Hidden in plain sight: lessons on misdiagnosis of pulmonary paragonimiasis in a setting of high burden of pulmonary tuberculosis from Zamboanga Peninsula, the Philippines.

Pulmonary tuberculosis (PTB) remains a major public health concern in several regions of the Philippines and in many parts of Southeast Asia. Overlapping with it in terms of clinical manifestations is pulmonary paragonimiasis or lung fluke disease. Paragonimiasis, a foodborne trematode infection, may be hidden in plain sight in the setting of a high burden of PTB. This raises questions about how much reported data on PTB is paragonimiasis and how much coinfection exists with PTB and this food-borne trematode infection. This research draws lessons from Zamboanga Peninsula in the Philippines, a region with considerable data on both disease entities. In this paper, a review of available data from published literature and from the country's Department of Health registry was undertaken. Results show that TB remains to be a major public health concern in the region. Coincidentally, paragonimiasis also exists in many parts of the region alongside TB, with Paragonimiasis being more common than PTB in some areas. The approach from Zamboanga Peninsula may be used to generate evidence from other regions and become the basis for national policy formulation. The results support an integrated policy for surveillance, and control. Capacity building and active surveillance may be combined to enhance case finding, treatment, and generation of data for mapping and targeted interventions for integrated tuberculosis-paragonimiasis control. These learnings may be applicable to other parts of the Philippines and Southeast Asia where there may be known or likely co-endemicity of the two diseases.