Do you like to eat things like crabs and water crabs? Especially in our country, crab curry, crab oil, and spicy food make your mouth water, right? Similarly, some people also like things like raw or undercooked crab pickles and salads made with vinegar. But, did you know that there is a dangerous parasite that can enter our body through this delicious food and damage our lungs, especially? The disease caused by that parasite is called Paragonimiasis. Let's talk about this in a little more detail today.
What is Paragonimiasis? Simply put...
Simply put, Paragonimiasis is a parasitic infection caused by a flatworm (also known as a fluke) of the genus Paragonimus. You can get it if you eat raw, undercooked, or pickled crabs or crayfish.
This `Paragonimus` parasite usually affects your lungs the most . However, sometimes these worms can travel to your skin (cutaneous paragonimiasis) or your brain (cerebral paragonimiasis) and cause infections there too. What's more, the symptoms of this infection – such as coughing up blood, chest pain, and weight loss – can sometimes be easily confused with tuberculosis (TB) or lung cancer. That's why it's so important to get an accurate diagnosis.
Where is this parasite (Paragonimus) most common?
These `Paragonimus` worms are found in many parts of the world. They are also reported to be present in some parts of America and Canada. However, most cases of paragonimiasis are reported from some countries in Asia, Africa, and Latin America. So, it is important to be aware of this in the Asian region where we are.
What are the symptoms of Paragonimiasis?
Symptoms may start to appear between two and eight weeks after you are infected with this parasite. You may first experience stomach upset or digestive symptoms. Then, lung symptoms appear.
Here are some common symptoms:
- Fever.
- Chest pain.
- Tiredness, fatigue.
- Cough: This may start as a dry cough, then become severe enough to produce rusty-colored, or even bloody, phlegm .
- Losing weight without you trying.
- Stomach upset (diarrhea).
- Stomach pain.
- Small lumps that appear under the skin of the abdomen. These can be painful to touch, and may even feel like they are moving upwards, towards the chest.
Symptoms if the brain is affected (`Cerebral Paragonimiasis`)
If this `Paragonimus` parasite suddenly reaches your nervous system, that is, your brain and spinal cord, you may experience the following symptoms:
- Seizures .
- Headache .
- Vision problems such as double vision and blurred vision.
- Confusion, feeling as if consciousness is being disturbed.
- Vomiting.
- Neck stiffness, difficulty bending.
- Muscle weakness.
If these symptoms occur, it is essential to seek medical advice immediately.
Why does this paragonimiasis occur? What is the cause?
As we mentioned earlier, this is caused by a parasitic flatworm called `Paragonimus`. You get it from eating raw or undercooked crabs or freshwater crabs. Just think, the small `cysts` of these worms, which are the larvae (i.e., young ones), can be found in the crabs' meat or in their body fluids.
When you eat something like that, the larvae hatch from these eggs in your small intestine . Then, these larvae travel through the stomach wall, through the diaphragm (the membrane that separates the stomach and chest) and into your lungs. That's where they gradually grow and become adult worms.
Your body's immune system fights off these worms in your lungs, forming hard shells called cysts around them. This is like trying to trap an enemy. However, these cysts can sometimes burst, releasing blood, pus, and worm eggs into your lungs. This can often lead to secondary bacterial infections.
Is paragonimiasis contagious from person to person?
No. Remember this. Paragonimiasis is not a disease that can be transmitted from one person to another. You only get it if you eat food that contains the parasite, as we mentioned earlier.
What are the possible complications of this disease?
Complications from paragonimiasis are most often related to your lungs. Some of them include:
- Pneumonia
- Bronchiectasis - Widening of the airways.
- Lung abscess - A collection of pus and dead tissue inside the lung.
- Pleural effusion - The accumulation of fluid around the lungs.
- Empyema - A collection of pus around the lungs.
How does a doctor diagnose paragonimiasis?
A doctor will diagnose this disease by checking your body fluids or tissues for the presence of the parasite's eggs. This is usually done by:
- Sputum test: A sample of mucus from your lungs is taken and tested.
- Stool test: Sometimes worm eggs can be passed in the stool.
- Checking the fluid around the lungs (pleural fluid).
- Skin or other tissue sample testing: Sometimes, if there are skin lumps, a small piece of skin is taken and examined.
