Chronic pulmonary paragonimiasis in an indigenous Kichwa child infected in the Ecuadorian Amazon

Paragonimiasis is caused by the trematode Paragonimus spp. and is considered a foodborne trematodiasis; it is classified as a neglected tropical disease by the World Health Organization, primarily transmitted through the consumption of infected and undercooked freshwater crustaceans. In Ecuador, it predominantly affects tropical regions such as the Coast and the Amazon. We present the case of a ten-year-old Kichwa boy from a rural Amazonian community, diagnosed at the Hospital Pediátrico de Quito. The child presented persistent cough and rusty sputum for four years, with a history of eating crabs. Computed tomography indicated pulmonary parenchymal alterations. The diagnosis of pulmonary paragonimiasis was confirmed via microscopic identification of operculated Paragonimus spp. eggs in the sputum. Treatment with triclabendazole for two days resulted in subsequent negative sputum findings during follow-up examinations. We discuss the possibility of diagnosis in non-endemic regions and the lack of clinical suspicion and laboratory diagnosis in endemic areas. Furthermore, we highlight the shortage of the drugs of choice, triclabendazole, and praziquantel, in Ecuador.