocytes 2. Paragonimiasis complement fixation tests of the serum and the cerebrospinal fluid were negative. Repeated examinations of sputum and feces showed no paragonimus ova. Nor was tubercle bacillus found in the sputum. However, Charcot-Leyden crystals were found. On April 6 an intradermal test with paragonimus antigen (1:250) gave a strongly positive reaction. On April 22 and May 3 a few paragonimus ova were found in the sputum, and diagnosis of paragonimiasis was established.

The sputum of the patient had been repeatedly examined but no eges of the parasite were found. Paragonimiasis complement fixation tests of the serum and the cerebrospinal fluid were both negative. The fact that the patient had lived in an endemic area of paragonimiasis, the positive intradermal test, the eosinophilia and the presence of Charcot-Leyden crystals in the sputum all confirmed the diagnosis of paragonimiasis.

The sputum was examined daily with the concentration method for paragonimus ova, and only on the twenty-eighth day and thirty-third day after admission were a few ova found. Thus it is clear that odd cases of paragonimiasis with a negative complement fixation test and absence of paragonimus ova can be diagnosed by means of epidemiological data and the intradermal test.

Case 4. Patient Hsieh was a male of 28 and native of Hopei. He went to Korea in March 1951 and returned in March 1954. During his stay there he had eaten half-cooked crabs and drunk unboiled water. He began to have cough with dark ved blood clot and occasionally blood streaks since March 1953. Half a month later the symptoms disappeared. He had no chest pain, fever or dyspnea. However, in August of the same year, he felt ill again with pain in the right upper chest

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