Clonorchiasis is an

infectious disease An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

caused by the Chinese liver fluke (''Clonorchis sinensis'') and two related species. Clonorchiasis is a known risk factor for the development of

cholangiocarcinoma Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile ducts. Symptoms of cholangiocarcinoma may include abdominal pain, yellowish skin, weight loss, generalized itching, and fever. Light colored stool ...

, a

neoplasm A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

of the biliary system. Symptoms of opisthorchiasis caused by ''Opisthorchis viverrini'' and by '' O. felineus'' are indistinguishable from clonorchiasis caused by ''

Clonorchis sinensis ''Clonorchis sinensis'', the Chinese liver fluke, is a liver fluke belonging to the class Trematoda, phylum Platyhelminthes. It infects fish-eating mammals, including humans. In humans, it infects the common bile duct and gall bladder, feeding on ...

'', leading some to argue that the disease by these three parasites should be referred to collectively as clonorchiasis..

Signs and symptoms

Cause

''Clonorchiasis sinensis'' is a

trematode Trematoda is a class of flatworms known as flukes. They are obligate internal parasites with a complex life cycle requiring at least two hosts. The intermediate host, in which asexual reproduction occurs, is usually a snail. The definitive host ...

(fluke) which is part of the phylum

Platyhelminthes The flatworms, flat worms, Platyhelminthes, or platyhelminths (from the Greek language, Greek πλατύ, ''platy'', meaning "flat" and ἕλμινς (root: ἑλμινθ-), ''helminth-'', meaning "worm") are a Phylum (biology), phylum of relati ...

. The parasitic worm is as long as 10 to 25 mm and lives in the bile ducts of the liver. It is a

hermaphroditic In reproductive biology, a hermaphrodite () is an organism that has both kinds of reproductive organs and can produce both gametes associated with male and female sexes. Many taxonomic groups of animals (mostly invertebrates) do not have separ ...

fluke that requires two

intermediate host In biology and medicine, a host is a larger organism that harbours a smaller organism; whether a parasitic, a mutualistic, or a commensalist ''guest'' (symbiont). The guest is typically provided with nourishment and shelter. Examples include a ...

s. The eggs of the worms are passed in fecal matter into a body of water and are then ingested by

mollusk Mollusca is the second-largest phylum of invertebrate animals after the Arthropoda, the members of which are known as molluscs or mollusks (). Around 85,000 extant species of molluscs are recognized. The number of fossil species is e ...

s. The water snail is the first intermediate host, in which a

miracidium The Miracidium is the second stage in the life cycle of trematodes. When trematode eggs are laid and come into contact with fresh water, they hatch and release miracidium. In this phase, miracidia are ciliated and free-swimming. This stage is com ...

(an embryonated egg discharged in stool) goes through its

developmental stages Stages of development may refer to: Biology *Developmental biology, the study of the process by which animals and plants grow and develop *Prenatal development, also called fetal development, or embryology *Human development (biology), the proc ...

(sporocyst, rediae and cercariae).

Freshwater fish Freshwater fish are those that spend some or all of their lives in fresh water, such as rivers and lakes, with a salinity of less than 1.05%. These environments differ from marine conditions in many ways, especially the difference in levels of s ...

are a second intermediate host for the parasitic worm. They become infected when the larva (

cercaria A cercaria (plural cercariae) is the larval form of the trematode Trematoda is a class of flatworms known as flukes. They are obligate internal parasites with a complex life cycle requiring at least two hosts. The intermediate host, in w ...

) of the worm leaves the snail and penetrates the flesh of the fish. Humans then become infected by eating infected fish that has been undercooked, smoked, pickled, or salted, and from there the cycle repeats. Clonorchiasis is

endemic Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found elsew ...

in the

Far East The ''Far East'' was a European term to refer to the geographical regions that includes East and Southeast Asia as well as the Russian Far East to a lesser extent. South Asia is sometimes also included for economic and cultural reasons. The ter ...

, especially in Korea, Japan, Taiwan, and Southern China. Clonorchiasis has been reported in areas to which it is not endemic (including the United States). In such cases, the infection follows the ingestion of undercooked or pickled freshwater fish imported from one of the endemic areas and containing

metacercariae Trematodes are parasitic flatworms of the class ''Trematoda'', specifically parasitic flukes with two suckers: one ventral and the other oral. Trematodes are covered by a tegument, that protects the organism from the environment by providing secr ...

Diagnosis

Adult ''C. sinensis'' worms can inhabit the bile ducts of humans for 20–25 years without any clear clinical symptoms. This, in addition to the nonspecific symptoms infected persons may develop, can lead to missed diagnoses. Patients are diagnosed when ''C. sinensis'' eggs are found in stools. The formalin-ether concentration technique (FECT) method of stool examination is most effective at diagnosing light cases of infection, while the Kato-Katz (KK) method is more suitable for the diagnosing of persons with clonorchiasis. Serological methods that use enzyme-linked immunosorbent assay (ELISA) can help differentiate the eggs of ''C. sinensis'' from other flukes.

Treatment

Praziquantel Praziquantel (PZQ), sold under the brandname Biltricide among others, is a medication used to treat a number of types of helminthiasis, parasitic worm infections in mammals, birds, amphibians, reptiles, and fish. In humans specifically, it is us ...

is the treatment of choice for clonorchiasis.

References

External links

{{Helminthiases Hepatology Helminthiases Foodborne illnesses Tropical diseases