Clonorchiasis Sinensis Dept. Of Infectious Disease Shengjing Hospital

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  • Clonorchiasis SinensisDept. Of Infectious DiseaseShengjing Hospital

  • IntruductionThe disease is a kind of chronic parasitosis caused by clonorchis sinensis, which inhabit human intrahepatic ductsClinical Manifestation: hepatomegaly, vague pain of upper abdomen, lassitude and tirednessThe infection is acquired by ingestion of raw or inadequately cooked freshwater fish or shrimp

  • Etiology MorphologyAdult worm Flat, elongated worm, with the size 10-153-5 mm They are monocious, with two suckers The most characteristic feature is branched testis in the posterior third of the body, and relative small ovary before themEggs The smallest one of the eggs of human parasites. The sizes are 27.3-35.111.7-12.9m Yellow brown operculated eggs,with a fully embryonated miracidia in it

  • Life Cycle adult worm in human and mammal eaten 1 month eggs into watermetacercariae first intermediate hostSecocond intermediate host (special snail)(Freshwater fish and shrimp) swallow eggs invade miracidia enter water 2 months cercaria

  • Epidemiology Source of infection: patients, infected reservior hosts:cats, dogs, mice, pigsRoute of transmission: the infection is acquired by eating raw or inadequately cooked freshwater fish or shrimp, which are previously infectedSusceptibility: human is generally susceptive, related with the dietary habits

  • PathogenesisWorms mechanical stimulation proliferate inflammatory reaction in the biliary epitheliumThe wall of the bile ducts thickened ,fibrous tissue around the bile duct, and worm obstruction cause cholestasisWhen bacteria infection occur, cause cholecystitis, cholangeitis, sometimes cholelithiasis happens

  • PathologyIntrahepatic bile ducts expansion, hepatomegaly, necrosis of liver tissueContinuous severe infection may cause liver cirrhosisPersistent Cholestasis cause biliary liver cirrhosis Associate with cholangiocarcinoma and hepatic carcinoma

  • Clinical ManifestationIncubation period: 1-2 monthsMost person with mild clonorchis sinensis infections are asymptomatic, only eggs can be found in the fecesSevere infections: onset is insidious, with intestinal manifestations like viral hepatitis, hepatomegaly, neurasthenia, person with heavy worm loads may suffer from biliary angina and obstructive icteric

  • Clinical ManifestationAcute symptoms appear when the primary infection is heavy: sudden onset, chill, high fever, slight jaundice, hepatomegaly, eosinophilia, a few patients have splenomegaly, and weeks later, enter chronic stageContinuous reinfection: cirrhosis and portal hypertension. In children may cause malnutrition growth development disturbance, even dwarf

  • ComplicationsAcute or chronic cholecystitis, cholangeitis and cholelithiasis are the most common complicationsPortal liver cirrhosis: portal hepertension result in upper gastrointestinal bleedingCholestatic cirrhosisPancreatitisPrimary carcinoma of the liver and cholangiocarcinoma

  • Laboratory FindingsBlood routine test: eosinophilia, anemia in severe infectionEggs examination: simple smear feces to find eggs Stool concentration technique may increase the positive rate Duodenal aspiration: raise the chance of finding eggs

  • Laboratory FindingsImmunological TestSkin test: positive rate 97.9%, 99.5% coincide with the result of the fecesPHA: positive rate 53.7%, 80% coincide with the result of the fecesELISA: positive rate 98.3%, 93.5% coincide with the result of the feces

  • DiagnosisEpidemiologic date: living in or come from the endemic area The history of eating raw or inadequately cooked freshwater fish and shrimp Clinical date: gastrointestinal symptoms, hepatomegaly, neurasthenia, cholangoitis, cholecystitis, etc.Laboratory findings: Discovery of characteristic eggs in feces or by duodenal aspiration come to accurate diagnosis Eosinophilia and positive immunologic test support the diagnosis

  • Differential DiagnosisViral hepatitisLiver cirrhosis of other originsPrimary carcinoma of the liverFasciolopsiasisOther specie of flukes infection

  • PrognosisGood of the mild infectionCo-infection with viral hepatitis may make the disease severe

  • TreatmentPathogenic TreatmentPraziquantel is the best choice of drug for the therapy Dose: 15-25mg/kg, three times a day, for 2 days, the total dose is 90-150mg/kgAnother choice of drug is AlbendazoleHeteropathy Treatment

  • Prevention Control of the source of infection: Treat the patients and domestic animal(cats and dogs, etc.) at the same time.Cut off the route of transmission: Avoid of eating inadequately cooked freshwater fish and shrimp Sanitary disposal of the excreta Avoid of drinking raw water