You may also have special imaging tests to look at your lungs and other organs that may be affected. Depending on your symptoms, you may also have a blood test to check for antibodies to the worm, or a cerebrospinal fluid test if your brain is affected.
What tests and methods are performed?
Your doctor may use tests and procedures like these:
- Blood tests
- Chest X-ray
- CT scan
- MRI scan `(MRI)`
- Bronchoscopy: This involves inserting a tube with a small camera into the trachea to look inside the lungs and take samples if necessary.
- Skin biopsy: If there is a skin lump, a small piece is taken and examined.
How is this treated?
The good news is that there is a treatment for paragonimiasis! Doctors use antiparasitic medications to treat it. The most common medications are Praziquantel or Triclabendazole .
Important: It is very important to take this medication exactly as prescribed by a doctor, for the prescribed period of time.
If you have cerebral paragonimiasis, a condition that affects the brain, doctors may also give you a medicine called corticosteroids to reduce inflammation in the brain and spinal cord. Very rarely, you may need surgery to remove the cysts that these worms have formed.
Can paragonimiasis be completely cured?
Yes, this is a curable disease. Studies done in Japan have shown that the drug Praziquantel can completely cure between 86% and 100% of `Paragonimus` infections. So, there is nothing to worry about, if you get the right treatment, you can be cured.
What should you expect if you develop this disease?
If you have paragonimiasis, you will usually be given a short course of antiparasitic medication, usually one to three days. However, sometimes if the medication does not completely eliminate the worms, your symptoms may return. If this happens, you will need to be treated again.
Is this dangerous if left untreated? Can it be fatal?
Yes, if left untreated, about 5% of patients with cerebral paragonimiasis, which affects the brain, may die. Therefore, if there are symptoms, it is not a good idea to delay seeking treatment.
How do you avoid paragonimiasis? (Prevention)
This is the most important part. To avoid this problem, you should avoid eating crabs and shellfish that are thought to be harboring the `Paragonimus` parasite. Remember, cooking food thoroughly is the best defense.
Be especially careful with these foods:
- Raw or undercooked crab.
- Pickled crab: There is a risk if it is not properly seasoned.
- Salted crab: This method may not kill the parasite.
- "Drunken" crab: This means crabs that have been marinated or soaked in alcohol, such as wine. Don't assume that the alcohol will kill the parasite.
- Crab juice: These are used in some places. They are dangerous if consumed raw.
Simply put, if you eat crabs and other shellfish, cook them well to a temperature above 63 degrees Celsius (145 Fahrenheit). That's when these parasites die.
When should I see a doctor?
If you have symptoms of paragonimiasis (the cough, chest pain, and fever we talked about earlier), see a doctor right away. Especially if you remember recently eating undercooked crab or mussels, tell your doctor about that. It can take anywhere from two weeks to two months for symptoms to appear, so don't forget to eat something you've eaten in the past.
When do you need to go to the Emergency Treatment Unit (ETU) ?
If you have one or more of these severe symptoms, go to the nearest emergency room immediately:
- High fever (over 103 degrees Fahrenheit/40 degrees Celsius).
- Severe chest pain.
- If you cough up blood.
- If you have seizures .
- If you feel confused or have an altered mental state.
These could be signs of a serious condition, so don't delay.
What are the important questions to ask the doctor?
When you go to see a doctor, it may be helpful to ask these questions:
- How long will it take for me to get better?
- How exactly should I take this medicine? (times to take it, before or after meals, etc.)
- What are the serious symptoms I should be concerned about? (i.e. symptoms that require seeing a doctor again)
- When should I come see you again? (For follow-up)
Finally, things to remember (Take-Home Message)
Paragonimiasis is a parasitic disease that can be contracted from eating undercooked crabs and freshwater crayfish. It most commonly affects the lungs, but can sometimes affect the brain and skin.
The best part is, it's very easy to prevent this. When eating things like crabs and mussels , the most important thing is to cook them thoroughly. Avoid raw, undercooked, or underseasoned with vinegar.
If you think you have symptoms of this disease, don't be afraid and see a doctor as soon as possible. There are good treatments for this, and if treated properly, it can be completely cured. Therefore, it is important to be a little careful about the food you eat and stay healthy. Do you understand?
` Paragonimiasis, lungworm disease, raw crab, freshwater crab, parasitic infections, coughing up blood, chest pain
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