﻿PARAGONIMIASIS IN THE PHILIPPINES. 59 



tive symptoms and physical signs which furnish strong supporting data. 

 Of these the following, occurring singly or together, may be noticed : Un- 

 explained epilepsy or other evidence of localized brain lesions; cough 

 with occasional small amounts of blood, particularly with but slight or 

 no constitutional disturbance and with broncho pneumonia and empyema. 

 Evidences of chronic peritonitis, enlarged prostate, epididymitis, or 

 cirrhosis of the liver, and chronic skin ulceration with enlargement of 

 the lymphatic glands. 



Owing to the slow progress of the disease in many cases and to the 

 probable late appearance of ova in the excreta, many of these infections 

 will continue first to be diagnosed at autopsy, until other accurate diag- 

 nostic data are available. 



X. COURSE, DURATION AND PROGNOSIS. 



The course is usually chronic, the disease lasting for years; however 

 in some cases, and particularly in mixed infections, it may be acute, 

 and death may result in a few days from the time the symptoms are first 

 noticed. Several writers have stated that patients may live for fifteen 

 or even twenty years. 



The prognosis, if the patient remains in the region where the infection 

 is endemic, is usually bad as to recovery, although several writers say 

 that this may take place. After a study of the pathology of the disease, 

 this statement seems difficult to believe. Evidence is sometimes found 

 indicating that there may be an arrest of the progress of the disease, 

 and were this to occur in the early stages of the infection, the patient 

 might remain in good condition for many years. However, with the 

 usual types of the disease it is doubtful if complete healing of the 

 pathologic process ever takes place. 



Death probably most often is caused by intercurrent diseases, "but in 

 at least two of my fatal cases no evidence of such a condition was found 

 at autopsy. 



XI. COMPLICATIONS. 



While it is probable that a great variety of diseases may be found 

 associated with paragonimiasis and while other diseases often develop 

 during the course of this infection and hasten its outcome, there are but 

 two which, because of their special importance, will be noticed here. 

 These are tuberculosis and amcebiasis. 



Tuberculosis, either local or general, may complicate either a local or 

 more general distribution of the parasitic disease. The two diseases 

 existed together in 2 of my 8 fatal cases and such a combination has in 

 addition been found 3 times clinically. There are several reasons why 

 this particular complication should receive close attention. The symp- 

 tomatology of the two diseases is. often very similar. The lesions are 



