Chinese Medical Journal

RECENT ADVANCES IN DIAGNOSIS OF PARAGONIMIASIS 13

and afternoon fever. He recovered spontaneously after a week. In June 1954 he was fiuoroscoped at the hospital where he worked and was found to have pleural fluid in the right chest cavity. He was admitted to the Central People’s Hospital on October 29, 1954 for cough and hemoptysis.

Physical examination. Well developed and well nourished. Skin normal. No general glandular enlargement. Left submaxillary lymph glands were palpable and tonsils enlarged. Trachea was in the middle. Slight dullness was found in the right upper chest and dullness from the seventh thoracic vertebra downward. Respiratory sound was diminished. No rales. The heart was normal. The liver was found to be enlarged one finger breadth below the right costal margin. The spleen was just felt. Knee jerks normal. Body temperature 36C. Blood pressure 118/70. Hemoglobin 14.8 gm. Leukocytes were 6,700 with 71 per cent of polymorphonuclear neutrophils and 4 per cent of eosinophils. Urine and stools were normal; the latter contained no ova. EKG showed suspicious evidence of incomplete right bundlebranch block and myocardial damage. X-ray of chest showed evidence of rightsided pleurisy with effusion. Tubercle bacilli were found in the sputum. Repeated examinations of the latter failed to show paragonimus ova. Clinical - diagnosis: pulmonary tuberculosis and tuberculous pleurisy with pleural effusion. In view of the fact that the patient had been to endemic areas of paragonimiasis, the serum complement fixation test and the intradermal test for paragonimiasis were done. The results of both tests were strongly positive. Further examinations of the sediments of the pleural fluid showed presence of paragonimus ova. The patient was therefore suffering not only from pulmonary tuberculosis but also from para-

gonimiasis. The latter diagnosis would have been missed if the three diagnostic methods had not been used.

Case 5. Patient Hsi, a male of 27 from Shansi province, began to have frequent dull pain around the umbilicus and severe attacks of hematemesis in the spring of 1951. The symptoms became worse in 1952 and he was unable to work. However, he had neither cough nor chest pain. In 1953 his stool was found to contain blood. He had been treated elsewhere in two different hospitals on many occasions as a case of peptic ulcer without any success. In the same year two small intra-abdominal masses were found on the left side of the umbilicus and the patient vomited blood. His lungs were normal. On January 17, 1955 he was admitted to the Chinese Union Medical College Hospital for severe abdominal pain.

Examination on admission. Development and nutrition normal. Chest not remarkable. Tenderness over right side of abdomen. An elongated mass was felt in the left umbilical area. Liver edge was just palpable. Other findings were normal.

During hospitalization, the patient was subjected to x-ray examination of the chest, bronchoscopy, biopsy of lymph nodules, examination of gastric juice and bile fluid, liver function test, cholecystography and rectal biopsy. The results were all normal. There was no sputum. Repeated examinations of the stools for paragonimus ova gave negative results. Except for an increase of eosinophils to 45 per cent, the blood picture was normal. Because of the unexplained eosinophilia the patient was subjected to the intradermal test and the complement fixation test of the serum for paragonimiasis. Unexpectedly, both results turned out to be strongly positive. Our attention was therefore focused on the diagnosis of paragonimiasis. On being further questioned, the patient admitted that on four different occasions from April to July 1950 he had eaten raw crabs caught from a brook in Wenkiang district some 20 miles from Chengtu in Szechuan province. Each time he ate 2 or 3