PARAGONIMIASIS

infection caused by Paragonimus westermani, or lung fluke, a parasitic worm some 8 to 12 mm (0.3 to 0.5 inch) long. It is common in Japan, Korea, China, the Philippines, and Indonesia and has also been reported in parts of Africa and South America. The worm lives in the lungs of the infected individual, where it produces small cysts with fibrous walls. When a cyst in the lung ruptures, the eggs of the worm are coughed up in the sputum, some of which is swallowed so that the eggs are passed in the feces. Finding their way to water, the eggs hatch into larvae, which then infect water snails. When the larvae emerge from the snails, they enter and infect freshwater crabs and crayfish. Humans acquire the infection by eating undercooked crab or crayfish harbouring the fluke larvae. The pulmonary lesions and symptoms resemble those of tuberculosis in many respects. Definitive diagnosis is obtained by finding the fluke eggs in the sputum, which may be bloodstained and purulent. In heavy infestations, lesions may also be found in the liver, skeletal muscle, and brain. Bithionol is an effective therapeutic drug used against the fluke. In the absence of reinfection, gradual recovery takes place after the worms die. Prevention consists of the thorough cooking of shellfish; salting, pickling, or soaking in rice wine is usually not effective in killing the infective larvae.