Paragonimiasis: Food-borne infection a neglected disease in Nagaland

* 34.7% patients misdiagnosed for tuberculosis 

* Local serological based test kit developed

Kohima, April 27 (EMN): Paragonimiasis is an endemic, neglected disease in the Northeast region of India. It is often wrongly diagnosed due to lack of understanding about the disease although the disease is not new in Nagaland.

Due to overlapping clinical symptoms between tuberculosis and paragonimiasis, there have been cases of wrong diagnosis and wrong treatment: 34.7% of patients with paragonimiasis have been diagnosed for tuberculosis.

A survey by Das from 2012 to 2013 in Mon district of Nagaland reported that 3% of 96 patients receiving TB treatment in Mon were actually paragonimiasis positive. Another survey conducted by the Healthcare Laboratory and Research Centre of the Naga Hospital on Paragonimiasis in villages of Phek district, identified Razheba village as an endemic area.

This was revealed by Dr. V Khamo, principal investigator of the hospital at the launch of a diagnostic test kit for paragonimiasis.

The programme was launched by I Himato Zhimomi, commissioner-secretary for Health and Family Welfare at the Naga Hospital’s research centre on April 27. A host of doctors from Assam, Mizoram and Arunachal Pradesh attended the programme too.

Dr. Khamo informed that the first confirmed report and description of Paragonimus heterotremus as the causative agent in Nagaland was made by a TS Singh during 2009. She explained that pragonimiasis was a lung fluke disease caused by trematodes belonging to the genus Paragonimus. A food-borne infection transmitted via consumption of raw or undercooked crab or crayfish, Paragonimiasis is a neglected disease, rare and region-specific, she said.

The crab species, which reportedly harbour paragonimus, according to her are ‘potamiscus manipurensis’ and ‘maydelliathelphusa lugubris.’

Dr. Khamo pointed out that there were many cases in the state as people are fond of consuming crab, crayfish, and snails as a delicacy or exotic cuisine, besides taken for so-called medicinal purposes. However, people infected with the disease are often wrongly diagnosed as tuberculosis due to lack of understanding and diagnostic test kits.

Explaining in brief co-infection of paragonimiasis and tuberculosis and the often wrongly diagnosed cases, Dr. Khamo said they have overlapping clinical symptoms leading to misdiagnosis and mistreatment.

Expressing grave concern at the lack of information and understanding even among clinicians about the disease, Dr. Khamo asserted the need to create publicity on Paragonimiasis among the public especially clinicians because it is often wrongly diagnosed as tuberculosis.

Also sounding a note of caution to the public, Dr. Khamo has advised cooking crabs, crayfish and snails properly before eating and also get tested for Paragonimiasis if one develops persistent TB-like symptom. She said that the diagnosis was simple and easy and that treatment was simple, short, and cost-effective.

The doctor advised clinicians to note patients’ history of raw crab intake. During diagnosis, she advised clinicians to remember that all blood stained sputum are not TB; resistance to ATT should be checked for Paragonimiasis, high eosinophils count in pleural fluid and that blood should be checked for migratory nodules in the body.

Also speaking during the occasion was Professor Mihir Kumar Goswami, head of department (Pulmonary medicine) from Jorhat Medical College & Hospitals. The professor said that the Northeast region was the hub of various zoonotic illness.

Stating that paragonimias was common in the region especially in Assam and Nagaland due to common food habits, Goswami said that paragonimias was posing a great threat to the people of the region.

The main crux of the problem, he noted is the lack of awareness among the medical fraternity too wherein paragonimias is often treated as a case of as pulmonary tuberculosis by doctors both from government and non-government sectors. He has insisted on creating awareness among the medical fraternity as well to the common populace.

Describing Dr. Khamo as a pioneer in coming out with the first diagnostic test kit for paragonimiasis in the state, Himato has encouraged the medical team to continue to do more researches towards conquering and eliminating diseases.

He also assured of all possible help and support from the government for any research, which endeavours to provide a healthy life to the citizens of the state.

Mentioned may be made that with no robust testing tool available in the market to identify the paragonimus egg, Dr. V Khamo and her team have developed the serological based test kit using local species.

Dr. Khamo said the serological based test kit is more specific and very important for the diagnosis of extra pulmonary paragonimiasis. The method, she informed, is useful for mass screening or community based survey which is also cost effective.

The paragonimiasis research laboratory at NHAK is being funded by department of Science and Technology, Ministry of Science & Technology, Government of India.

She also informed that it will conduct awareness programme on Paragonimiasis to school children, teachers and at churches and organise CME/workshops among the health workers.

Besides, the research laboratory would be screening sputum samples from TB clinics and hospitals for paragonimiasis, morphological identification of crabs, crayfish and snails harbouring Paragonimus sp. in Nagaland, developing rapid molecular assay for diagnosis of Paragonimiasis and also survey of food habits using questionnaire.