Fig 1.
Demographic characteristics of cerebral paragonimiasis patients in this study.
(A) Age distribution of patients at the time of definitive diagnosis. (B) Duration of patient symptoms until definitive diagnosis.
Table 1.
Initial presumptive diagnosis of cerebral paragonimiasis patients enrolled in this study.
Fig 2.
Fluid attenuated inversion recovery (FLAIR) sequence of brain magnetic resonance image of a 68-year-old female patient who suffered from dysarthria and right-sided weakness for 9 years.
The laboratory results including eosinophil counts were within the normal range. The patient could not recall the consumption of freshwater crustaceans. The anti-Paragonimus specific IgG antibody levels against adult worm extracts were 0.31 (serum) and 0.26 (CSF), respectively. (A and B) FLAIR sequence shows cerebromalacia and ventriculomegaly with a round calcified mass on the left frontal lobe. (C and D) Several well-defined calcified masses in the left inferior frontal lobe are seen.
Table 2.
Relationship between lesion locations and clinical manifestations of cerebral paragonimiasis patients.
Fig 3.
Comparative evaluation of the diagnostic performance of P. westermani adult worm extracts (PwAWE) and recombinant P. westermani yolk ferritin (rPwYF).
Specific IgG antibody levels in the serum and CSF samples of patients with various neurological diseases and those in the sera of healthy controls against PwAWE (A and B) and rPwYF (C and D). The y-axis shows the absorbance values of the tested sera and CSFs. The x-axis depicts the following groups: CP, cerebral paragonimiasis (n = 102 [serum] and n = 101 [CSF]); NC, neurocysticercosis (n = 149); NSP, neurosparganosis (n = 42); M, meningitis (n = 17); Tum, tumor (n = 27); Hydro, hydrocephalus (n = 29); Cal, calcification (n = 31); G/C, granuloma/cystic mass (n = 31); CVD, cerebrovascular diseases (n = 20); Cont, healthy controls (n = 42). The cutoff values determined by receiver operating characteristic analysis shown in Fig 4 are marked by double-dotted blue lines. The red bars indicate the mean absorbance in each group. Inset in panel A shows the protein profiles of PwAWE and rPwYF separated by 15% reducing SDS-PAGE. Mr, molecular weight in kDa.
Fig 4.
Analysis of receiver operating characteristic (ROC) curves.
The ROC curves demonstrate the plots of sensitivity versus 1-specificity for serum (A) and CSF samples (B) against adult worm extract (PwAWE) (black line) and recombinant P. westermani yolk ferritin (rPwYF) (red line), respectively. The diagonal reference line is also shown. ROC curves were used to determine the cutoff values and area under the curve (AUC) each for PwAWE and rPwYF in serum (n = 102) and CSF (n = 101) samples by ELISA in cerebral paragonimiasis cases.
Table 3.
Evaluation of the biomarker potential of different antigenic preparations for the serodiagnosis of cerebral paragonimiasis.
Table 4.
Comparison of the diagnostic efficacy of serological biomarkers for cerebral paragonimiasis.