Transcript Clonorchiasis Sinensis

Clonorchiasis Sinensis
Dept. Of Infectious Disease
Shengjing Hospital
Intruduction
 The disease is a kind of chronic
parasitosis 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
Etiology
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 27.3-35.1×11.7-12.9m
Yellow brown operculated eggs,with a fully embryonated
miracidia in it
Life Cycle
adult worm
in human and mammal
eaten
1 month
eggs into water
metacercariae
first intermediate host
Secocond 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, pigs
 Route of transmission: the infection is
acquired by eating raw or inadequately
cooked freshwater fish or shrimp, which are
previously infected
 Susceptibility: human is generally susceptive,
related with the dietary habits
Pathogenesis
 Worms
mechanical stimulation proliferate
inflammatory reaction in the biliary epithelium
 The wall of the bile ducts thickened ,fibrous
tissue around the bile duct, and worm
obstruction cause cholestasis
 When bacteria infection occur, cause
cholecystitis, cholangeitis, sometimes
cholelithiasis happens
Pathology
 Intrahepatic bile ducts expansion,
hepatomegaly, necrosis of liver tissue
 Continuous severe infection may cause liver
cirrhosis
 Persistent Cholestasis cause biliary liver
cirrhosis
 Associate with cholangiocarcinoma and
hepatic carcinoma
Clinical Manifestation
 Incubation period: 1-2 months
 Most person with mild clonorchis sinensis
infections are asymptomatic, only eggs can be
found in the feces
 Severe 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 Manifestation
 Acute 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 stage
 Continuous reinfection: cirrhosis and portal
hypertension. In children may cause
malnutrition growth development disturbance,
even dwarf
Complications
 Acute or chronic cholecystitis, cholangeitis and
cholelithiasis are the most common complications
 Portal liver cirrhosis: portal hepertension result in
upper gastrointestinal bleeding
 Cholestatic cirrhosis
 Pancreatitis
 Primary carcinoma of the liver and
cholangiocarcinoma
Laboratory Findings
 Blood routine test: eosinophilia, anemia in
severe 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 Findings
Immunological 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
Diagnosis
 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 Diagnosis
 Viral hepatitis
 Liver cirrhosis of other origins
 Primary carcinoma of the liver
 Fasciolopsiasis
 Other specie of flukes infection
Prognosis
 Good of the mild infection
 Co-infection with viral hepatitis may make
the disease severe
Treatment
 Pathogenic Treatment
 Praziquantel 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/kg
 Another choice of drug is Albendazole
 Heteropathy 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