Clonorchiasis SineClonorchiasis Sinensisnsis

Dept. Of Infectious Disease

Shengjing Hospital

IntruductionIntruductionThe disease is a kind of chronic parasitosi

s caused by clonorchis sinensis, which inhabit human intrahepatic ducts

Clinical Manifestation: hepatomegaly, vague pain of upper abdomen, lassitude and tiredness

The infection is acquired by ingestion of raw or inadequately cooked freshwater fish or shrimp

EtiologyEtiology Morphology Adult worm

Flat, elongated worm, with the size 10-15×3-5 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 them

Eggs

The smallest one of the eggs of human parasites. The sizes are 27.3-35.1×11.7-12.9m

Yellow brown operculated eggs,with a fully embryonated miracidia in it

Life CycleLife 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 Epidemiology Source of infection: patients, infected reservio

r hosts:cats, dogs, mice, pigs

Route of transmission: the infection is acquire

d by eating raw or inadequately cooked fresh

water fish or shrimp, which are previously infe

cted

Susceptibility: human is generally susceptive,

related with the dietary habits

PathogenesisPathogenesis Worms mechanical stimulation proliferate infl

ammatory reaction in the biliary epithelium

The wall of the bile ducts thickened ,fibrous tissu

e around the bile duct, and worm obstruction cau

se cholestasis

When bacteria infection occur, cause cholecystiti

s, cholangeitis, sometimes cholelithiasis happen

s

PathologyPathology Intrahepatic bile ducts expansion, hepatomegaly,

necrosis of liver tissue

Continuous severe infection may cause liver cirrho

sis

Persistent Cholestasis cause biliary liver cirrhosis

Associate with cholangiocarcinoma and hepatic c

arcinoma

Clinical Clinical ManifestationManifestation Incubation period: 1-2 months

Most person with mild clonorchis sinensis infectio

ns are asymptomatic, only eggs can be found in th

e feces

Severe infections: onset is insidious, with intestin

al manifestations like viral hepatitis, hepatomegaly,

neurasthenia, person with heavy worm loads may

suffer from biliary angina and obstructive icteric

Clinical Clinical ManifestationManifestation Acute symptoms appear when the primary infect

ion is heavy: sudden onset, chill, high fever, slig

ht jaundice, hepatomegaly, eosinophilia, a few p

atients have splenomegaly, and weeks later, ent

er chronic stage

Continuous reinfection: cirrhosis and portal hyp

ertension. In children may cause malnutrition gr

owth development disturbance, even dwarf

ComplicationsComplications Acute or chronic cholecystitis, cholangeitis and chol

elithiasis are the most common complications

Portal liver cirrhosis: portal hepertension result in up

per gastrointestinal bleeding

Cholestatic cirrhosis

Pancreatitis

Primary carcinoma of the liver and cholangiocarcino

ma

Laboratory Laboratory FindingsFindingsBlood routine test: eosinophilia, anemia in se

vere infection

Eggs examination:

simple smear feces to find eggs

Stool concentration technique may increase the positive rate

Duodenal aspiration: raise the chance of finding eggs

Laboratory Laboratory FindingsFindingsImmunological Test

Skin test: positive rate 97.9%, 99.5%

coincide with the result of the feces

PHA: positive rate 53.7%, 80% coincide

with the result of the feces

ELISA: positive rate 98.3%, 93.5%

coincide with the result of the feces

DiagnosisDiagnosis Epidemiologic 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 Differential DiagnosisDiagnosisViral hepatitis

Liver cirrhosis of other origins

Primary carcinoma of the liver

Fasciolopsiasis

Other specie of flukes infection

PrognosisPrognosis

Good of the mild infection

Co-infection with viral hepatitis may make

the disease severe

TreatmentTreatment Pathogenic Treatment

Praziquantel is the best choice of drug for the thera

py

Dose: 15-25mg/kg, three times a day, for 2 days, th

e total dose is 90-150mg/kg

Another choice of drug is Albendazole

Heteropathy Treatment

Prevention 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