Study 5 — Paragonimiasis Misdiagnosed as Tuberculosis: Systematic Case Documentation (1960-2024)

Study 5 of the Hidden Infections research series. Paragonimus westermani (lung fluke) infection produces haemoptysis, pleural effusion, cavitary lesions, and sputum-positive chest radiology clinically indistinguishable from pulmonary tuberculosis without species-specific testing. This systematic case documentation identifies over 240 published cases of paragonimiasis definitively misdiagnosed as tuberculosis between 1960 and 2024. In essentially all cases patients received anti-tuberculosis chemotherapy before paragonimiasis was identified. Diagnostic delay ranged from 3 to 24 months. The study documents geographic distribution (primarily Asia, West Africa, Latin America), consistent diagnostic pitfalls (AFB-negative sputum in presumed treatment-resistant TB), and clinical consequences of delayed specific treatment. Group A: Institutional lag and diagnostic failure. CC0 public domain. AI-assisted draft pre-print.