{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:11:50Z","timestamp":1792613510152,"version":"4.5.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009120","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000}}],"reference-count":139,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:00:00Z","timestamp":1612483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Paragonimiasis is caused by zoonotic trematodes of<jats:italic>Paragonimus<\/jats:italic>spp., found in Asia, the Americas and Africa, particularly in tropical regions. These parasites have a complex, multi-host life cycle, with mammalian definitive hosts and larval stages cycling through two intermediate hosts (snails and freshwater decapod crustaceans). In Africa, paragonimiasis is particularly neglected, and remains the only human parasitic disease without a fully characterised life cycle. However paragonimiasis has potentially significant impacts on public health in Africa, and prevalence has likely been underestimated through under-reporting and misdiagnosis as tuberculosis due to a similar clinical presentation. We identified the need to synthesise current knowledge and map endemic foci for African<jats:italic>Paragonimus<\/jats:italic>spp. together with<jats:italic>Poikilorchis congolensis<\/jats:italic>, a rare, taxonomically distant trematode with a similar distribution and morphology. We present the first systematic review of the literature relating to African paragonimiasis, combined with mapping of all reported occurrences of<jats:italic>Paragonimus<\/jats:italic>spp. throughout Africa, from the 1910s to the present. In human surveys, numerous reports of significant recent transmission in Southeast Nigeria were uncovered, with high prevalence and intensity of infection. Overall prevalence was significantly higher for<jats:italic>P<\/jats:italic>.<jats:italic>uterobilateralis<\/jats:italic>compared to<jats:italic>P<\/jats:italic>.<jats:italic>africanus<\/jats:italic>across studies. The potential endemicity of<jats:italic>P<\/jats:italic>.<jats:italic>africanus<\/jats:italic>in C\u00f4te d\u2019Ivoire is also reported. In freshwater crab intermediate hosts, differences in prevalence and intensity of either<jats:italic>P<\/jats:italic>.<jats:italic>uterobilateralis<\/jats:italic>or<jats:italic>P<\/jats:italic>.<jats:italic>africanus<\/jats:italic>were evident across genera and species, suggesting differences in susceptibility. Mapping showed temporal stability of endemic foci, with the majority of known occurrences of<jats:italic>Paragonimus<\/jats:italic>found in the rainforest zone of West and Central Africa, but with several outliers elsewhere on the continent. This suggests substantial under sampling and localised infection where potential host distributions overlap. Our review highlights the urgent need for increased sampling in active disease foci in Africa, particularly using molecular analysis to fully characterise<jats:italic>Paragonimus<\/jats:italic>species and their hosts.<\/jats:p>","DOI":"10.1371\/journal.pntd.0009120","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T03:27:18Z","timestamp":1612754838000},"page":"e0009120","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":28,"title":["Endemicity of Paragonimus and paragonimiasis in Sub-Saharan Africa: A systematic review and mapping reveals stability of transmission in endemic foci for a multi-host parasite system"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8351-2313","authenticated-orcid":true,"given":"Muriel","family":"Rabone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2008-1613","authenticated-orcid":true,"given":"Joris","family":"Wiethase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul F.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1999-1716","authenticated-orcid":true,"given":"David","family":"Rollinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0568-6414","authenticated-orcid":true,"given":"Neil","family":"Cumberlidge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9028-8586","authenticated-orcid":true,"given":"Aidan M.","family":"Emery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,5]]},"reference":[{"key":"pntd.0009120.ref001","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/978-3-030-18616-6_5","volume-title":"Digenetic Trematodes. 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Nwokolo","year":"1972b","journal-title":"Tropical and Geographical Medicine"},{"issue":"1","key":"pntd.0009120.ref022","first-page":"1","article-title":"Investigation of Crab-eating Influence on Paragonimiasis Infection in Six Communities of Abayong from Cross River State Nigeria","volume":"1","author":"CI Iboh","year":"2018","journal-title":"South Asian Journal of Parasitology"},{"key":"pntd.0009120.ref023","unstructured":"Eze JC. Epidemiological Pattern of Presentation of Paragonimus Infection in the Human Host in South East Nigeria and Their Correlative Sonographic Findings, 2015; University of Nigeria, Thesis."},{"issue":"1","key":"pntd.0009120.ref024","first-page":"25","article-title":"Familial and occupational clustering of paragonimiasis in a riverine community in Eastern Nigeria","volume":"3","author":"EC Uttah","year":"2013","journal-title":"Transnational Journal of Science and Technology"},{"issue":"257810","key":"pntd.0009120.ref025","article-title":"Paragonimiasis Reemergence in Nigeria: Predisposing Factors and Recommendations for Early Intervention and Everlasting Eradication","volume":"2013","author":"RA Eke","year":"2013","journal-title":"ISRN Infectious Diseases"},{"issue":"1","key":"pntd.0009120.ref026","first-page":"5","article-title":"The Epidemiology of Pulmonary Paragonimiasis in Cross River Basin in Nigeria: Update on infection prevalence and distribution of the snail and crab intermediate hosts","volume":"3","author":"JE Asor","year":"2003a","journal-title":"Mary Slessor Journal of Medicine"},{"issue":"1","key":"pntd.0009120.ref027","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4314\/msjm.v3i1.10990","article-title":"Association of pulmonary paragonimiasis with active pulmonary tuberculosis in rural Yakurr community in Cross River Basin, Nigeria","volume":"3","author":"ES Ibanga","year":"2003","journal-title":"Mary Slessor Journal of Medicine"},{"issue":"9","key":"pntd.0009120.ref028","doi-asserted-by":"crossref","first-page":"963","DOI":"10.9734\/IJTDH\/2014\/11252","article-title":"A new focus of pleuro-pulmonary paragonimiasis in Manjo Health District, Littoral Region of Cameroon","volume":"4","author":"R Moyou-Somo","year":"2014","journal-title":"International Journal of Tropical Disease and Health"},{"issue":"3","key":"pntd.0009120.ref029","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.trstmh.2008.09.014","article-title":"Paragonimiasis in Cameroon: molecular identification, serodiagnosis and clinical manifestations","volume":"103","author":"A Nkouawa","year":"2009","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"issue":"1","key":"pntd.0009120.ref030","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/S1080-6032(13)80008-7","article-title":"Paragonimiasis in southwest Cameroon: isolation of microcercous cercariae from land snails caught in a Paragonimus africanus endemic zone","volume":"6","author":"R Moyou-Somo","year":"1995","journal-title":"Wilderness and Environmental Medicine"},{"key":"pntd.0009120.ref031","unstructured":"Moyou-Somo R, Enyong PA, Kouamouo J. 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Plant Genetic Resources Newsletter"},{"key":"pntd.0009120.ref058","unstructured":"Sachs R, Distribution of Paragonimus uterobilateralis metacercariae in Liberonautes latidactylus, Annual Report 1985, Liberia Research Unit of the Tropical Institute Hamburg 1985c:4\u201347."},{"issue":"1","key":"pntd.0009120.ref059","doi-asserted-by":"crossref","DOI":"10.4314\/ijonas.v5i1.49948","article-title":"Polyparasitic infections in school children of Equatorial Guinea","volume":"5","author":"O Chukwu","year":"2009","journal-title":"International Journal of Natural and Applied Sciences"},{"key":"pntd.0009120.ref060","unstructured":"N\u2019Dzossi AAC. Observations clinique et \u00e9pid\u00e9miologique du premier cas de paragonimose humaine au Congo-Brazzaville (Doctoral dissertation). University of Bordeaux. 2000."},{"key":"pntd.0009120.ref061","unstructured":"Bosse, D. 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