Clonorchiasis B66.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Chinese liver fluke infection

History
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Cobbold, 1875

Definition
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Trematode infection by Clonorchis sinensis.

Pathogen
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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/Epidemiology
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Occurs mainly in East Asia. Worldwide about 20 million people are affected, but also fish-eating mammals.

Etiopathogenesis
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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 features
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  • 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 .

Diagnosis
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  • 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)
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  • Secondary infections (especially with E. coli): cholangitis, cholecystitis, pancreatitis
  • Cholelithiasis
  • liver abscesses, fibrosis, cirrhosis
  • Cholangiocarcinoma.

Internal therapy
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  • 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.

Prophylaxis
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Thorough heating of fish (from 55 °C onwards, metazercaria die), freezing at -10 °C for 5 days also kills metazercaria.

Literature
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  1. 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
  2. Ziegler K, Burchard GD, Meier-Brook A (1996) Liver and lung fluke infections. In: Knobloch J, tropical and travel medicine. Gustav Fischer

Incoming links (2)

Biothionol; Fascioliasis;

Outgoing links (3)

Biothionol; Icterus; Praziquantel;

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020