Chinese Medical Journal

Y THE CHINESE MEDICAL JOURNAL

Journal. Three symposia on paragonimiasis(9-11) have recently been published in the first two of these journals.

Paragonimiasis occurs in different clinical forms. The typical cases with chronic cough, hemoptysis and ova in the sputum are easy to recognize, but symptomless cases (including very mild cases, inapparent infection or latent cases, early cases, and spontaneously healed or therapeutically cured cases) and cases with most atypical or very obscure symptoms without expectoration or with slight expectoration but no ova in the sputum are usually either missed, wrongly diagnosed or confused with other conditions. The. various clinical forms of parago-

-nimiasis which — present diagnostic difficulties include the following groups of cases: 1. Cases with central nervous system involvement (cases simulating tuberculous meningitis, encephalitis, brain tumors, cerebral abscess, cerebral cysticercosis, idiopathic epilepsy, spinal neoplasm, and tuberculosis of the spine); 2. Cases with involvement of intrathoraciec structure simulating chronic bronchitis, bronchiectasis, pulmonary new growth, lung tuberculosis, acute or chronic pleurisy with or without pleural effusion, chronic adhesive pericarditis, spontaneous pneumothorax, pyothorax, polyserositis, etc.; 3. Cases with involvement of intra-abdominal structures simulating chronic tuberculous peritonitis, chronic enterocolitis, chronic appendicitis, intestinal adhesions with or without obstructive symptoms, hepatitis, liver abscess, sub-

-phrenie abscess, perisplenitis, and renal tuberculosis or neoplasm; 4. Cases with involvement of the superficial lymph nodes, cutaneous or subcutaneous structures simulating localized inflammatory swelling of the lymph glands, the skin, or subcutaneous tissues. To ensure correct diagnosis of such clinical forms of paragonimiasis, particularly those without expectoration or with sputa containing no ova, we propose the application of three important diagnostic procedures in the study of all suspected cases as follows: 1. Epidemiological considerations; 2. Intradermal test; 3. Complement fixation test.

1. Diagnostic importance of epidemiological data and considerations. Epidemiological data are of paramount importance in the diagnosis of all infectious diseases. This is especially true in the diagnosis of all parasitic or endemic diseases. Since human paragonimiasis is contracted through eating raw or under-cooked crabs or crayfish containing metacercariae of Paragonimus westermani and since such infected crabs and crayfish usually occur only in endemic areas, it is most important in diagnosis to ascertain whether patients suspected of the disease come from endemic regions and whether they have the habit of eating raw or inadequately cooked crabs or crayfish. With the rapid development of modern communications, clinicians in nonendemic areas have to be ever alert to the possibility of meeting cases from infected areas. We believe that any