Ankylosing spondylitis coexisting with Clonorchis sinensis infection: A case report

BACKGROUND Ankylosing spondylitis(AS)is a chronic immune-mediated inflammatory disease.The prevailing theory links AS onset to infections in susceptible individuals.Furthermore,infections may impair the immune responses.Numerous studies have investigated links between AS and various infections-bacterial,viral,fungal,and other microorganism infections.However,limited attention has been given to the association between AS and Clonorchis sinensis(C.sinensis)infection.CASE SUMMARY A 27-year-old male with a 10-yr history of AS presented to our hospital with inflammatory lower back pain as the primary manifestation.Ten years ago,the patient had achieved a stable condition after treatment with biological agents.However,he experienced a recurrence of lumbosacral pain with an unexplained cause 10 d before hospital admission.A lumbosacral magnetic resonance imaging(MRI)scan revealed bone marrow edema in the left sacroiliac joint,and laboratory indicators were elevated.Moreover,the presence of C.sinensis eggs was detected in the stool.The patient was prescribed praziquantel,resulting in the disap-pearance of C.sinensis eggs in subsequent routine stool tests and relief from lumbosacral pain.A follow-up MRI scan performed after 4 months revealed a reduction in bone marrow edema around the left sacroiliac joint.CONCLUSION C.sinensis infections could potentially trigger the exacerbation of AS.Clinicians should pay attention to investigating the presence of infections.INTRODUCTION Ankylosing spondylitis(AS)is a chronic inflammatory and rheumatic disease resulting from an imbalance between innate and acquired immune responses[1].While it can affect any part of the spine,its primary symptoms are persistent back pain and stiffness in the lower back and pelvis.The prevalence of AS per 10000 individuals is 23.8 in Europe,31.9 in North America,16.7 in Asia,10.2 in Latin America,and 7.4 in Africa[2].Infections commonly occur in the first 3 months and may act as potential triggers for the first symptoms of AS,often manifesting as gastrointestinal,urinary tract,and respiratory infections of microbiological origin[3,4].Clonorchis sinensis(C.sinensis)infection is a severe parasitic disease affecting millions globally,especially prevalent in China,South Korea,the Far East of Russia,and Vietnam,with an estimated 15 million cases[5].Transmission occurs through the consumption of undercooked freshwater fish containing metacercariae.Adult C.sinensis parasites then establish themselves within the human hepatobiliary system[6].C.sinensis infection triggers the activation of sphingosine 1-phosphate receptor 2,leading to the injury and fibrosis of the hepatobiliary[7].Recent research in a rat model found that C.sinensis infection increases the risk of hepatocellular carcinoma by stimulating hepatic progenitor cell proliferation[8].Complications of C.sinensis infection include cholestasis,cholangitis,biliary system fibrosis,and in severe cases,the development of cholangiocarcinoma[9].Consequently,the primary preventive measure is to abstain from consuming raw or undercooked freshwater fish.Praziquantel is the recommended and effective treatment for this infection[10].While there is existing literature on the coexistence of AS and parasitic infections,there is limited research specifically addressing the simultaneous presence of AS and C.sinensis infection.This case report details a rare scenario of AS coexisting with C.sinensis infection,underscoring the potential impact of C.sinensis infection on AS disease activity.

Analysis of the Results of Two Nationwide Surveys on Clonorchis sinensis Infection in China

Objective To examine Clonorchis sinensis infection in China and evaluate the effectiveness of efforts to prevent and control it,two nationwide surveys were undertaken in 31 provinces,autonomous regions,and municipalities（PAMs） during 1988-92（the 1990 survey） and during 2001-04（the 2003 survey）.Methods During the period 2001-04,two sampling methods were applied.The first method repeated the stratified cluster random sampling used in the 1990 survey;the second method applied two-characteristic stratified cluster random sampling in 27 PAMs—the 2003 endemic area（EA） survey.The Kato-Katz thick smear method was used for the nationwide survey.Results The infection rates of Clonorchis sinensis in the 1990 and 2003 surveys were 0.311% and 0.579%,respectively.The infection rate was 2.40% in the 2003 EA survey,and it was estimated that 12.49 million people in China were infected with Clonorchis sinensis.Conclusion The 2003 survey showed that the standardized infection rate of Clonorchis sinensis increased by 74.85% compared with the 1990 survey.The infection rate in males was higher than in females;the infection rate among people eating raw fish or eating out frequently was higher than among those who did not.

