Cerebral paragonimiasis: Clinicoradiological features and serodiagnosis using recombinant yolk ferritin.

Cerebral paragonimiasis (CP), caused by aberrant migration of Paragonimus worms, frequently invokes serious illness. The causal relationship between the lesion characteristics and patients' symptoms has poorly been understood. CP serodiagnosis has not been properly evaluated to date. A total of 111 CP cases were diagnosed in our laboratory between 1982 and 2003. This study retrospectively assessed the clinical and imaging characteristics of the 105 patients along with the evaluation of diagnostic potentials of recombinant P. westermani yolk ferritin (rPwYF) by enzyme-linked immunosorbent assay (ELISA) employing patients' sera and cerebrospinal fluids (CSFs). We analyzed 60 male and 45 female patients; 50 early-stage patients with non-calcified enhancing nodule(s) (median age, 38 years; interquartile range [IQR], 24.75–52; median symptom duration, 0.75 years; IQR, 0.2–2) and 54 chronic cases having calcified lesion(s) (median age, 33 years; IQR, 25–41; median symptom duration, 10 years; IQR, 5–20). One patient showed a normal neuroimage. The patients were largely diagnosed in their 30s. The parietal lobe was most commonly affected, followed by occipital, frontal, and temporal lobes. Twenty-six patients had lesions encompassing ≥ two lobes. The patients complained mainly of seizures, headaches, hemiparesis, and focal neurologic deficits (P < 0.001). Seizures and visual defect were predominant in patients with calcified lesion(s) (P < 0.001). The diagnostic sensitivity and specificity of rPwYF against serum/CSF were 100%/97% and 97.2%/92.5%, respectively. The specific IgG antibody levels against rPwYF in sera and CSFs showed a positive correlation (r = 0.59). The clinical manifestations of the early-stage patients might be associated with cortical lesions or meningeal irritation, while those in the chronic stage were caused by conglomerated space-occupying lesions. rPwYF would be useful for the serodiagnosis of both early and chronic CP cases. Author summary: Paragonimiasis, caused by the lung fluke Paragonimus spp., is a global foodborne zoonosis of great public health concern. Paragonimiasis is primarily a pleuropulmonary disease. However, the worms sometimes migrate aberrantly to other parts of the body, thereby causing the granulomatous lesion(s). The most serious condition elicited by ectopic migration is cerebral paragonimiasis. This study retrospectively analyzed the clinical and imaging features of the largest number of 105 cases diagnosed between 1982 and 2003 in our laboratory. We also evaluated diagnostic feasibility of recombinant P. westermani yolk ferritin by ELISA. The patients were largely diagnosed in their 30s with the chief complaints of seizures, headaches, hemiparesis, and focal neurologic deficits. Seizures and visual defect were significant in the chronic stage patients having calcified lesion(s). The diagnostic sensitivity and specificity of recombinant P. westermani yolk ferritin by ELISA against patients' sera or CSFs were 100% or 97%, and 97.2% or 92.5%, respectively. The diverse neurological manifestations of patients might be related to the nature and/or location of the lesions. P. westermani yolk ferritin is a promising antigen for serodiagnosis of both early-stage patients with non-calcified lesion(s) and chronic calcified cerebral paragonimiasis cases. [ABSTRACT FROM AUTHOR]