Clinical Features and Outcomes of Pediatric Intraspinal Paragonimiasis

Yan Jiang,1,* Yunying Yang,2,* Helin Zheng,3 Siqi Hong,1 Xiujuan Li,1 Li Jiang,1 Chengbing Tan1 1Department of Neurology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, People’s Republic of China; 2Department of Neurosurgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, People’s Republic of China; 3Department of Radiology Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chengbing Tan, Department of Neurology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, No, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, People’s Republic of China, Tel +86-023-68370422, Email [email protected]: Central nervous system infection is the most common and severe clinical subtype of ectopic paragonimiasis. Intraspinal paragonimiasis is rarely reported. This study aimed to provide experience for diagnosis and treatment strategies of pediatric intraspinal paragonimiasis.Methods: We performed a retrospective clinical analysis of patients hospitalized for intraspinal paragonimiasis between January 1, 2015, and December 31, 2021.Results: Nine patients were included. The median age was 9 years. Clinical symptoms mainly included weakness (9/9), sensory disturbances (6/9), urinary retention (2/9), fever (4/9), chest pain (3/9), cough (2/9), dyspnea (2/9) and subcutaneous nodules (1/9). Spinal magnetic resonance imaging revealed intraspinal extradural enhancing lesions in the thoracic spine in 8 patients and isolated cervical spinal cord lesions in 1 patient. Seven extradural lesions were connected with the pleural lesion and subcutaneous nodes. All patients received praziquantel without undergoing spinal surgery. After a median follow-up of 36 months, two patients had sequelae of mild weakness and urinary urgency, and seven patients recovered completely after a median time of 13 weeks of initial praziquantel treatment.Conclusion: Pediatric intraspinal paragonimiasis mainly involves the thoracic segment of the spine. Weakness is the most common manifestation, and some patients may develop sensory disturbances and sphincter dysfunction. Most patients can recover completely with praziquantel treatment. Lesion resection is no longer a necessary treatment strategy.Keywords: lung fluke infection, intraspinal lesion, pediatric, praziquantel