Overview of parasitic lung diseases
| Condition | Presentation | Imaging features | Geographical distribution | Incubation period | Investigations | Treatment |
| Focal disease | ||||||
| Cystic lesions | ||||||
| Hydatidosis | Symptoms due to mass effect Chest pain, cough, haemoptysis Hypersensitivity reaction Secondary abscess formation | Single or multiple lung cysts Pleural effusion Pneumothorax Hydro-pneumothorax | Wide distribution: Mediterranean borders, East and Central Asia, sub-Saharan Africa, Russia, China, South America | Months to decades after exposure | Hydatid serology positive in 50-60% Blood eosinophilia uncommon unless cyst leaking Aspiration and microscopy | Surgery Albendazole with or without praziquantel Aspiration |
| Coin lesions | ||||||
| Dirofilariasis | Chest pain, cough, haemoptysis, wheezing Fever, malaise | Coin lesion with or without calcification | Pulmonary dirofilariasis reported from USA, Japan, Australia, South America | May be years after exposure | Blood eosinophilia uncommon Biopsy usually diagnostic | Surgical excision |
| Consolidation/pleural effusion | ||||||
| Paragonimiasis | Pleuritic chest pain, cough, fever, haemoptysis | Pulmonary infiltrates Consolidation or cystic lesions Pleural effusion Pneumothorax | Asia, West Africa, Central and South America | 1–27 months | Eggs in stool or sputum Eosinophilia in peripheral blood, pleural fluid or bronchoalveolar lavage Serology | Praziquantel |
| Amoebiasis | Right upper quadrant or shoulder tip pain Cough and bile expectoration | Pleural effusion, atelectasis, Empyema Amoebic lung abscess Secondary pneumonia Hepatobronchial fistula | Widely distributed | Weeks to years after exposure | Serology (may be negative, especially in early disease) Does not cause eosinophilia; usually does cause neutrophilia | Tinidazole (or metronidazole) followed by diloxanide furorate or paromomycin |
| Diffuse disease | ||||||
| Transient pulmonary infiltrates | ||||||
| Ascariasis | Cough, wheeze, dyspnoea, chest pain, fever Loeffler's syndrome Haemoptysis | Transient pulmonary infiltrates Bacterial pneumonia, eosinophilic pneumonia Pneumothorax | Worldwide in areas where sanitation is poor (faecal-oral transmission) | 1–2 weeks from infection to onset of pulmonary symptoms | Larvae in pulmonary, gastric secretions Eggs in stool in established infection with adult worms, may be absent in larval migratory phase Blood eosinophilia during larval migration | Albendazole, mebendazole, piperazine, or pyrantel pamoate |
| Hookworm infection | Cough, wheeze, dyspnoea, chest pain, fever Loeffler's syndrome | Transient pulmonary infiltrates Eosinophilic pneumonia | Widely distributed: (infection usually by contact of bare feet with faecally contaminated soil) | Pulmonary manifestations start within 10 days of exposure, can continue for more than one month | Blood eosinophilia during migration, which may persist Eggs in stool in established infection with adult worms Eggs may be absent in larval migratory phase | Albendazole, mebendazole or pyrantel pamoate |
| Toxocariasis | Cough, dyspnoea, wheeze, asthma or bronchitis Hepatomegaly, splenomegaly, ocular lesions | Pulmonary infiltrates Secondary bacterial pneumonia | Worldwide distribution (adult worms live in gut of cats and dogs) | Several weeks | Peripheral blood eosinophilia common Eosinophilia in bronchoalveolar lavage Toxocara serology | Albendazole for visceral disease |
| Alveolar/ interstitial changes | ||||||
| Schistosomiasis | Acute disease: Katayama fever with cough, dyspnoea, rash, and arthralgias Loeffler's syndrome, pneumonitis Chronic disease: dyspnoea, pulmonary hypertension | Acute disease: transient reticulonodular changes Chronic disease: granulomatous lung disease, pulmonary hypertension, pulmonary AV fistulae | Africa, South America, south east Asia, China | Acute disease: 5–7 weeks after exposure. Chronic disease: years | Acute disease: blood eosinophilia common Acute disease: eggs in sputum, or bronchoalveolar lavage after 6 weeks Chronic disease: eggs in stool and/or urine (S haematobium) after about 6 weeks Schistosomal serology positive after 6-12 weeks | Praziquantel |
| Strongyloidiasis | In hyperinfection syndrome: asthma, ARDS, intra-alveolar haemorrhage | In hyperinfection syndrome: pulmonary infiltrates, miliary nodules, airspace opacities ARDS in severe disease, rarely granulomatous changes | Worldwide distribution where sanitation poor | Pulmonary symptoms may occur days after acute infection; hyperinfection may occur up to decades after infection | Blood eosinophilia common Larvae in stool or duodenal aspirate but not usually in sputum in chronic infection; In hyperinfection also in sputum, body fluids on microscopy or culture Strongyloides serology | Ivermectin, albendazole less effective |
| Tropical pulmonary eosinophilia (filariasis) | Cough, dyspnoea, wheeze Fever, malaise, weight loss | Bilateral reticulonodular shadowing Mediastinal lymphadenopathy | Asia, sub-Saharan Africa, South America | Up to years after leaving endemic area | Blood eosinophilia No microfilariae in peripheral blood Filarial serology (IgG) | Diethylcarbamazine with or without albendazole |