Nasopharyngeal myiasis is a rare parasitic disease caused by Cochliomyia hominivorax larvae that affects the nasal cavity and paranasal sinuses. A 12-year-old adolescent presented with a lesion caused by a fly entering the left nostril, characterised by the emergence of larvae. Sinus tomography documented inflammatory changes consistent with ethmoid-maxillary sinusitis in the left nasal cavity and parapharyngeal abscess. Treatment included ivermectin for myiasis, clindamycin and cefotaxime for the abscess, and functional endoscopic sinus surgery (FESS) for cleaning and debridement. The patient's clinical course was favourable after multidisciplinary treatment, and she was discharged after improvement.

Cerebral sparganosis, a rare parasitic disease of the central nervous system (CNS) caused by the infection of the plerocercoid larvae of the genus Spirometra, is mainly reported in East and Southeast Asia. Our aim in this study is to summarize its clinical, neuroradiological, and pathological features. A retrospective study was performed for all patients who were selected from electronic case databases between January 2012 and January 2025 in the Jiangxi Provincial People's Hospital and the Xinyu People's Hospital. The clinical manifestations, neuroimaging findings, pathological results, treatment and outcomes of these patients were analyzed. A total of 11 patients, including 2 females and 9 males, were included in this study. The average age was 44 years. The commonest symptoms were headache (72.73%) and seizure (45.45%). The lesions are mostly single and often located in the subcortical white matter of cerebral hemispheres. Different forms of enhancement were visualized on the enhanced-T1 weighted images, including ring-like (100%), beaded or knot-like (81.82%), nodular or irregular (36.36%), and tunnel-like enhancement (72.73%). Moreover, migration sign was found in more than half of the patients on follow-up MRI. Four out of 11 patients received surgical treatment. The pathological feature of cerebral sparganosis was inflammatory granuloma. Migration sign is the most prominent MRI feature of cerebral sparganosis. It is very important to conduct a dynamic imaging evaluation in order to monitor the changes of location and shape of the lesion. Surgery is the best choice for the treatment of cerebral sparganosis.

Angiostrongylus cantonensis (A. cantonensis)-induced central nervous system (CNS) infection is a rare parasitic disease. Although global incidence is rising, pediatric cases remain underrecognized. This study aimed to characterize clinical features and evaluate the diagnostic utility of metagenomic next-generation sequencing (mNGS) in children. We retrospectively analyzed pediatric CNS angiostrongyliasis cases admitted to a national neurology center in Guangdong, China, between 2017 and 2024. A total of 22 pediatric patients were enrolled (median age 1.8 years; male: female = 14:8). Most cases (68.2%) began between June and October; 45.5% had confirmed or probable exposure. Fever was the most common symptom (77.2%), followed by somnolence or lethargy (63.6%) and vomiting (59.1%). No patients reported neck stiffness or hyperesthesia. All patients showed peripheral eosinophilia (median peak 24.0%, IQR 16.0%-36.0%) and cerebrospinal fluid (CSF) pleocytosis. The initial CSF eosinophil percentage exceeded 10% in 10/22 patients (45.5%), and this increased in 7/22 patients (31.8%) during follow-up. Median peak CSF eosinophil percentage was 17.2% at day 18. Among 10 patients tested for CSF cytokines, 90.0% had elevations, with IL-6 being the most common and associated with higher CSF eosinophil percentages. Serum and CSF IgG against A. cantonensis were positive in 44.4% and 46.7%, respectively. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid was performed in 18 of the 22 patients, and A. cantonensis was identified in all tested cases (18/18, 100%), including four who were seronegative. The median mNGS read counts of A. cantonensis were 2,453 (IQR 353.5-28,641.75), which were not significantly correlated with CSF eosinophil percentages, white blood count, or protein levels. Brain magnetic resonance imaging abnormalities (81.8%) included leptomeningeal enhancement (45.5%), ventricular enlargement (40.9%), and cortical lesions (31.8%). Electroencephalogram was abnormal in 54.5%, mainly showing slowing (50.0%) or epileptiform activity 9.1%. Albendazole was used alone in 13.6% of patients, while 86.4% received combined therapy with corticosteroids. Of the 20 patients with follow-up (median 2.5 months), all recovered clinically and radiologically without relapse or sequelae. Pediatric CNS angiostrongyliasis in Guangdong primarily affects rural children during summer-autumn. Clinical signs may be nonspecific. mNGS outperformed serology, especially in early or seronegative cases. Most patients had favorable short-term outcomes.

