In Russia, a parasite transmitted through crayfish began to spread among people
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The diagnosis of paragonimiasis is only known to a number of narrow specialists, but everything can change in the coming years. The parasitic disease, which in the 90s of the last century was found in 1-6% of the inhabitants of the Far East, and then disappeared somewhere, reasserted itself. At the same time, experts believe that the geography of the presence of the parasite is expanding and will continue to expand. The disease can last for years, periodically aggravating in the form of strange pneumonia. Diagnosis of the disease is difficult. Alexander Popov, an infectious disease specialist from Vladivostok, spoke about the situation with paragonimiasis and its prospects during the XV annual All-Russian Congress on Infectious Diseases.
Paragonimiasis is a disease caused by parasites of the trematode class of flukes. They are found in America, Africa, southeastern Eurasia and the Pacific Islands. In total, the genus Paragonimus has more than 50 species, but from 7 to 12 species and subspecies are dangerous for humans. When infected, they affect the lungs (the so-called eosinophilic pneumonia develops), subcutaneous tissue, skeletal muscles, and less often the brain or other organs. You can get infected through shellfish, crayfish, poorly processed meat of wild animals (boars, minks).
The first description of the disease dates back to 1879, but in Russia it has been known since 1928. Today, paragonimiasis is common in the south of the Far East, in Primorye, the Khabarovsk Territory, and the Amur Region. You can bring it from China, Thailand.
According to the infectious disease specialist Popov, an explosion in the incidence in our country was recorded in the 70-80s of the last century: in the summer, a lot of patients began to enter hospitals with unusual pneumonia that could not be treated with penicillin and other antibiotics. Patients’ blood tests revealed high levels of eosinophils. Russian researcher Galina Sukhanova became interested in these unusual cases. She asked the sick people in detail about their lifestyle and finally found out that they all ate raw crayfish. The fact is that in Vladivostok the dish “drunken crayfish” is very popular: raw arthropods are covered with salt, poured with red wine and put under oppression for half an hour. They say it’s very tasty. But also very dangerous.
Together with biologists from the Pacific Institute of Fisheries, Galina Sukhanova, animal experiments were carried out, as a result of which various forms of this disease were described in the Far East. Sometimes the larvae settle in the muscles, causing the larval form of the disease (the disease is asymptomatic). Muscle larvae are able to migrate into the lungs of the host: in this case, the pulmonary form of paragonimiasis begins, which manifests itself as pneumonia with a wet cough. Among other symptoms, such patients develop a toxic-allergic rash, sweating, weight loss, neurological symptoms (headache, dizziness, visual disturbances), abdominal pain, vomiting, upset stool. At least one case of a fatal outcome is known in a patient with an acute form of paragonimiasis at the age of 21: death occurred 5 months after infection from a traumatic brain injury. At autopsy, paragonimus larvae were found in the lungs without signs of sexual maturity. “Specific eosinophilic pneumonia occurs with chest pain, shortness of breath, fever, and such patients often end up in a tuberculosis dispensary because they develop pleurisy,” says Alexander Popov.
Radiologists described the X-ray picture of the lungs of such patients, and physicians developed diagnostic algorithms. “Patients were followed for 10-15 years, and they periodically had relapses: then no one knew how to treat it,” Alexander Popov continues.
In the early 1990s, during routine medical examinations, paragonimiasis was detected in 1-6% of the inhabitants of the Far East, but since 1996 everything has changed. An epidemic of plague occurred in China, and almost all crayfish died in the territory from Southern Primorye to the Amur River basin. Since 2000, the number of cases of paragonimiasis has decreased, and then completely disappeared. And local doctors began to forget about this unpleasant disease.
But since 2014, the number of crayfish in the watercourses of Primorsky Krai has again begun to increase. In 2020, a tiger died in the Far East, and paragonimosis was found in its lungs. A year earlier, in 2019, the first patient with paragonimiasis was registered. A 54-year-old man was admitted to the hospital on the referral of a general practitioner. He had fever, cough, chest pain, skin rash. Changes in the lungs on the x-ray indicated pneumonia. He underwent a two-week course of antibiotics, but the temperature did not subside, the rash on the skin remained, and most importantly, leukocytosis and eosinophilia increased. He was transferred to the infectious diseases department simply because the limit of stay in the therapeutic bed was over. But there was a young infectious disease specialist who immediately suspected something was wrong. And found out that the man ate raw crayfish. The patient was prescribed an antiparasitic drug and after three days had no fever, no rash, no cough. Last year there was a similar case with a hospitalized patient who also developed similar symptoms a few years after eating raw crayfish. At first they suspected sepsis, then tuberculosis, but, having seen eosinophilia in blood tests, they prescribed an antiparasitic drug – and everything went away. Experts note that today there is simply nothing to confirm the diagnosis – only by clinical symptoms and anamnesis (for example, if you ate raw crayfish, the chances increase dramatically). “Often such patients have to be diagnosed with community-acquired pneumonia of unknown etiology, although we know that these are worms,” continues Alexander Popov. “Today, crayfish with paragonimiasis are spreading again in Primorsky Krai, and we should expect a new outbreak of paragonimiasis. This disease can occur in any part of Russia, in addition, it can be brought by tourists after visiting Southeast Asia.”
The main way to prevent this parasitic disease is to refuse to eat raw crayfish, shrimp, shellfish, as well as free-range wild boar meat. However, cases of paragonimiasis have been described in patients who did not eat anything like that – they just swam in open water, so it is quite possible to get infected from water. So it is better not to swallow water while swimming. If you are a lover of wildlife and extreme food, be prepared for some health troubles.
Newspaper headline:
Contagion for gourmets
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