LAUSR

Tuberculosis (TB) and paragonimiasis are two endemic lung diseases in Lao People's Democratic Republic (Lao PDR). As pulmonary tuberculosis is the most common (70–80%) expression of Mycobacterium tuberculosis infection, pulmonary paragonimiasis (PP) is the most common (76–90%) clinical form of human infection with certain species of trematodes belonging to the genus Paragonimus (Singh et al., 2012). These two diseases share many common symptoms such as cough, hemoptysis, chest pain, sometimes accompanied by fever, asthenia and weight loss, while the lack of chest radio specificity does not allow to differentiate them from each other (Singh et al., 2012). In areas where the two endemics coexist, PP cases are often mistakenly considered as smear-negative TB and receive inappropriate treatment (Narain et al., 2004). In Lao PDR, sporadic cases of PP are reported from most provinces since 1947 (Kirkley, 1973), associated with traditional eating habits as the consumption of raw freshwater crabs or crayfishes containing metacercariae (Odermatt et al., 2009). Little is known about the distribution of this endemic parasitic disease, which appears scattered in multiple areas throughout the country. Thus, a cluster of 12 confirmed cases was identified in 2003 in a village of Hinheub District, Vientiane Province (Tran et al., 2004). The prevalence of PP is probably underestimated because it is often confused with TB or other lung diseases. It was estimated at 0.6% in a 2004 survey in three villages of Vientiane Province (Odermatt et al., 2007). Because misidentified and mistreated, paragonimiasis should be classified as neglected diseases in Laos (WHO, 2009). So, it is recommended to rule out the diagnosis of PP by repeated egg search in sputum and pleural fluid before starting antiTB antibiotic treatment (Singh et al., 2005). Although the shell of Paragonimus eggs is clearly revealed by the Ziehl-Neelsen (ZN) staining, this method has been rejected for the diagnosis of PP because it could damage the eggs in the sputum sample (Sadun &