Clinical Analysis Of681Children Cases Of Paragonimiasis In Chongqing And Near Areas

Objective: To summarize the clinical features and explore the causesof misdiagnosis of the paragonimiasis in children.Method:681confirmed cases of Paragonimiasis in the past12yearsfrom Children’s Hospital of Chongqing Medical University wereretrospectively analyzed.Results: Among the681cases, boy accounted for72.6%. and the agebetween2to8years old accounted for62.5%. Seventy-one point onepercent of the patient had clear raw or uncooked crabs ingesting history.The average incubation period was20days to5years, average12.6months. Fifty-eight point eight percent of the children had sub-acutedisease onset. The clinical manifestations were complex and diverse.Mixed type, extrapulmonary type and pleuropulmonary type accountedfor57.4%,26.4%and16.2%, respectively. The most frequently involvedpart was pleuropulmonary, then subcutaneous tissue, pericardium, centralnervous system and abdomen. Eighty-seven percent of patients wereadmitted to hospital mostly because of subcutaneous mass, cough,abdominal pain, headache, vomiting, convulsions, paralysis and unconsciousness. The rest of13.0%patients were hospitalized due toabnormal findings of physical exam or atypical manifestations likerecurrent fever, edema, anorexia, weight loss, chest pain, shortness ofbreath and abdominal distension. Sixteen point nine percent of thechildren had fever, mostly moderate fever, in these children36.1%lad afever lasting for less than1week. Forty-nine percent of the children hadliver enlargement, and8.5%had spleen enlargement. Seventy-one pointsix percent of children had elevated white blood cells,92.5%of childrenhad increased the proportion of eosinophils, and93.6%of the children hadabsolutely increased number of eosinophils. For-hundred and forty cases(64.6%) had effusion, in which190cases (43.2%) had multi-cavityeffusion, the most effusion test showed exudation, most effusion testshowed elevated eosinophils. Eighty-two percent of the patients hadabnormal chest X-ray film, ninty-eight had abnormal chest CT. Amongcerebral paragonimiasis,43.3%head CT scan and30.8%head MRIshowed intracranial hemorrhage. Forty-four point eight percent of thechildren had abnormal chest film without any clinic manifestation.Eighty-six point six percent of children who underwent immunologyexamination were positive. The biopsy of43/257cases of masses,88casesof pericardial,12/135cases of brain tissue,15cases of pleural prompted alarge number of eosinophil infiltration, in some cases eosinophilic abscessand necrotic tunnel formed. Eighty-eight point six percent of the children were misdiagnosed before admission to our hospital. Eighty-five pointnine percent of the patient confirmed Paragonimiasis in one week, theaverage time before diagnosis was3.9days. The misdiagnosis rate of ourhospital was8.4%. The disease was usually misdiagnosed as tuberculosis.With the treatment of praziquantel, the disease had a high cure rate.Conclusion: Children paragonimiasis in Chongqing and thesurrounding areas are more common in boys, aged2-8years,epidemiological data is important; Clinical manifestations ofparagonimiasis are complex and diverse, mixed type is the most conmon,followed by mass type, pericardium type, cerebral type and abdominaltype；Intracranial hemorrhage is the main character in cerebral type，accompanied by edema, enhancement was seen in some cases. Somechildren with pleuropulmonary or central pathology change withoutcorresponding clinical manifestations； when there was elevation ofproportion or the number of eosinophils, paragonimiasis should beconsidered；paragonimiasis were most complicated with serous cavityeffusion, and the effusion are most exudative； The immunologicalexamination had high diagnostic value with high sensitivity and specificity;The pathological examination should be done if the condition permit；Thedisease was often misdiagnosed，with the treatment of praziquantel, thedisease had a high cure rate；...