Clinical Studies on Human Lung Fluke Disease (Endemic Hemoptysis) Caused by Paragonimus Westermani Infestation

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Abstract
Summary and Conclusions Human lung fluke disease (endemic hemoptysis) is characterized by cough, hemoptysis and the ova of Paragonimus westermani in the sputum of a patient with almost no other symptoms—physical and roentgen-ray examinations being essentially negative. The history may indicate having lived in a district where lung fluke disease is endemic. In many patients on a percussion of the chest, it is possible to demonstrate hyperresonance of varying degree, but the breath sounds are essentially normal. The blood examination shows a moderate degree of leucocytosis and an essentially normal differential count. There is only a very slight degree of anemia. Other symptoms which have been recorded are: fever, chills, night sweats, shortness of breath, distress in the chest, loss of appetite, loss of weight, and indigestion. These symptoms occurred in not more than half of the patients studied, and form no part of the clinical entity of pulmonary distomiasis. They are more or less coincident symptoms, and may be associated with some other pulmonary condition. Other lung conditions may be superimposed upon or coincident with pulmonary distomiasis and, under these conditions, the symptoms, physical examination and roentgen-ray findings partake largely of the nature of the other disease. A careful history and physical examination with repeated sputum examinations will, in most cases, reveal the presence of Paragonimus westermani infestation, if present. The differential diagnosis includes among others: bronchiectasis, tuberculosis, penumonia, mitral stenosis, myocarditis, pleurisy with or without effusion, lung absecess, amebic abscess of the lung, infestations of the lung due to the presence of the larvae of ascaris, bilharzia, or filaria. Roentgen-ray examinations in 39 uncomplicated cases of pulmonary distomiasis failed to show any shadows typical of this disease. Lipiodol oil instillations in 6 cases failed to demonstrate any dilation of the bronchi or connection with cavities except in one instance—there were two small pools of oil in the upper right lobe. Treatment has been mainly by the use of emetine in two courses consisting of 1 grain (0.06 gram) daily by hypodermic injection for 7 days, with a period of 1 week's rest, then a repetition of the treatment. Intravenous administration of emetine is absolutely contra-indicated in pulmonary distomiasis. Lipiodol oil instillations into the bronchi for diagnostic purposes seemed to give a measure of relief from the symptoms of cough, and in 1 case the patient stated that the bloody discharge was less. From experience to date, the instillation of oil seems to be well tolerated, but its therapeutic value can be determined only after extensive clinical trial with control observations. One negative sputum or stool examination is an insufficient criterion on which to base the statement that the patient is “cured.” Up to the present, it is not possible to point to a single case which has been “cured,” although many seem to be improved. Most of these patients under times of stress and strain, fatigue, or other unfavorable conditions, again develop blood-tinged sputum in the morning, and the ova again make their appearance, even after a lapse of several years.

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