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Retrospective study of pleural parasitic infestations: a practical diagnostic approach.
BMC Infect Dis 2019; 19(1):576BI

Abstract

BACKGROUND

Pleural parasitic infestation (PPI) is a disease prevalent in certain parts of the world. It is frequently misdiagnosed due to its lack of standardized diagnostic criteria. The purpose of this study was to evaluate the clinical characteristics of PPI patients and develop a practical diagnostic approach for PPI.

METHODS

A retrospective study was conducted by reviewing the medical records of 11 patients with PPI. A practical diagnostic approach was proposed based on the unique laboratory findings.

RESULTS

All patients demonstrated respiratory symptoms, including shortness of breath, cough, fever, chest pain, excessive sputum and hemoptysis. Leukocytosis (> 10,000/μL) and eosinophilia (> 500/μL) of peripheral blood were present in 45.5 and 36.4% patients, respectively. The mean concentrations of pleural effusion lactate dehydrogenase (LDH), adenosine deaminase (ADA), protein and carcinoembryonic antigen (CEA) were 338.2 U/L (range, 61-667 U/L), 11.6 U/L (range, 0.1-28.2 U/L), 43.7 g/dL (range, 21.9-88.1 g/dL), and 1.84 mg/mL (range, 0.28-4.8 mg/mL), respectively. The mean percentage of eosinophils in the pleural effusion was 19.5% (10.5-41%). Blood test was positive for parasite-specific IgG antibody in 9 patients, including 4 for Paragonimus westermani, 3 for Taenia solium, 1 for Clonorchis sinensis and 1 for Echinococcus granulosus. Eggs of Clonorchis sinensis were detected in the stool of two patients. Sparganum was found in the pleural effusion of one patient. Respiratory symptoms and abnormal appearances in pulmonary radiographic examination were disappeared in all patients who received anti-parasitic treatment.

CONCLUSIONS

In patients with unexplained pleural effusion, parasite-specific IgG antibody tests should be performed when pleural fluid testing shows eosinophilic pleural effusion. It is preferable to consider the diagnosis of PPI in clinical practice when serum parasite-specific IgG antibody test is positive.

Authors+Show Affiliations

Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.Department of Cardiothoracic Surgery, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, Guangdong Province, China. drjxhe@126.com.Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31272486

Citation

Wang, Jinlin, et al. "Retrospective Study of Pleural Parasitic Infestations: a Practical Diagnostic Approach." BMC Infectious Diseases, vol. 19, no. 1, 2019, p. 576.
Wang J, Luo W, Shen P, et al. Retrospective study of pleural parasitic infestations: a practical diagnostic approach. BMC Infect Dis. 2019;19(1):576.
Wang, J., Luo, W., Shen, P., He, J., & Zeng, Y. (2019). Retrospective study of pleural parasitic infestations: a practical diagnostic approach. BMC Infectious Diseases, 19(1), p. 576. doi:10.1186/s12879-019-4179-9.
Wang J, et al. Retrospective Study of Pleural Parasitic Infestations: a Practical Diagnostic Approach. BMC Infect Dis. 2019 Jul 4;19(1):576. PubMed PMID: 31272486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrospective study of pleural parasitic infestations: a practical diagnostic approach. AU - Wang,Jinlin, AU - Luo,Weizhan, AU - Shen,Panxiao, AU - He,Jianxing, AU - Zeng,Yunxiang, Y1 - 2019/07/04/ PY - 2018/05/21/received PY - 2019/06/11/accepted PY - 2019/7/6/entrez PY - 2019/7/6/pubmed PY - 2019/9/10/medline KW - Eosinophilic pleural effusion KW - Pleural effusion KW - Pleural parasitic infestation SP - 576 EP - 576 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 19 IS - 1 N2 - BACKGROUND: Pleural parasitic infestation (PPI) is a disease prevalent in certain parts of the world. It is frequently misdiagnosed due to its lack of standardized diagnostic criteria. The purpose of this study was to evaluate the clinical characteristics of PPI patients and develop a practical diagnostic approach for PPI. METHODS: A retrospective study was conducted by reviewing the medical records of 11 patients with PPI. A practical diagnostic approach was proposed based on the unique laboratory findings. RESULTS: All patients demonstrated respiratory symptoms, including shortness of breath, cough, fever, chest pain, excessive sputum and hemoptysis. Leukocytosis (> 10,000/μL) and eosinophilia (> 500/μL) of peripheral blood were present in 45.5 and 36.4% patients, respectively. The mean concentrations of pleural effusion lactate dehydrogenase (LDH), adenosine deaminase (ADA), protein and carcinoembryonic antigen (CEA) were 338.2 U/L (range, 61-667 U/L), 11.6 U/L (range, 0.1-28.2 U/L), 43.7 g/dL (range, 21.9-88.1 g/dL), and 1.84 mg/mL (range, 0.28-4.8 mg/mL), respectively. The mean percentage of eosinophils in the pleural effusion was 19.5% (10.5-41%). Blood test was positive for parasite-specific IgG antibody in 9 patients, including 4 for Paragonimus westermani, 3 for Taenia solium, 1 for Clonorchis sinensis and 1 for Echinococcus granulosus. Eggs of Clonorchis sinensis were detected in the stool of two patients. Sparganum was found in the pleural effusion of one patient. Respiratory symptoms and abnormal appearances in pulmonary radiographic examination were disappeared in all patients who received anti-parasitic treatment. CONCLUSIONS: In patients with unexplained pleural effusion, parasite-specific IgG antibody tests should be performed when pleural fluid testing shows eosinophilic pleural effusion. It is preferable to consider the diagnosis of PPI in clinical practice when serum parasite-specific IgG antibody test is positive. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/31272486/Retrospective_study_of_pleural_parasitic_infestations:_a_practical_diagnostic_approach L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4179-9 DB - PRIME DP - Unbound Medicine ER -