Table 1

Overview of parasitic lung diseases

ConditionPresentationImaging featuresGeographical distributionIncubation periodInvestigationsTreatment
Focal disease
Cystic lesions
HydatidosisSymptoms due to mass effect
Chest pain, cough, haemoptysis
Hypersensitivity reaction
Secondary abscess formation
Single or multiple lung cysts
Pleural effusion
Wide distribution: Mediterranean borders, East and Central Asia, sub-Saharan Africa, Russia, China, South AmericaMonths to decades after exposureHydatid serology positive in 50-60%
Blood eosinophilia uncommon unless cyst leaking
Aspiration and microscopy
Albendazole with or without praziquantel
Coin lesions
DirofilariasisChest pain, cough, haemoptysis, wheezing
Fever, malaise
Coin lesion with or without calcificationPulmonary dirofilariasis reported from USA, Japan, Australia, South AmericaMay be years after exposureBlood eosinophilia uncommon
Biopsy usually diagnostic
Surgical excision
Consolidation/pleural effusion
ParagonimiasisPleuritic chest pain, cough, fever, haemoptysisPulmonary infiltrates
Consolidation or cystic lesions
Pleural effusion
Asia, West Africa, Central and South America1–27 monthsEggs in stool or sputum
Eosinophilia in peripheral blood, pleural fluid or bronchoalveolar lavage
AmoebiasisRight upper quadrant or shoulder tip pain
Cough and bile expectoration
Pleural effusion, atelectasis, Empyema
Amoebic lung abscess
Secondary pneumonia
Hepatobronchial fistula
Widely distributedWeeks to years after exposureSerology (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
AscariasisCough, wheeze, dyspnoea, chest pain, fever
Loeffler's syndrome
Transient pulmonary infiltrates
Bacterial pneumonia, eosinophilic pneumonia
Worldwide in areas where sanitation is poor (faecal-oral transmission)1–2 weeks from infection to onset of pulmonary symptomsLarvae 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 infectionCough, 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 monthBlood 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
ToxocariasisCough, 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 weeksPeripheral blood eosinophilia common
Eosinophilia in bronchoalveolar lavage
Toxocara serology
Albendazole for visceral disease
Alveolar/ interstitial changes
SchistosomiasisAcute 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, ChinaAcute 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
StrongyloidiasisIn hyperinfection syndrome: asthma, ARDS, intra-alveolar haemorrhageIn hyperinfection syndrome: pulmonary infiltrates, miliary nodules, airspace opacities
ARDS in severe disease, rarely granulomatous changes
Worldwide distribution where sanitation poorPulmonary symptoms may occur days after acute infection; hyperinfection may occur up to decades after infectionBlood 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 AmericaUp to years after leaving endemic areaBlood eosinophilia
No microfilariae in peripheral blood
Filarial serology (IgG)
Diethylcarbamazine with or without albendazole