Clonorchis sinensis

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Clonorchis sinensis

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Chapter 102 Trematodes (Flatworms) CLONORCHIS SINENSIS osms.it/clonorchis-sinensis PATHOLOGY & CAUSES ▪ Parasitic ﬂuke; invasion of biliary tree → liver infection ▪ AKA Chinese liver ﬂuke ▪ Morphology ▫ Adult: ﬂat, elongated body; 25 x 5mm ▫ Egg: oval-shaped; 30 x 15μm ▪ Intermediate hosts ▫ First: freshwater snail (e.g. Parafossarulus manchouricus) ▫ Second: freshwater ﬁsh/shrimp ▪ Reservoirs: cats, dogs ▪ Transmission ▫ Ingestion of raw/undercooked ﬁsh/ shrimp ▪ Infectious form: metacercariae ▫ Ingestion of metacercariae → excyst in duodenum → migration to biliary tract → inﬂammation, epithelial hyperplasia ▪ Endemic to Eastern Asia (e.g. China, Japan, Philippines, Vietnam) RISK FACTORS ▪ Recent travel to endemic areas ▪ Consumption of raw/undercooked ﬁsh/ shrimp COMPLICATIONS ▪ Pancreatitis, cholangitis, liver abscesses, cholangiocarcinoma DIAGNOSIS DIAGNOSTIC IMAGING Ultrasound, CT scan, MRI ▪ Enlarged gallbladder, hepatomegaly, bile duct inﬂammation, dilated/thickened intrahepatic bile ducts Endoscopy ▪ Visualization of adult organisms LAB RESULTS ▪ Acute infection ▫ Eosinophilia, ↑ IgE ▪ Chronic infection ▫ ↑ alkaline phosphatase, ↑ bilirubin ▪ Direct microscopy ▫ Detection of Clonorchis eggs in stool samples ▫ Formalin ethyl-acetate concentration technique (FECT) → parasite separation from faeces ▪ Serologic tests ▫ E.g. ELISA ▪ Polymerase chain reaction (PCR) TREATMENT MEDICATIONS ▪ Anthelmintic (e.g. praziquantel) SIGNS & SYMPTOMS ▪ Mostly asymptomatic ▪ Acute infection: fatigue, right upper quadrant abdominal pain, indigestion, diarrhea, ﬂatulence ▪ Chronic infection: fatigue, weight loss, abdominal discomfort, diarrhea, dyspepsia, jaundice (severe cases) Figure 102.1 An adult Clonorchis sinensis worm. OSMOSIS.ORG 571

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Clonorchis sinensis

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A 41-year-old man is hospitalized for cholangitis. Two months ago he traveled around eastern Asia and ate several meals consisting of raw fish. Temperature is 38.3°C (100.9°F), blood pressure is 138/80 mmHg, and pulse is 85/min. Laboratory studies reveal an alkaline phosphatase of 415 U/L (reference range: 20-70 U/L) and total bilirubin of 4.1 mg/dL (reference range: 0.1-1.0 mg/dL). Both liver biopsy and serum tests for Echinococcus granulosus are negative. A stool sample is collected and found to contain several eggs. Which of the following pathologies is most likely responsible for this clinical presentation?

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