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OpisthorchiasisB66.0
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).
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