Paragonimus kellicotti Flukes in Missouri, USA

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Release date: July 20, 2012; Expiration date: July 20, 2013

Learning Objectives

Upon completion of this activity, participants will be able to:
• Analyze the epidemiology and microbiology of paragonimiasis
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AUTHORS

Disclosures: Michael A. Lane, MD, MSc; Luis A. Marcos, MD; Nur F. Onen, MBChB, MRCP; Lee M. Demertzis, MD; Samuel Z. Davila, MD; Diana R. Nurutdinova, MD; Thomas C. Bailey, MD; and Gary J. Weil, MD, have disclosed no relevant financial relationships. Erika V. Hayes, MD, has disclosed the following relevant financial relationships: received grants for clinical research from: Gilead Sciences: grant funding for ED Adolescent Rapid HIV testing project, which is now complete.

Parasites articles
Volume 18, Number 8–August 2012

Paragonimus kellicotti Flukes in Missouri, USA - Vol. 18 No. 8 - August 2012 - Emerging Infectious Disease journal - CDC

Paragonimus kellicotti Flukes in Missouri, USA

Michael A. Lane

, Luis A. Marcos, Nur F. Onen, Lee M. Demertzis, Ericka V. Hayes, Samuel Z. Davila, Diana R. Nurutdinova, Thomas C. Bailey, and Gary J. Weil

Author affiliations: Washington University School of Medicine, St. Louis, Missouri, USA (M.A. Lane, L.A. Marcos, N.F. Onen, L.M. Demertzis, E.V. Hayes, S.Z. Davila, D.R. Nurutdinova, T.C. Bailey, G.J. Weil); and John Cochran Veterans Administration Medical Center, St. Louis (D.R. Nurutdinova)

Abstract

Paragonimiasis is an infection caused by lung flukes of the genus Paragonimus. In Asia, P. westermani infections are relatively common because of dietary practices. However, in North America, cases of paragonimiasis, which are caused by P. kellicotti flukes, are rare. Only 7 autochthonous cases of paragonimiasis were reported during 1968–2008. In 2009, we reported 3 new case-patients with paragonimiasis who had been seen at our medical center over an 18-month period. Six additional case-patients were identified in St. Louis, Missouri, USA, and treated at Washington University–affiliated health centers in 2009–2010. We report detailed descriptions of these case-patients, which includes unusual clinical manifestations. We also describe public health interventions that were undertaken to inform the general public and physicians about the disease and its mode of transmission.

Paragonimiasis is an infection caused by lung flukes of the genus Paragonimus. As many as 9 species of Paragonimus are responsible for human infections worldwide (1). Human paragonimiasis is common in Asia, where diets often include raw, cured, pickled, or salted crustaceans (2,3). In contrast, consumption of uncooked crustaceans is uncommon in North America.
In North America, paragonimiasis is caused by Paragonimus kellicotti flukes (4). Paragonimus spp. lung flukes have a complex life cycle, requiring snail and crustacean intermediate hosts. Definitive hosts excrete eggs in feces or sputum, which hatch in water to become ciliated miracidia. The miracidia invade soft tissue of snails where they reproduce asexually. Cercariae released from snails invade the secondary intermediate host, a crustacean. Secondary intermediate hosts for P. kellicotti flukes are crayfish in the genera Cambarus and Orconectes. Mammals acquire the infection when they ingest raw or undercooked crustaceans (5). P. kellicotti fluke infections have been found in cats, dogs, bobcats (6), raccoons (7), foxes (8,9), skunks (9), minks (9,10), and coyotes (9). Human infections are uncommon; only 7 cases were reported during 1968–2008 (2,11–18)
In 2009, we reported a cluster of 3 patients who had probable or proven paragonimiasis caused by P. kellicotti flukes and who were seen at a single tertiary-care center over an 18-month period (19). We report an additional 6 patients seen at Washington University Medical Center, St. Louis, Missouri, and at an affiliated Veterans Administration hospital over 14 months (September 2009–October 2010). The purpose of this report is to emphasize that P. kellicotti flukes are an emerging pathogen in Missouri, to highlight unusual clinical features observed in these patients, to educate the public in hopes of preventing new cases, and to increase awareness among the medical community to promote early diagnosis and treatment.