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Paragonimiasis is common in Asia, Africa, and Central and South America and is caused by ingestion of liver or lung flukes. Paragonimus kellicotti, a lung fluke, is endemic to North America, and its life cycle involves two intermediate hosts: freshwater snails and crayfish.
In 2006, three cases of paragonimiasis were recognized in Missouri among individuals who had gone canoeing or camping. Surveillance was heightened, and six similar cases were detected between September 2009 and September 2010. All cases were attributed to ingestion of raw or undercooked crayfish.
Symptoms — most commonly fever, cough, weight loss, and malaise — began 2 to 14 days after crayfish ingestion. All nine patients had eosinophilia (range, 850–3900 eosinophils/mm3)…