1. Clonorchiasis Sinensis Dept. Of Infectious Disease Shengjing Hospital

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Differential Diagnosis  Viral hepatitis  Liver cirrhosis of other origins  Primary carcinoma of the liver  Fasciolopsiasis  Other specie of flukes infection

15. Prognosis  Good of the mild infection  Co-infection with viral hepatitis may make the disease severe

16. 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

17. 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