The acute phase (invasion and migration) may be marked by diarrhea, abdominal pain, fever, cough, urticaria, hepatosplenomegaly, pulmonary abnormalities, and eosinophilia. During the chronic phase, pulmonary manifestations include cough, expectoration of discolored sputum, hemoptysis, and chest radiographic abnormalities. The sputum may be peppered consisting of clumps of eggs produced by the adult fluke living in the lung. Extrapulmonary locations of the adult worms result in more severe manifestations, especially when the brain is involved.

CNS involvement occurs in up to 25% of hospitalized patients and may be associated with Paragonimus-induced meningitis. CNS symptoms may include headaches, seizures, and visual disturbances. Paragonimus flukes may also invade the liver, spleen, intestinal wall, peritoneum, and abdominal lymph nodes.

Ectopic lesions from aberrant migration of flukes can involve any organ, including abdominal viscera, the heart, and the mediastinum. The infection can also affect the liver, spleen, abdomen, and skin. The most clinically recognizable ectopic lesions arise from cerebral paragonimiasis, which, in highly endemic countries, more commonly affects children. These children present with eosinophilic meningoencephalitis, seizures, or signs of space-occupying lesions. Many patients with central nervous system disease also have pulmonary infections. P. skrjabini often produces skin nodules, subcutaneous abscesses, or a type of creeping eruption known as “trematode larva migrans.”