Clonorchiasis

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Clonorchiasis
Symptoms of Raw fish infection.png
Differential symptoms of parasite infection by raw fish: Clonorchis sinensis (a trematode/fluke), Anisakis (a nematode/roundworm) and Diphyllobothrium a (cestode/tapeworm), [1] all have gastrointestinal, but otherwise distinct, symptoms. [2] [3] [4] [5]
Specialty Infectious diseases, medical parasitology, helminthologist  OOjs UI icon edit-ltr-progressive.svg

Clonorchiasis is an infectious disease caused by the Chinese liver fluke (Clonorchis sinensis) and two related species. Clonorchiasis is a known risk factor for the development of cholangiocarcinoma, a neoplasm of the biliary system.[ citation needed ]

Contents

Symptoms of opisthorchiasis caused by Opisthorchis viverrini and by O. felineus are indistinguishable from clonorchiasis caused by Clonorchis sinensis , [6] leading some to argue that the disease by these three parasites should be referred to collectively as clonorchiasis. [6]

Signs and symptoms

Cause

Clonorchis sinensis is a trematode (fluke) which is part of the phylum Platyhelminthes. The parasitic worm is as long as 10 to 25 mm and lives in the bile ducts of the liver. It is a hermaphroditic fluke that requires two intermediate hosts. The eggs of the worms are passed in fecal matter into a body of water and are then ingested by mollusks. The water snail is the first intermediate host, in which a miracidium (an embryonated egg discharged in stool) goes through its developmental stages (sporocyst, rediae and cercariae). Freshwater fish are a second intermediate host for the parasitic worm. They become infected when the larva (cercaria) of the worm leaves the snail and penetrates the flesh of the fish. Humans then become infected by eating infected fish that has been undercooked, smoked, pickled, or salted, and from there the cycle repeats.[ citation needed ]

Clonorchiasis is endemic in the Far East, especially in Korea, Japan, Taiwan, and Southern China. Clonorchiasis has been reported in areas to which it is not endemic (including the United States). In such cases, the infection follows the ingestion of undercooked or pickled freshwater fish imported from one of the endemic areas and containing metacercariae. [7]

Diagnosis

Adult C. sinensis worms can inhabit the bile ducts of humans for 20–25 years without any clear clinical symptoms. This, in addition to the nonspecific symptoms infected persons may develop, can lead to missed diagnoses.[ citation needed ]

Patients are diagnosed when C. sinensis eggs are found in stools. The formalin-ether concentration technique (FECT) method of stool examination is most effective at diagnosing light cases of infection, while the Kato-Katz (KK) method is more suitable for the diagnosing of persons with clonorchiasis. Serological methods that use enzyme-linked immunosorbent assay (ELISA) can help differentiate the eggs of C. sinensis from other flukes. [8]

Prevention and control

The CDC recommends against eating raw, undercooked, or lightly salted, smoked, or pickled fish. [9] The WHO recommends a combination of veterinary public health measures, education of food safety practices, and expanding access to anthelminthic drugs. The NHFPC of China has a recommendation similar to that of the WHO. [10]

Health regulators including the FDA have established requirements on the freezing of fish intended for raw consumption. The European Union (EFSA) specifically require an extended time for fish suspected of containing Clonorchis or Opisthorchis compared to other parasites. [11] According to WHO data, larvae of these two genera are killed by freezing at −10 °C (14 °F) for 5 days. [12]

The EFSA recommends a cooking time of 30 minutes at 70 °C (158 °F) to kill the parasite. [12]

Treatment

Praziquantel is the treatment of choice for clonorchiasis.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Trematoda</span> Class of parasitic flatworms

Trematoda is a class of flatworms known as flukes or trematodes. They are obligate internal parasites with a complex life cycle requiring at least two hosts. The intermediate host, in which asexual reproduction occurs, is usually a snail. The definitive host, where the flukes sexually reproduce, is a vertebrate. Infection by trematodes can cause disease in all five traditional vertebrate classes: mammals, birds, amphibians, reptiles, and fish.

<i>Clonorchis sinensis</i> Species of fluke

Clonorchis sinensis, the Chinese liver fluke, is a liver fluke belonging to the class Trematoda, phylum Platyhelminthes. It infects fish-eating mammals, including humans. In humans, it infects the common bile duct and gall bladder, feeding on bile. It was discovered by British physician James McConnell at the Medical College Hospital in Calcutta (Kolkata) in 1874. The first description was given by Thomas Spencer Cobbold, who named it Distoma sinense. The fluke passes its lifecycle in three different hosts, namely freshwater snail as first intermediate hosts, freshwater fish as second intermediate host, and mammals as definitive hosts.