Interspecies Phylogenetic Analysis of Clonorchis sinensis in High-incidence Areas of Hunan Province, China

Objective This study aims to investigate the infection of Clonorchis sinensis(C.sinensis)in highincidence areas of Hunan Province,China.The phylogenetic analysis of the C.sinensis species in the highly infected areas was carried out.Method Infection of the definitive human host and intermediate fish host by C.sinensis was investigated,and the mitochondrial genes cox1 and Nad1 were used as genetic markers for phylogenetic analysis.Results In 2016–2020,the average population infection rate of Hunan was 1.38%,while in Tongdao County the rate was up to 26.90%,and the highest fish infection rate was detected in Qiyang County(99.44%in the dorsal fin of crucian carp).High genetic sequence similarity was observed in the samples from Qiyang and Lengshuitan which exhibited high homology with those from Guangdong and Gansu,whereas the parasitic species from Tongdao was highly homologous with those located in high-latitude areas.Moreover,no significant difference was found in the gene sequence of the parasitic species in definitive hosts dogs and cats.Conclusion The systematically study of C.sinensis infection in the high-incidence areas will contribute greatly to the prevention and effectively controlling the spread of Clonorchis sinensis in Hunan Province The endemic of C.sinensis infection in Hunan Province is the result of co-action of local and foreign parasite species.

Novel mechanism of hepatobiliary system damage and immunoglobulin G4 elevation caused by Clonorchis sinensis infection

Clonorchis sinensis infection is still a major public health problem.It is estimated that more than 15 million people worldwide are infected,especially in Northeast China,Taiwan,South Korea,and North Vietnam.The detection of Clonorchis sinensis eggs in feces and bile is still the only gold standard for the diagnosis of Clonorchis sinensis infection,and new detection methods are needed to improve the detection rate.After Clonorchis sinensis invades the human body,it mainly parasitizes the hepatobiliary tract.Therefore,it is closely related to hepatobiliary diseases such as cholangitis,bile duct stones,liver fibrosis,and cholangiocarcinoma.The increase in immunoglobulin G4(IgG4)caused by Clonorchis sinensis infection is rare and there are few reports about the relevant mechanism.It may be related to the inflammatory factors interleukin(IL)-4,IL-10,and IL-13 produced by human phagocytes,T cells,B cells,and other immune cells in the process of resisting the invasion of Clonorchis sinensis.However,this finding still needs further clarification and confirmation.This article reviews the epidemiology,clinical manifestations,serology,imaging,pathogenic mechanism,and control measures of Clonorchis sinensis infection to help establish the diagnostic process for Clonorchis sinensis.We report novel mechanisms of IgG4 elevation due to Clonorchis sinensis infection to provide more experience and a theoretical basis for clinical diagnosis and treatment of this infection.

Spatio-temporal disparities of Clonorchis sinensis infection in animal hosts in China:a systematic review and meta-analysis

Background Clonorchis sinensis,one of the most important food-borne zoonotic trematodes,remains prevalent in China.Understanding its infection status in animals is crucial for controlling human clonorchiasis.Here we conducted a systematic review and meta-analysis to focus on the spatio-temporal disparities ofC.sinensis infection in animals in China.Methods Data onC.sinensis prevalence in snails,the second intermediate hosts,or animal reservoirs in China were extracted from electronic databases including PubMed,Embase,Web of Science,Chinese Wanfang database,CNKI,VIP,and China Biomedical Literature database.A random-effects meta-analysis model was utilized to estimate the pooled prevalence in each of the above animal hosts.Subgroup analysis and multivariable meta-regression were performed to explore potential sources of heterogeneity across studies and compare the temporal disparity of infection rates between high and low epidemic areas.Scatter plots were used to depict the biogeographical characteristics of regions reportingC.sinensis infection in animals.Results The overall pooled prevalence ofC.sinensis was 0.9%(95%CI:0.6-1.2%)in snails,14.2%(12.7-15.7%)in the second intermediate host,and 14.3%(11.4-17.6%)in animal reservoirs.Prevalence in low epidemic areas(with human prevalence<1%)decreased from 0.6%(0.2-1.2%)before 1990 to 0.0%(0.0-3.6%)after 2010 in snails(P=0.0499),from 20.3%(15.6-25.3%)to 8.8%(5.6-12.6%)in the second intermediate hosts(P=0.0002),and from 18.3%(12.7-24.7%)to 4.7%(1.0-10.4%)in animal reservoirs.However,no similar decrease in prevalence was observed in high epidemic areas(with human prevalence≥1.0%).C.sinensis infections were predominantly reported in areas with altitudes below 2346 m and annual cumulative precipitation above 345 mm and were mostly concentrated in eastern China.Conclusions There are spatio-temporal disparities in the animal infections ofC.sinensis in different areas of China.Animal infections are primarily concentrated in regions with low altitude and high precipitation.The results suggest that implementing One Health-based comprehensive measures targeting both humans and animals,especially in high epidemic areas,is essential for successful eradication ofC.sinensis in China.

