Clonorchiasis - Causes, Symptoms and Treatment
Clonorchiasis is an infection of the biliary system caused by a worm called Clonorchis sinensis. Infection follows the consumption of raw, dried, salted or pickled fish from areas where the worm breeds. Clonorchiasis is a disease which is most common in the Far East, especially Korea, Japan, Taiwan, and southern China. In some areas, most of the population is infected but asymptomatic. Up to 26% of immigrants from China to the United States have been found to be infected with C. sinensis. The rate of infection is not related to gender or years since immigration. Prognosis is good with treatment.
Causes of Clonorchiasis
Humans become infected after ingesting metacercariae in poorly cooked fish. The metacercariae exist in the small intestine and migrate through the ampulla of Vater into the biliary ducts, where they mature in 3 to 4 weeks and subsequently release eggs. Adult flukes can survive for 20 to 25 years.
Signs and Symptoms of Clonorchiasis
Light infections of clonorchiasis are usually asymptomatic. But in some severe infections, there may be vague complaints such as fever, chills, anorexia, diarrhea, and epigastric pain, which begin 10 to 26 days after eating inadequately cooked infected fish. Symptoms generally last 2 to 4 weeks. In chronic infections, chronic cholangitis may progress to portal fibrosis and may be associated with portal hypertension, cirrhosis, and atrophy of liver parenchyma. Jaundice is usually caused by biliary obstruction due to a mass of flukes or to fonnation of stones. Other complications include cholangiocarcinoma, suppurative cholangitis, and chronic pancreatitis.
Diagnosis for Clonorchiasis
The diagnosis is established when Clonorchis eggs are found in feces; therefore, three samples of stool for ova and parasites should be obtained. Adult flukes may be found in the gallbladder or bile ducts during exploratory surgery for biliary tract disease. Endoscopic retrograde cholangiopancreatography may reveal stones, dilated ducts, or both. Alkaline phosphatase and bilirubin levels may be elevated. Complete blood count may reveal eosinophilia and leukocytosis.
The differential diagnosis of the acute phase of Clonorchis sinensis infection includes acute schistosomiasis.
Treatment of Clonorchiasis
The treatment of choice is oral praziquantel taken after each meal in one day. Albendazole can also be used, but a 7-day treatment course is required.
Special Considerations for Clonorchiasis
1) There should be a high index of suspicion when diagnosing Asian immigrants and those who prepare fish imported from endemic areas.
2) Help the patient maintain adequate nutrition and hydration through the acute phase of the infection.
3) Explain procedures and support the patient and family through possible diagnostic tests such as ultrasound, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography.
Encourage careful preparation and cooking of freshwater fish, crustaceans, and vegetables. Also advise patients to avoid eating raw, pickled, or smoked freshwater fish from endemic areas.
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