<i>Diphyllobothrium</i> Genus of flatworms

Diphyllobothrium is a genus of tapeworms which can cause diphyllobothriasis in humans through consumption of raw or undercooked fish. The principal species causing diphyllobothriasis is D. latum, known as the broad or fish tapeworm, or broad fish tapeworm. D. latum is a pseudophyllid cestode that infects fish and mammals. D. latum is native to Scandinavia, western Russia, and the Baltics, though it is now also present in North America, especially the Pacific Northwest. In Far East Russia, D. klebanovskii, having Pacific salmon as its second intermediate host, was identified.

Metagonimiasis is a disease caused by an intestinal trematode, most commonly Metagonimus yokagawai, but sometimes by M. takashii or M. miyatai. The metagonimiasis-causing flukes are one of two minute flukes called the heterophyids. Metagonimiasis was described by Katsurasa in 1911–1913 when he first observed eggs of M. yokagawai in feces. M. takahashii was described later first by Suzuki in 1930 and then M. miyatai was described in 1984 by Saito.

<i>Anisakis</i> Genus of parasitic nematodes

Anisakis is a genus of parasitic nematodes that have life cycles involving fish and marine mammals. They are infective to humans and cause anisakiasis. People who produce immunoglobulin E in response to this parasite may subsequently have an allergic reaction, including anaphylaxis, after eating fish infected with Anisakis species.

<i>Paragonimus westermani</i> Species of fluke

Paragonimus westermani is the most common species of lung fluke that infects humans, causing paragonimiasis. Human infections are most common in eastern Asia and in South America. Paragonimiasis may present as a sub-acute to chronic inflammatory disease of the lung. It was discovered by Coenraad Kerbert (1849–1927) in 1878.

Opisthorchis viverrini, common name Southeast Asian liver fluke, is a food-borne trematode parasite from the family Opisthorchiidae that infects the bile duct. People are infected after eating raw or undercooked fish. Infection with the parasite is called opisthorchiasis. O. viverrini infection also increases the risk of cholangiocarcinoma, a cancer of the bile ducts.

<span class="mw-page-title-main">Paragonimiasis</span> Medical condition

Paragonimiasis is a food-borne parasitic disease caused by several species of lung flukes belonging to genus Paragonimus. Infection is acquired by eating crustaceans such as crabs and crayfishes which host the infective forms called metacercariae, or by eating raw or undercooked meat of mammals harboring the metacercariae from crustaceans.

<span class="mw-page-title-main">Eucestoda</span> Subclass of flatworms

Eucestoda, commonly referred to as tapeworms, is the larger of the two subclasses of flatworms in the class Cestoda. Larvae have six posterior hooks on the scolex (head), in contrast to the ten-hooked Cestodaria. All tapeworms are endoparasites of vertebrates, living in the digestive tract or related ducts. Examples are the pork tapeworm with a human definitive host, and pigs as the secondary host, and Moniezia expansa, the definitive hosts of which are ruminants.

<i>Dicrocoelium dendriticum</i> Species of fluke

Dicrocoelium dendriticum, the lancet liver fluke, is a parasite fluke that tends to live in cattle or other grazing mammals.

<i>Opisthorchis felineus</i> Species of fluke

Opisthorchis felineus, the Siberian liver fluke or cat liver fluke, is a trematode parasite that infects the liver in mammals. It was first discovered in 1884 in a cat's liver by Sebastiano Rivolta of Italy. In 1891, Russian parasitologist, Konstantin Nikolaevich Vinogradov (1847–1906) found it in a human, and named the parasite a "Siberian liver fluke". In the 1930s, helminthologist Hans Vogel of Hamburg published an article describing the life cycle of Opisthorchis felineus. Felineus infections may also involve the pancreatic ducts. Diagnosis of Opisthorchis infection is based on microscopic identification of parasite eggs in stool specimens. Safe and effective medication is available to treat Opisthorchis infections. Adequately freezing or cooking fish will kill the parasite.

Diphyllobothriasis is the infection caused by tapeworms of the genus Diphyllobothrium.

Opisthorchiasis is a parasitic disease caused by certain species of genus Opisthorchis. Chronic infection may lead to cholangiocarcinoma, a cancer of the bile ducts.

<span class="mw-page-title-main">Liver fluke</span> Group of liver parasites

Liver fluke is a collective name of a polyphyletic group of parasitic trematodes under the phylum Platyhelminthes. They are principally parasites of the liver of various mammals, including humans. Capable of moving along the blood circulation, they can occur also in bile ducts, gallbladder, and liver parenchyma. In these organs, they produce pathological lesions leading to parasitic diseases. They have complex life cycles requiring two or three different hosts, with free-living larval stages in water.

