Opisthorchiasis B66.0

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Synonym(s)

Cat liver rule infection

History
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Blanchard, 1895

Definition
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Trematode infection by Opisthorchis viverrini or Opisthorchis felineus (cat liver rule).

Pathogen
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Opisthorchis viverrini, Opisthorchis felineus (related to Clonorchis sinensis).

Occurrence/Epidemiology
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  • 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.

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).

Localization
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  • 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 features
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  • 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.

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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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.

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

Outgoing links (2)

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