Duk Jin Yun

Paragonimiasis in children in Korea. Related to the custom of ingesting raw crayfish for the treatment of measles.

Summary Eight cases of paragonimiasis in children are reported, all of which were caused by ingesting raw crayfish for the treatment of measles. Such a custom, which is prevalent throughout Korea in both city and rural areas, originated with herb doctors. The common practice is to mash and strain the raw crayfish and administer the juice. 1.Cough and wheezing were the first signs of the disease and the children had an x-ray picture of blotchy or fluffy infiltration of the lungs. 2.Six of the 8 patients had x-ray evidence of pleural effusion; one of them had massive empyema. Differential counts of pleural, pericardial, and peritoneal effusions showed 85 to 90 per cent eosinophils. 3.Peripheral blood counts showed moderate to market leukocytosis and an eosinophilia ranging from 11 to 52 per cent, with a mean of 35 per cent. 4.Mild to marked increase in the globulin fraction of the serum protein is almost a constant finding. The total protein may be normal or increased. The albumin and globulin ratio is usually reversed because of an increase in globulin, particularly in the gamma globulin level, and not to a decrease in albumin. 5.Three of the 8 patients had mild to moderate ascites with hepatomegaly which subsided spontaneously within 1 year. Liver function usually was not impaired. 6.Aspiration of the bone marrow in 2 severely ill children showed eosinophilic hyperplasia, in which 70 per cent were mature eosinophils. 7.Subcutaneous biopsy in one revealed an eosinophilic granuloma. 8.Skin tests for Paragonimus westermani were positive in all 8. Paragonimus westermani ova were demonstrated in 4 of the 8, 3 of them from sputum and 1 from the pus in a brain cyst. 9.The clinical course is a chronic but benign one, and the prognosis is good except in cerebral paragonimiasis which may leave mental retardation, blindness, and motor disturbances. 10.Paragonimiasis is one of the important public health problems in Korea and can be resolved only by extensive public health education. A similarity between the symptoms of visceral larva migrans due to the larvae of Ascaris lumbricoides and those due to the larvae of Toxocara is noticed.