A 22 y.o. college student returns from a camping trip with a fever and a cough productive of bloody sputum.
She had been “living off the land” What does her CXR show?
Our patient had paragonimiasis from eating undercooked crayfish. Paragonimiasis is a lung fluke infection. Undercooked crayfish contain the parasite’s larvae. After being ingested they penetrate the intestinal wall and migrate to the diaphragm; then enter the pleural cavity. They travel to the bronchi where they develop into adult worms often in cystic cavities. Once the worms reach the lungs a chronic cough, bloody sputum , chest pain , dyspnea and fever can result. Only rarely are the parasites found in extrapulmonary sites.
The red swamp crayfish can grow to five inches. It is the most commonly farmed crayfish
While Missouri has more than 35 species of crayfish the most commonly farmed is the red swamp crayfish. It is found on every continent except Antarctica and is used as a biological control in Africa to eliminate snails that are key to the life cycle of schistosomiasis.
A case series was reported in Missouri with ingestions of crayfish from the Jacks Fork, Current, Meramac, and Missouri rivers. Their patients reported fever, cough and chest pain. In their series all patients had eosinophilia and 4/6 had a pericardial effusion with one case of tamponade.
The treatment of paragonimiasis is praziquantel (75mg/kg in three divided doses for 2 days)
Our patient was treated and recovered successfully.
paragonimiasis has been found in a scrotal abscess. It only rarely affects other body part and is usually in the lungs.
While eating raw or poorly cooked crayfish or crab can cause disease, many other diseases are more common while enjoying nature.
Inhaling Contaminated soil or water
Leptospirosis-is a bacterial infection that sickened 52 out of 474 athletes swimming in a race in Lake Springfield Ill. In 1998. It was tracked to raccoon feces contamination of the water.
Melioidosis- is a bacterial illness found in the Gulf coast and Puerto Rico caused by Berkholderia pseudomallei. It is present in the soil and can be inhaled.
Viral illnesses- hanta virus causes disease when inhaled. The reservoir is in rodents.
Bacterial illnesses-plague, tularemia (rabbit fever) and Q fever( found in infected sheep and goats) can be contracted from aerosolized particles.
Coccidiomycosis is a fungus common in the dust of the southwestern US. It can cause lung disease and become disseminated to the bones , skin and joints.
dust storms are a common occurence in Phoenix AZ
Eating contaminated food/drinking contaminated water
Parasites- are common in nature: Giardiasis cryptosporidium, toxoplasma and trichinella can cause significant human disease.
Food borne illnesses like E. coli, salmonella, botulism and brucellosis all occur in contaminated food. Mycobacterium bovis can be acquired by drinking unpasteurized milk. Diseases like tularemia and rabies can be acquired by eating an infected animal.
It is recommended that water be boiled for one minute at lower elevations and 3 minutes at higher elevations. Food should be thoroughly cooked to between 140 and 165 degrees.
FUN FACTS
You can fish for crayfish in Tower Grove Park in the lily ponds. . They are eating the water lily roots and are considered an invasive species and can be taken from the pond . Dogfood and hot dogs are used as bait.
fishing for crayfish in tower grove park
Wang L, Banaei N. Pleural paragonimiasis. N Engl J Med 2025;392:e19 doi:10/1056/NEJMicm2412622 Vol 392(7)
Kim K, Lee K, Park H, et al. A pulmonary paragonimiasis case mimicking metastatic pulmonary tumor. Korean J Parasitol. 2011 Mar 18;49(1):69-72
Ali S, Ahmed R, Deebb M, et al. Rare case of pulmonary paragonimiasis in Jubail city. Egyptian Journal of Bronchology 19,59 (2025) https://doi.org/a0.1186/s43168-025-00419-w
Lane M, Marcos L, Onen N, et al. Paragonimus kellicotti flukes in Missouri, USA. Emerg Infect Dis 2012 Aug;19(8):1263-1267.