Capillaria philippinensis is a parasitic nematode which causes intestinal capillariasis. This sometimes fatal disease was first discovered in Northern Luzon, Philippines, in 1964. Cases have also been reported from China, Egypt, Indonesia, Iran, Japan, Korea, Lao PDR, Taiwan and Thailand. Cases diagnosed in Italy and Spain were believed to be acquired abroad, with one case possibly contracted in Colombia. The natural life cycle of C. philippinensis is believed to involve fish as intermediate hosts, and fish-eating birds as definitive hosts. Humans acquire C. philippinensis by eating small species of infested fish whole and raw.

<i>Fasciolopsis</i> Genus of flukes

Fasciolopsis is a genus of trematodes. They are also known as giant intestinal flukes.

<span class="mw-page-title-main">Trematodiasis</span> Medical condition

Trematodiasis is a group of parasitic infections due different species of flukes, the trematodes. Symptoms can range from mild to severe depending on the species, number and location of trematodes in the infected organism. Symptoms depend on type of trematode present, and include chest and abdominal pain, high temperature, digestion issues, cough and shortness of breath, diarrhoea and change in appetite.

Carcinogenic parasites are parasitic organisms that depend on other organisms for their survival, and cause cancer in such hosts. Three species of flukes (trematodes) are medically-proven carcinogenic parasites, namely the urinary blood fluke, the Southeast Asian liver fluke and the Chinese liver fluke. S. haematobium is prevalent in Africa and the Middle East, and is the leading cause of bladder cancer. O. viverrini and C. sinensis are both found in eastern and southeastern Asia, and are responsible for cholangiocarcinoma. The International Agency for Research on Cancer declared them in 2009 as a Group 1 biological carcinogens in humans.

<span class="mw-page-title-main">Gastropod-borne parasitic disease</span> Medical condition

Gastropod-borne parasitic diseases (GPDs) are a group of infectious diseases that require a gastropod species to serve as an intermediate host for a parasitic organism that can infect humans upon ingesting the parasite or coming into contact with contaminated water sources. These diseases can cause a range of symptoms, from mild discomfort to severe, life-threatening conditions, with them being prevalent in many parts of the world, particularly in developing regions. Preventive measures such as proper sanitation and hygiene practices, avoiding contact with infected gastropods and cooking or boiling food properly can help to reduce the risk of these diseases.

References

  1. WaiSays: About Consuming Raw Fish Retrieved on April 14, 2009
  2. For Chlonorchiasis: Public Health Agency of Canada – Clonorchis sinensis – Material Safety Data Sheets (MSDS) Retrieved on April 14, 2009
  3. For Anisakiasis: WrongDiagnosis: Symptoms of Anisakiasis Retrieved on April 14, 2009
  4. For Diphyllobothrium: MedlinePlus > Diphyllobothriasis Updated by: Arnold L. Lentnek, MD. Retrieved on April 14, 2009
  5. For symptoms of diphyllobothrium due to vitamin B12-deficiency University of Maryland Medical Center > Megaloblastic (Pernicious) Anemia Archived 2011-11-26 at the Wayback Machine Retrieved on April 14, 2009
  6. 1 2 King, Sandie; Scholz, Tomáš (2001). "Trematodes of the family Opisthorchiidae: A minireview". The Korean Journal of Parasitology. 39 (3): 209–21. doi:10.3347/kjp.2001.39.3.209. PMC   2721069 . PMID   11590910..
  7. "Clonorchiasis". CDC – DPDx. Archived from the original on 2013-02-16.
  8. Tang, Ze-Li; et al. (6 Jul 2016). "Current status and perspectives of Clonorchis sinensis and clonorchiasis: epidemiology, pathogenesis, omics, prevention and control". Infectious Diseases of Poverty. 5 (5): 71. doi: 10.1186/s40249-016-0166-1 . PMC   4933995 . PMID   27384714.
  9. CDC-Centers for Disease Control and Prevention (27 February 2019). "CDC - Clonorchis - Prevention & Control". www.cdc.gov.
  10. Tang, Ze-Li; Huang, Yan; Yu, Xin-Bing (December 2016). "Current status and perspectives of Clonorchis sinensis and clonorchiasis: epidemiology, pathogenesis, omics, prevention and control". Infectious Diseases of Poverty. 5 (1): 71. doi: 10.1186/s40249-016-0166-1 . PMC   4933995 . PMID   27384714.
  11. Public Health Ontario; Parto, N; Caturay, A (August 2017). "Evidence Brief: Control of parasites by freezing in fish for raw consumption" (PDF). Toronto, ON: Queen’s Printer for Ontario. Retrieved 2023-09-29.
  12. 1 2 "GUIDANCE ON VIABLE PARASITES IN FISHERY PRODUCTS THAT MAY REPRESENT A RISK TO THE HEALTH OF THE CONSUMER" (PDF). 16 November 2011.