Synonym(s)
Cat liver rule infection
HistoryThis section has been translated automatically.
Blanchard, 1895
DefinitionThis section has been translated automatically.
Trematode infection by Opisthorchis viverrini or Opisthorchis felineus (cat liver rule).
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PathogenThis section has been translated automatically.
Opisthorchis viverrini, Opisthorchis felineus (related to Clonorchis sinensis).
Occurrence/EpidemiologyThis section has been translated automatically.
- O. viverrini: South-East Asia, in some cases up to 90% of the population is affected.
- O. felineus: Baltic States and Russia, especially in Siberia.
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).
LocalizationThis section has been translated automatically.
- Detection of eggs in faeces or duodenal juice (because eggs are very small, detection often difficult)
- Sonography
- Transhepatic cholangiogram
- ERCP
- Serum antibodies hardly measurable
Clinical featuresThis section has been translated automatically.
- Integument: In the foreground are the extracutaneous manifestations. Often a progressive icterus appears.
- Extracutaneous manifestations: Mechanical irritation and inflammatory reactions, epithelial proliferation and desquamation and wall fibrosis of the bile ducts. Bacterial superinfection may lead to suppurative cholangitis.
- Acute stage: after about 1-3 weeks general feeling of discomfort, fever, upper abdominal pain, diarrhoea.
- Chronic stage: > 30,000 eggs/g of stool is a severe infection causing symptoms: headache, fatigue, irregular bowel movements, meteorism, vomiting, colicky pain in the right upper abdomen, irregular 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.
One-day therapy with Praziquantel 3 times 25 mg/kg bw p.o. In case of severe infestation 120 mg/kg bw for 2 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
