What is the best specific treatment for paragonimus infection? Can pregnant and nursing women use specific drugs to treat the infection according to the guidelines of the Ministry of Health in Vietnam?
- How to test and diagnose paragonimus infection according to the guidelines of the Ministry of Health in Vietnam?
- What is the best specific treatment for paragonimus infection? Can pregnant and nursing women use specific drugs to treat the infection according to the guidelines of the Ministry of Health in Vietnam?
- What is the criteria of a recovered patient from paragonimus infection according to the guidelines of the Ministry of Health in Vietnam?
- How to prevent paragonimus infection according to the guidelines of the Ministry of Health in Vietnam?
How to test and diagnose paragonimus infection according to the guidelines of the Ministry of Health in Vietnam?
Pursuant to Section 3, Section 4 of the Guidelines issued together with Decision 1573/QD-BYT in 2022 of the Ministry of Health, there are guidelines on testing and diagnosing paragonimus infection as follows:
“3. SUBCLINICAL SYMPTOMS
3.1. Test
+ Pap smears: sputum, stool, pleural fluid to find eggs of lung fluke.
+ CBC may have eosinophilia.
+ IgE quantification may be increased.
+ Immunoassay: ELISA lung fluke (+)
3.2. IMAGE ANALYSATION
+ Chest X-ray: there are faint nodules, opacities, small cavernous shape and mainly in the low area (if fluke is in the lung) or pleural effusion (if fluke is in the pleura).
+ Chest CT/MRI: used in differential diagnosis with some other cases of hemoptysis such as lung cancer, bronchiectasis, pulmonary tuberculosis...
+ Abdominal ultrasound: find ectopic lung fluke lesions.
4. DIAGNOSIS
4.1. SUSPECTED CASE DIAGNOSIS
- Have ever eaten undercooked freshwater crabs or crayfish
or
- Live in an endemic area.
- Have clinical signs mentioned above.
4.2. CONFIRMED CASE DIAGNOSIS
Are suspected cases accompanied by the following tests:
- Test
+ Found eggs of lung fluke in sputum, feces, pleural fluid.
+ ELISA for lung fluke (+)
+ May have eosinophilia
+ Quantitative IgE can increase
- Chest X-ray: there are faint nodules, fuzzy patches, small cavernous shape and mainly in the low area (if the fluke is in the lung) or pleural effusion (if the fluke is in the pleura).
4.3. DIFFERENTIAL DIAGNOSIS
- The clinical picture of paragonimus infection needs to be distinguished from pulmonary tuberculosis.
- In addition, it should be distinguished from other conditions that cause coughing up blood such as bronchiectasis, lung cancer...
- Distinguishing parasitic diseases that cause lung damage from other causes such as toxocara, large liver flukes, strongyloides, hookworms..."
Thus, to determine the subclinical symptoms of paragonimus infection, it is possible to follow methods such as testing or imaging. The diagnosis of paragonimus infection will be classified into suspected case diagnosis, confirmed case diagnosis and differential diagnosis made according to the guidelines outlined above.
What is the best specific treatment for paragonimus infection? Can pregnant and nursing women use specific drugs to treat the infection according to the guidelines of the Ministry of Health in Vietnam?
What is the best specific treatment for paragonimus infection? Can pregnant and nursing women use specific drugs to treat the infection according to the guidelines of the Ministry of Health in Vietnam?
Pursuant to Section 5 of the Guidelines promulgated together with Decision 1573/QD-BYT in 2022 of the Ministry of Health, there are guidelines for the treatment of paragonimus infection as follows:
“5. TREATMENT
5.1. The principles of treatment
- Use specific drugs
- Treat accompanying symptoms.
5.2. Specific treatment
* Praziquantel was selected as the best medicine to treat lung flukes.
- Dose 75 mg/kg/day, divided into 3 times 4-6 hours apart x 2 days in a row.
- Undesirable effects: Dizziness, headache, somnolence, nausea, lower stomach discomfort, rash and possibly fever, symptoms are mild, quickly disappear and usually do not require any intervention.
- Contraindications:
+ Women who are pregnant in the first 3 months.
+ Have acute infection or liver failure, kidney failure or mental disorder.
+ Have an allergy to praziquantel.
* Note: nursing mothers should not breast-feed within 72 hours of taking the drug.
* In addition, the World Health Organization (WHO) recommends the use of triclabendazole for adults or children, 10 mg/kg, orally once or twice.
5.3. Treatment of symptoms and improvement of physical condition
- In the treatment of lung fluke coughing up a lot of blood at once, it is necessary to give the patient absolute rest and give hemostatic drugs, cough medicine...
- Improve fitness.
5.4. Follow-up after treatment
After treatment with specific drugs, patients are evaluated:
- Clinical: patients are monitored and evaluated for clinical symptoms after 3, 6 months.
- Test:
+ Complete blood count (BCAT), liver and kidney function after 3, 6 months.
+ Test sputum and stool for lung fluke eggs after 1 week, 1 month, 3 months, and 6 months.
+ Test lung fluke ELISA after 3 months, 6 months.
+ Chest X-ray after 6 months”
Accordingly, when using drugs to treat paragonimus infection, patients will have side effects such as dizziness, headache, somnolence, nausea, lower stomach discomfort, rash and possibly fever. Pregnant women in the first 3 months can not use specific drugs to treat paragonimus infection.
Thus, the treatment of paragonimus infection is carried out according to the above guidelines of the Ministry of Health.
What is the criteria of a recovered patient from paragonimus infection according to the guidelines of the Ministry of Health in Vietnam?
Pursuant to Section 6 of the Guidelines promulgated together with Decision 1573/QD-BYT in 2022 of the Ministry of Health, there are guidelines on determining the criteria for cure of paragonimus infection as follows:
“6. STANDARDS OF RECOVER
- No clinical symptoms.
- Re-test after treatment: stool, sputum and pleural fluid are negative for lung flukes.
Accordingly, the patient is only considered to have recovered from paragonimus infection when meeting both of these criteria.
How to prevent paragonimus infection according to the guidelines of the Ministry of Health in Vietnam?
According to Section 7 of the Guidelines issued together with Decision 1573/QD-BYT in 2022 of the Ministry of Health, guiding measures to prevent paragonimus infection are as follows:
“7. PREVENTION
- Do not eat undercooked crab or shrimp.
- Manage waste such as sputum, feces or pleural fluid, and keep the environment clean.
- Propaganda and education on health in the community: eat the ripe thing and drink boiled water, do not eat undercooked crabs and shrimps.
- Tackle pathogens by early detection and specific treatment for patients.
Thus, to prevent paragonimus infection, people need to cook shrimp and crab when eating, manage waste and maintain environmental hygiene.
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