Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

Lung Cancer Lung Fluke 925

complications and prognosis

Complications

■1/3 of recurrences occur locally, 2/3 distant

■Postobstructive pneumonia: antibiotics; consider local therapy

(stent, laser)

■Radiation pneumonitis: weeks-months after finishing treatment;

trial of prednisone

■Hypercalcemia: hydration, etidronate or pamidronate

Prognosis

■5-y survival for stage I disease >60%

■Overall 5-y survival 13–15%

■Histopathologic response to chemotherapy correlates with survival

■Second malignancies occur at 1–5% per year after treated disease

LUNG FLUKE

J. GORDON FRIERSON, MD

history & physical

History

■Life cycle: Adult worms live encysted in lung tissue. Eggs are passed

and coughed up into sputum or swallowed and pass in the stool. In

fresh water they hatch, larvae invade snails and multiply. New larvae

(cercariae) are released and encyst in fresh-water crabs. When eaten,

the larvae penetrate gut wall and migrate to the lungs, where they

encyst, mate and produce new eggs.

➣Exposure: Ingestion of undercooked infested fresh-water crabs.

Present in Asia, India, Pacific islands, Africa, South and Central

America.

Signs & Symptoms

■Acute phase: abdominal pain, diarrhea, fever, urticaria, followed by

cough, wheeze, dyspnea

■Chronic phase: cough, sputum, often blood-streaked, wheeze, dys-

pnea, chest pains

tests

■Basic tests: blood: eosinophilia

■Basic tests: urine: normal

■Specific tests: exam of sputum and/or stool for eggs