Cerebral Paragonimiasis In Children:a Clinical Analysis(Clinical Report Of 212 Cases)

Objective:Analyses the epidemiology features,clinical manifestation, laboratory tests,imaging examinations,treatment and prognosis about children’scerebral paragonimiasis in Chongqing and surrounding areas.Method:A retrospective analysis of 212 children with cerebral paragonimiasis, from January 2004 to January 2014,was conducted to investigate it’s epidemiology features,clinical manifestations,treatment and prognosis.Results:Most of the 212 cases distributed in northeast and southern areas of Chongqing,east area of Sichuan province, age range from 1.8-14.3 years.Sex:male 155(73.1%),female 57 (26.9%).152 (71.7%) patients with positive epidemiology history. Cerebral paragonimiasis accounted for 19.5% of the total paragonimiasis(1085 cases) that admitted to our hospital in the corresponding period. Central nervous system manifestations: intracranial hypertension symptoms 169 cases(79.7%), convulsions 54 cases (25.5%), paralysis 45 cases (21.2%).Other manifestations:fever 78 cases(36.8%),lung symptoms49 cases(23.1%),migratory subcutaneous nodule 21 cases(9.9%). Laboratory tests:increased eosinophil ratio 178 cases(84.0%), positive paragonimiasis associated immunological tests 119 cases(95.2%). Lumber puncture was conducted in 97 cases,73 cases(75.3%) was found increased white blood cell ratio in cerebralspinal fluids, whereas eosinophil count incresed only in 41 cases(42.3%). Imaging examinations: 114 cases(87.0%) have positive findings among the 131 cases with head CT, the most common manifestation is intracranial hemorrhage (ICH) and cystic lesions with ring-enhanced.125 cases have received head MRI and all of them with positive findings,such as nodosity lesion and "tunnel". All diagnosed as cerebral paragonimiasis children were treated with Praziquantel for 6-8 courses and adjusted according to clinical effect. However, there are 25 cases(11.8%) received operation therapy.21 cases of them were conducted hematoma dissection, the other were exploratory craniotomy. Followed up 6 months to 4 years, valid 167 cases(78.8%).Prognosis:eusemia 126 cases (75.4%), secondary epilepsy 17 cases(10.2%),hemiplegia 13 cases (7.8%),facial palsy 5 cases(3.0%), recurrence 6 cases(3.6%).Conclusion:Children erebral paragonimiasis in Chongqing and surroundings mainly distributed in northeast and southern areas of Chongqing,east area of Sichuan. Boys in School age are the vulnerable population. Hypertension intracranial,convulsions,convulsions are the most common symptoms, some of them may accompanied other respiratory system or skin symptoms, which may cause misdiagnosis or missed diagnosis. Positive epidemiology history, imaging examinations, increased eosinophil ratio and paragonimiasis associated immunological tests play an important role in the diagnosis of children cerebral paragonimiasis. Most of the cerebral paragonimiasis children have favorable prognosis if they are diagnosed in time and received regulatory treatment.