被误诊的肺吸虫感染1例

One Case of Misdiagnosed Paragonimus Infection

摘要: 肺吸虫病作为一种重要的食源性寄生虫病，其研究历史可以追溯至19世纪末，分布广泛且感染率较高，尤其在亚洲地区呈现显著的地方性流行特点，由于其感染人体时表现非特异性的症状，容易导致误诊漏诊。本例患者为46岁男性，自诉2023年9月始出现反复发热、咳嗽、咳血，痰中可见暗红色血丝。外院胸部CT提示“右肺感染性病变，结核并形成空洞，两肺少许混合肺气肿”，建议做肺结核抗结核治疗，待症状短暂缓解后，再重新复发。患者因咽痒、异物感，伴咯血加重，于2024年10月30日进入我医院呼吸内科就诊。化验，血常规：嗜酸性粒细胞百分数(EOS) 9.3%，痰涂片：未检出抗酸杆菌(-)，经痰液集卵化验，检出典型肺吸虫卵。发现肺吸虫卵，明确诊断患者为肺吸虫感染，按临床指南给予患者口服吡喹酮(吡喹酮)治疗。治疗后复查血常规：白细胞(WBC)计数正常，嗜酸性粒细胞(EOS)百分数正常，患者无咳嗽、咯血等不适症状，无畏冷、发热、胸闷、胸痛等症状。2024年11月8日予办理出院。

Abstract: As an important food-borne parasitic disease, paragonimiasis can be traced back to the end of the 19th century. It has a widespread distribution and high infection rate, particularly showing significant endemic characteristics in Asia. Due to its non-specific symptoms when infecting humans, it often leads to misdiagnosis and missed diagnosis. The patient is a 46-year-old male who reported recurrent fever, cough, and hemoptysis since September 2023, with dark red blood streaks visible in his sputum. Chest CT at an external hospital suggested “right pulmonary infectious lesion, tuberculosis with cavity formation, and mild mixed emphysema in both lungs”, recommending anti-tuberculosis treatment for tuberculosis. After brief symptom relief, the symptoms recurred. Due to throat itching, foreign body sensation, and worsening hemoptysis, the patient visited our hospital’s respiratory department on October 30, 2024. Laboratory tests showed: eosinophil percentage (EOS) 9.3% in blood routine, acid-fast bacilli negative (-) in sputum smear. Through Paragonimus egg concentration examination, typical Paragonimus eggs were detected (Figures 3~8). After identifying Paragonimus eggs and confirming the diagnosis of paragonimiasis, the patient was treated with oral praziquantel according to clinical guidelines. Follow-up blood tests after treatment showed: normal white blood cell (WBC) count and normal eosinophil (EOS) percentage. The patient had no discomfort symptoms such as cough or hemoptysis, and no symptoms of chills, fever, chest tightness, or chest pain. The patient was discharged on November 8, 2024.