Synonym(s)
Chinese liver fluke infection
HistoryThis section has been translated automatically.
Cobbold, 1875
DefinitionThis section has been translated automatically.
Trematode infection by Clonorchis sinensis.
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PathogenThis section has been translated automatically.
Clonorchis sinensis (Chinese liver fluke; related to Opisthorchis viverrini and felineus); size 7-20 mm x 2-5 mm) depending on the intensity of infestation (the more parasites, the smaller the parasite) Morphologically, the rear end of the body shows deer antler-like tests. Eggs are yellow-brown, 28-32 µm x 12 x 17 µm in size; tiny appendage at the rear end of the egg. Mirazidia are detectable. Distinctly set off egg lid (like a teapot).
Occurrence/EpidemiologyThis section has been translated automatically.
Occurs mainly in East Asia. Worldwide about 20 million people are affected, but also fish-eating mammals.
EtiopathogenesisThis section has been translated automatically.
Eggs enter surface water with faeces and are ingested by gill snails; in the snails, cercaria mature within 3 weeks; the cercaria are released and penetrate fish (mainly of the carp family), in whose muscles they disintegrate; consumption of raw fish leads to human infection; there the adult worms settle in the intra- and extrahepatic bile ducts (by retrograde invasion of the bile ducts by the papilla vateri).
Clinical featuresThis section has been translated automatically.
- Integument: Often a mild icterus appears. In the foreground are the extracutaneous manifestations.
- Extracutaneous manifestations: Mechanical irritation and inflammatory reactions, epithelial proliferation and desquamation and wall fibrosis of the bile ducts.
- Acute stage: after about 1-3 weeks general malaise, fever, upper abdominal pain, diarrhoea.
- Chronic stage: > 30.000 eggs/g of stool is a severe infestation which causes symptoms: headache, fatigue, irregular bowel movement, meteorism, vomiting, colicky pain in the right upper abdomen, irregular attacks of fever, jaundice .
DiagnosisThis section has been translated automatically.
- Detection of eggs in faeces or duodenal juice (because eggs are very small, detection is often difficult)
- Sonography
- Transhepatic cholangiogram
- ERCP
- Serum antibodies are hardly measurable.
Complication(s)This section has been translated automatically.
- Secondary infections (especially with E. coli): cholangitis, cholecystitis, pancreatitis
- Cholelithiasis
- liver abscesses, fibrosis, cirrhosis
- Cholangiocarcinoma.
Internal therapyThis section has been translated automatically.
- Praziquantel: One-day therapy with 3 times 25 mg/kg bw p.o. In case of severe infestation 120 mg/kg bw for 2 days.
- Alternatively biothionol (lorothidol, bitin [available from international pharmacies]): 30-50 mg/kg bw/day in 3 doses every other day, alternating with a day without treatment. 5-15 treatment days.
ProphylaxisThis section has been translated automatically.
Thorough heating of fish (from 55 °C onwards, metazercaria die), freezing at -10 °C for 5 days also kills metazercaria.
LiteratureThis section has been translated automatically.
- Haswell-Elkins MR, Levri E (2003) Food-borne Trematodes. In: Cook GC, Zumla A Manson's Tropical diseases. WB Saunders, 21st Edition, pp. 1472-1486
- Ziegler K, Burchard GD, Meier-Brook A (1996) Liver and lung fluke infections. In: Knobloch J, tropical and travel medicine. Gustav Fischer
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Disclaimer
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.
Prof. Dr. med. Peter Altmeyer
