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Massive secretions in paragonimiasis pleural effusion: a new finding concerning clinical recognition and treatment

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Abstract

Some paragonimiasis patients in Chongqing, southwest China, have recently exhibited pleural effusions (PEs) with massive viscous secretions. This study aimed to investigate their clinical characteristics, thereby promoting effective treatments. A 3-year retrospective review of paragonimiasis patients who were admitted for nonhomogeneous PEs at Chongqing University Three Gorges Hospital was conducted. Epidemiological data, symptoms, laboratory and imaging findings, treatments, and outcomes were analyzed. Twenty-eight patients were identified, of which 22 (78.6%) were males and 22 (78.6%) were rural residents. Respiratory (85.7%) and constitutional (57.1%) symptoms were common. Paragonimus-specific ELISA was positive in all patients. Eosinophilia was detected in all patients in peripheral blood and PEs. Irregular hyperdense signals were observed in PEs by chest CT scans (96.4%) and ultrasonography (100.0%). Thoracic closed drainage failed in 10 patients (conservative group) because of tube blockage and was eventually replaced by video-assisted thoracoscopic surgery (VATS). Eighteen patients (surgery group) initially underwent VATS, or thoracotomy surgery, without complications. Massive secretions, described as “bean-dregs” or “egg-floccule,” were detected intraoperatively, which explained the imaging findings and tube blockage. All patients recovered well after 2–3 courses of postoperative praziquantel treatment. Viscous secretions in paragonimiasis patients warrant great concern. Irregular hyperdense signals in effusions are important characteristics in CT scans and ultrasonography. Treatments such as thoracic closed drainage may fail due to viscous secretions blocking the tube; therefore, surgeries should be considered. In-depth multidisciplinary research may help determine the optimal treatment strategy and reveal the origin of these secretions.

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Data availability

The datasets generated during and/or analyzed during the current study are available in the Supplementary Material (Supplementary data.xlsx).

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Authors and Affiliations

Authors

Contributions

Thank you to all authors for their dedication to this work. Conception and design: Qiang Chen, Yimin Xie, Yunxuan Zhang, and Shulei Peng; administrative support: Qiang Chen, Yimin Xie, and Shulei Peng; provision of study materials or patients: Yarui Luo, Na Wu, Meng Chen, and Shulei Peng; provision of imaging or pathological interpretations: Shuang Xiang, Wen Zhong, and Xiaojiao Zhou; collection and assembly of data: Yunxuan Zhang, Yarui Luo, Na Wu, Meng Chen, and Shulei Peng; data analysis and interpretation: Yunxuan Zhang, Yimin Xie, and Qiang Chen; manuscript writing: all authors; final approval of manuscript: all authors.

Corresponding authors

Correspondence to Shulei Peng or Qiang Chen.

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The guidelines of the Code of Ethics of the World Medical Association were completely fulfilled (Declaration of Helsinki). Ethics approval was granted by the Ethics Committee of Chongqing University Three Gorges Hospital (approval number: 2022114).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that no human image was provided in this research.

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The authors declare no competing interests.

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Supplementary information

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10096_2023_4567_MOESM1_ESM.png

Supplementary file1 Large amounts of “bean-dregs” or “egg-floccule” substances deposited as lumps at the bottom of the pleural cavity in the endoscopic view. B: The extracted yellowish and viscous secretions nearly filled the bow. (PNG 4805 KB)

Supplementary file2 (DOCX 15 KB)

Supplementary file3 CT scan of the typical tunnel sign in a paragonimiasis patient. (MP4 1883 KB)

Supplementary file4 Paragonimiasis PE with massive secretions in a thoracoscopic view. A large amount of viscous secretion is present in the yellowish PEs. Some of the secretions even block the aspirator. (MP4 6615 KB)

Supplementary file5 (XLSX 19 KB)

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Zhang, Y., Xie, Y., Luo, Y. et al. Massive secretions in paragonimiasis pleural effusion: a new finding concerning clinical recognition and treatment. Eur J Clin Microbiol Infect Dis 42, 493–501 (2023). https://doi.org/10.1007/s10096-023-04567-z

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