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ClonorchiasisB66.1
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.
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