Chronic pulmonary paragonimiasis in an indigenous Kichwa child infected in the Ecuadorian Amazon

Abstract

Paragonimiasis, caused by the trematode Paragonimus spp., is considered a foodborne trematodiasis and categorized as a neglected tropical disease by the World Health Organization (WHO), primarily transmitted through the consumption of infected, undercooked freshwater crustaceans. In Ecuador, it predominantly affects tropical regions such as the Coast and the Amazon. This paper details the case of a 10-year-old Kichwa boy, from a rural Amazonian community, diagnosed at the Pediatric Hospital of Quito. The child presented persistent cough and rusty sputum for four years, with a history of eating crabs. Computed tomography indicated pulmonary parenchymal alterations, and the diagnosis of pulmonary paragonimiasis was confirmed via microscopic identification of operculated Paragonimus eggs in the sputum. Treatment with triclabendazole for two days resulted in subsequent negative sputum findings during follow-up examinations. We discuss the possibility of diagnosis in non-endemic regions, as well as the lack of clinical suspicion and laboratory diagnosis in endemic areas. Furthermore, we highlight the shortage of the drugs of choice, triclabendazole and praziquantel, in Ecuador.