2. Endemic(native) areas are in Asia including Korea, China, Taiwan, and Vietnam. There have been cases in the United States in Asian immigrants due to the ingestion of undercooked freshwater fish containing metacercariae(infective cyst stage).

3.  Definitive host : humans, fish eating vertebrates  1 st Intermediate host: some sort of snail  2 nd Intermediate host: freshwater fish(over 100 species), common one is the grass carp

4.  Adults 8-25 mm long and 1.5 to 5 mm wide  Weak muscularity, lack spines  Have oral sucker at anterior end

7. rediae cercariae Metacercariae(on fish), pg 290 book

8.  A problem in Asia where raw fish is a delicacy  Many fish farms where fish are fed with human and animal feces, thus promoting the C. sinensis lifecycle  Metacercarie will survive pickling, drying, smoking, and salting so people can be infected where this imported fish is consumed  Dogs and cats also contaminate water supplies with feces

9.  Fever  Chills  Stomach pains  Jaundice(not common)  Digestive problems

10.  Causes clonorchisasis  C. sinensis generally only inhabit 2 nd order bile ducts, 1 st order to small  Cause production of excess mucus, erosion of epithelial lining, and surplus epithelial cell growth  Duct inflammation and necrosis or atrophy of adjacent liver cells  Deformation of ducts leads to gradual thickening and possible closure of duct

11.  Infiltrating pockets of eggs become surrounded by granulomas and interfere with liver function  Advanced clonorchiasis can cause cancer of the bile duct

12.  Diagnosis is based on the look of eggs recovered from feces.  Liver abnormalities in native areas or populations are a good clue for clonorchiasis, must be careful to rule out other liver diseases  Tissue sample to look for adult flukes is also used  Treatment  Drug used is called Praziquantel which kills the flukes in the intestine  Side effects include: headaches, dizziness, drowsiness, fever, nausea, stomach pain

13.  Thoroughly cook fish before consuming  Food pickled, dried, or pickled from endemic areas