Alveolar echinococcosis remains a rare parasitic disease, but the number of cases in Western Europe is increasing. Diagnosis is difficult due to a long incubation period and non-specific symptoms. Curative treatment can only be achieved through R0 resection. Suppressive therapy with albendazole can now achieve good long-term survival even in cases where surgery is not possible. Der infektiöse Lebertumor. Die Alveoläre Echinokokkose bleibt eine seltene parasitäre Erkrankung, mit jedoch steigenden Fallzahlen in Westeuropa. Die Diagnose ist aufgrund einer langen Inkubationszeit und unspezifischer Symptome erschwert. Eine kurative Therapie kann nur mittels R0-Resektion angestrebt werden. Durch die suppressive Therapie mit Albendazol kann mittlerweile auch bei bestehender Inoperabilität ein gutes Langzeitüberleben erreicht werden. Schlüsselwörter: Alveoläre Echinokokkose, Fehlwirt, Albendazol.

Paragonimiasis, a rare parasitic disease, often presents diagnostic challenges due to its insidious onset, multiorgan involvement, and nonspecific clinical manifestations, frequently leading to misdiagnosis. While numerous reports describe diagnostic errors in paragonimiasis management, cases involving repeated misdiagnoses across multiple tertiary hospitals over 2 years (particularly with comprehensive epidemiological evidence of freshwater crab consumption) remain exceptionally uncommon. We herein present such a noteworthy case. A 45-year-old male was hospitalized 5 times across 4 tertiary centers in Guilin (January 2023-October 2024) for recurrent cough, hemoptysis, and persistent eosinophilia (lasting 2 years). Initial leukocytosis normalized, while serial chest computed tomography (CT) revealed dynamic, migratory pulmonary lesions. Extensive investigations (X-pert/T-pert, repeated bronchoscopy with bronchoalveolar lavage fluid next-generation sequencing) were nondiagnostic, leading to successive misdiagnoses of viral pneumonia, mycoplasma infection, pulmonary mycosis, tuberculosis, and suspected malignancy. During the hospitalization at the 924 Hospital, a bronchoscopy was performed. Bronchoalveolar lavage fluid high-throughput sequencing revealed the presence of Paragonimus westermani (sequence count: 6). Upon further inquiry, the patient reported a history of capturing and consuming raw freshwater crabs during a trip to Guizhou Province in June 2022, with a self-recorded video of this activity shared on social media. Subsequent diagnostic evaluation included multiple sputum examinations for parasitic eggs. Paragonimus eggs were identified during the third sputum concentration test, confirming a diagnosis of paragonimiasis. Treatment consisted of oral praziquantel (0.2 g 3 times daily for 3 days), followed by a second cycle of anthelmintic therapy after a 1-week interval. During the 4-month postdischarge period, the patient remained asymptomatic with complete resolution of both cough and hemoptysis. Serial laboratory monitoring demonstrated normalization of previously elevated eosinophil counts. Follow-up chest CT revealed significant radiographic improvement, including the complete disappearance of the irregular nodule in the left upper lobe and marked resolution of perilesional infiltrates surrounding the right pulmonary cavity. In cases presenting with recurrent hemoptysis, persistent eosinophilia, and a history of raw crustacean consumption, accompanied by dynamic migratory pulmonary infiltrates on serial CT imaging, paragonimiasis should be strongly suspected despite initial diagnostic challenges.