other adventitious breath sounds. many patients are asymptomatic, and symptomatic patients frequently look well despite a prolonged course." in pleural paragonimiasis, symptoms may be minimal and diagnosis complicated, since ova are not coughed or spit out or swallowed and there is frequently no cough. such patients may develop pleural effusions and, because of the coendemicity with mycobacterium tuberculosis (and co-infection in some patients), such effusions are often misdiagnosed as isolated tuberculosis. adapted from heath, harley w & susan g marshall. "pleural paragonimiasis in a laotian child.* extra-pulmonary locations of the adult worms result in more severe manifestations, especially when the brain is involved. extra-pulmonary paragonimiasis is rarely seen in humans, as the worms nearly exclusively migrate to the lungs. despite this, cysts can develop in the brain and abdominal adhesions resulting from infection have been reported. cysts may contain living or dead worms; a yellow-brownish thick fluid (occasionally hemorrhagic). when the worm dies or escapes, the cysts gradually shrink, leaving nodules of fibrous tissues and eggs that can calcify. worldwide the most common cause of hemoptysis is paragonimiasis. other case studies: pachucki ct, levandowski ra, brown va, sonnenkalb bh, vruno mj (1984). "american paragonimiasis treated with praziquantel". n engl j med. 311 (9): 582–3. doi:10.1056/nejm198408303110906. pmid 6749230. procop gw, marty am, scheck dn, mease dr, maw gm (2000). "north american paragonimiasis: a case report". acta cytol. 44 (1): 75–80. doi:10.1159/000326230. pmid 10667165. s2cid 3366362. public health and prevention strategies prevention programs should promote more hygienic food preparation by encouraging safer cooking techniques and more sanitary handling of potentially contaminated seafood. the elimination of the first intermediate host, the snail, is not tenable due to the nature of the organisms habits. a key component to prevention is research, more specifically the research of everyday behaviors. this recent study was conducted as a part of a broader effort to determine the status of paragonimus species infection in laos. an epidemiological survey was conducted on villagers and schoolchildren in namback district between 2003 and 2005. among 308 villagers and 633 primary and secondary schoolchildren, 156 villagers and 92 children had a positive reaction on a paragonimus skin test. consequently, several types of crabs were collected from markets and streams in a paragonimiasis endemic area for the inspection of metacercariae and were identified as the second intermediate host of the paragonimus species. in this case study, we see how high prevalence of paragonimiasis is explained by dietary habits of the population. amongst schoolchildren, many students reported numerous experiences of eating roast crabs in the field. adult villagers reported frequent consumption of seasoned crabs (tan cheoy koung) and papaya salad (tammack koung) with crushed raw crab. in addition to this characteristic feature of the villagers' food culture, the denizens of this area drink fresh crab juice as a traditional cure for measles, and this was also thought to constitute a route for infection.