1. Clonorchis Sinesis/Chinese Liver Fluke Parasite
By: Gladys Y. Fontanez BSN,RN
TVOPC Outpatient Clinic
1/31/2019

2. Clonorchis Sinesis/ Chinese Liver Fluke Parasite
A parasite found in freshwater fish in many areas of Vietnam.
Humans can become infected by ingesting uncooked, salted, smoked, or pickled fish.
After ingestion, this parasite implants and grows in the duodenum and ascends to the biliary tract (CDC, 2018) .
Flukes do not live more than 25 years.
The fluke parasite can cause scarring in the biliary tract and lead to cancer.
Many Veterans have been enquiring about the possible exposure to the liver fluke worm parasite while in Vietnam. There seems to be lack of education from the providers and patients. The was contacted for further information. This presentation summarizes the guidelines for the liver fluke parasite recommended by the Deputy Under Secretary for Health for Operations and Management.

3. (CDC, 2018)

4. VHA Facts
Some of the articles regarding the liver fluke parasite refer to a pilot study that was not reviewed or published and occurred in one VA Medical Center.
The reliability of that study has not been verified.
The laboratory testing that was used during the study was performed in South Korea and is not approved by the US Food and Drug Administration (FDA).
There is no current verified data linking the Liver Fluke Parasite and cholangiocarcinoma (CCA) among the US Veterans.
At this time, the rate of Vietnam Veterans and the overall rate of CCA is not known.
The Northport VA Medical Center Infectious Disease team conducted a pilot study to see if there was evidence of exposure to the liver fluke parasite in Vietnam Veterans in 2017.
The VA is in the process of working to validate the South Korean testing and is considering on working with a larger study.
Additional information about this disease can be found at diseases/cholangiocarcinoma.asp.
Questions about this study, please contact Dr. Ralph Erickson, Chief Consultant for Post Deployment Health
The Northport VA study involved taking blood samples from 50 Veterans that served in Vietnam. The testing was done under VA research protocol and the samples were sent to South Korea. The test is not available in the VA because it is not FDA approved.

5. Cholangiocarcinoma (CCA)
Cancer in the biliary duct system.
Liver fluke infection is considered an extremely rare cause of CCA in the US.
There is no scientific evidence to prove that the risk of CCA is higher in Vietnam Veterans than in other Veterans.
There are 8000 cases of CCA diagnosed each year in the US.
There is a greater risk of developing liver cancer with Hepatitis B and/or C infection.

6. Testing for CCA related to Liver Fluke Infection
Veteran’s should be tested for Hepatitis B/C.
Stool examination is not indicated. Liver fluke does not live >25 years.
There is not an approved lab test in the US to check for liver fluke infection past/present.
Genetic factors, Hepatitis B/C, alcoholic cirrhosis, and chronic inflammation of the bile ducts can increase the risk of developing CCA.
Primary sclerosing cholangitis, obesity, ulcerative colitis also increase the risk of developing CCA.
Signs and Symptoms: jaundice and pruritus
Even though there are no lab test to provide evidence that there was past liver fluke infection, a thorough history and proper testing for liver disease should be performed.

7. Patient Management
Providers should perform a thorough military and health history.
Patients with signs or symptoms of liver disease should have LFT’s, Abdominal Ultrasound, and other imaging tests.
Stool tests are not recommended.
Veterans should be bested for Hepatitis B/C.
Asymptomatic patients should be educated and reassured. If Veterans are concerned, they should focus on lifestyle modifications such as avoiding alcohol, smoking cessation, and weight loss.
Refer the patient to /exposures/infectious- diseases/cholangiocarcinoma.asp for resources.
Patients can also be referred to GI or Liver clinic within the VA.

8. References
Centers for Disease Control and Prevention. (2018). About Clonorchis. Retrieved from:
Department of Veteran Affairs. (2017). Liver flukes and cholangiocarcinoma: Background and Veteran Guidelines.