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Clonorchiasis
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Clonorchiasis

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Contributors: David L. McCollum MD, J. Martin Rodriguez MD, James H. Willig MD, MSPH
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Synopsis

Clonorchiasis is the disease resulting from infection with the trematode Clonorchis sinensis (Chinese liver fluke, or Oriental liver fluke). It is a zoonotic infection in which humans become infected upon ingestion of raw or undercooked fish. Clonorchiasis is endemic in certain Asian countries. It is estimated that 35 million people are infected worldwide. China, Vietnam, and Korea are some of the most affected countries. Immigrants to the United States from these countries may be affected. Due to the long lifespan of C. sinensis in the human biliary system, patients may present after living in the United States for many years.

Clonorchis sinensis has a complex life cycle. The definitive host (a fish-eating mammal; this includes humans, cats, dogs) harbors the adult worm in its biliary system. The adult worms lay eggs, which are released in the host's feces. If the feces reach freshwater, the eggs can be ingested by the first intermediate host, freshwater snails. Within the snail, the parasite can transform to a free-swimming stage, cercariae. The cercariae can then penetrate the skin of a freshwater fish or shrimp, the second intermediate host. The organism encysts within the skin or musculature of the fish. If the fish or shrimp is then eaten raw or undercooked, the fluke can hatch in the duodenum and move into the definitive host's biliary system. Within 4 weeks, the fluke matures to the point where it begins producing eggs. Adult flukes are thought to be able to survive in humans for 20 years.

Most infections are asymptomatic, but clinical manifestations of clonorchiasis can be roughly correlated to the individual's worm burden (number of eggs per gram of stool):
  • Low worm burden (<100) may be asymptomatic or have vague abdominal symptoms. Signs may include occasional jaundice and eosinophilia. 
  • Moderate worm burden (<1000) may have more obvious abdominal signs including fevers, weight loss, colicky pain, and distention. Occasionally an acute syndrome of fever, abdominal pain, urticaria, and eosinophilia – reminiscent of acute schistosomiasis (Katayama syndrome) – may occur. 
  • High worm burden (up to 25 000) may present with an acute right upper quadrant pain syndrome. 
Manifestations and complications of chronic (occurring over years) clonorchiasis include ascites (due to portal hypertension), cholangitis, cholelithiasis, cholecystitis, pancreatitis, and cholangiocarcinoma.

Codes

ICD10CM:
B66.1 – Clonorchiasis

SNOMEDCT:
11938002 – Clonorchiasis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acute schistosomiasis (Katayama fever)
  • Fascioliasis – patient may have migratory skin nodules; poorly responsive to praziquantel
  • Cancer of the biliary tract
  • Recurrent pyogenic cholangitis (Oriental cholangitis) 
  • Sclerosing cholangitis – usually associated with ulcerative colitis
  • IgG4-associated cholangitis – elevated IgG4
  • Primary biliary cirrhosis
  • Caroli's disease – congenital disease that includes biliary duct dilatation

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Therapy

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References

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Last Updated: 05/16/2014
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Clonorchiasis
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Clonorchiasis : Diarrhea, Fever, Hepatomegaly, Jaundice, Anorexia, RUQ pain, EOS increased
Copyright © 2019 VisualDx®. All rights reserved.