Current status and perspectives of Clonorchis sinensis and clonorchiasis: epidemiology, pathogenesis, omics, prevention and contro

Clonorchiasis,caused by Clonorchis sinensis(C.sinensis),is an important food-borne parasitic disease and one of the most common zoonoses.Currently,it is estimated that more than 200 million people are at risk of C.sinensis infection,and over 15 million are infected worldwide.C.sinensis infection is closely related to cholangiocarcinoma(CCA),fibrosis and other human hepatobiliary diseases;thus,clonorchiasis is a serious public health problem in endemic areas.This article reviews the current knowledge regarding the epidemiology,disease burden and treatment of clonorchiasis as well as summarizes the techniques for detecting C.sinensis infection in humans and intermediate hosts and vaccine development against clonorchiasis.Newer data regarding the pathogenesis of clonorchiasis and the genome,transcriptome and secretome of C.sinensis are collected,thus providing perspectives for future studies.These advances in research will aid the development of innovative strategies for the prevention and control of clonorchiasis.

Marked elevation of serum alpha-fetoprotein following Clonorchis sinensis infection: A rare case report

Clonorchiasis,also known as the liver fluke disease,is caused by eating raw freshwater fish or shrimps that contain Clonorchis sinensis cyst larvae,which mainly involves the hepatobiliary system.Chronic abdominal pain and distention,loss of appetite,and hepatomegaly are the most common clinical manifestation.Persistent infection with Clonorchis sinensis would result in chronic inflammation,epithelial hyperplasia,and periductal fibrosis and even progress to cholangiocarcinoma.Nevertheless,the majority of the infected people are asymptomatic or mildly symptomatic,contributing to its high misdiagnosis rate.Alpha-fetoprotein(AFP)is a well-known biomarker for hepatocellular carcinoma(HCC).A high level of AFP can also be caused by several benign diseases,causing confusion and influ-encing treatment decisions.So far,clonorchiasis with a markedly elevated level of AFP has been rarely reported.We present a case of clonorchiasis with a high level of AFP in a 52-year-old man.We hope to raise clinical awareness of this food-borne disease.Clonorchiasis should be considered in patients with extremely high levels of AFP,excluding HCC and germ cell tumors,especially if the patient has a history of ingesting raw freshwater fish or shrimps.

Prevalence of clonorchiasis in patients with gastrointestinal disease: A Korean nationwide multicenter survey

AIM： To investigate prevalence of C/onorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea. METHODS： Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire. RESULTS： Of 3080 patients with gastrointestinal diseases, 396 （12.9%） had clonorchiasis and 1140 patients （37.2%） had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 （20.9%） patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than nonnfected patients [34/396 （8.6%） vs 145/2684 （5.4%）, P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation （P = 0.008）. Choledocholithiasis, cholecystolithiasis, cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis. CONCLUSION： Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.

Clinical and epidemiological features of patients with clonorchiasis

AIM:To study the clinical and epidemiological features of patients with clonorchiasis so as to provide scientific evidences for the diagnosis and prevention of clonorchiasis. METHODS:Stools from 282 subjects suspected of having clonorchiasis were examined for helminth eggs with modified Kato's thick smear and sedimentation methods,and their sera were tested for HAV-DNA,HBV-DNA,HCV-RNA,HDV- RNA and HEV-RNA with polymerase chain reaction (PCR). Clinical symptoms of patients with clonorchiasis only were analyzed,and their blood samples were tested for circulating antigen (CAg) with Dot-ELISA,esoinophilic granulocyte count, and alanine aminotransferase (ALT).Meanwhile,they were asked to provide data of occupation,eating habit,hygienic habit and knowledge of donorchiasis.In addition,the ecosystem of the environment in epidemic areas was surveyed. RESULTS:Among the 282 patients,61 (21.43%) were infected with clonorchis sinensis only,97 (34.64%) were co-infected with clonorchis sinensis and other pathogens, 92 (32.86%) were infected with hepatitis virus only and 31 (11.07%) neither with clonorchis sinensis nor hepatitis virus. Among the 61 patients with clonorchiasis only,there were 14 (22.95%) subjects with discomfort over hepatic region or epigasfrium,12 (19.67%) with general malaise or discomfort and inertia in total body,6 (9.84%) with anorexia,indigestion and nausea,4 (6.56%) with fever,dizziness and headache (6.56%),and 25 (40.98%) without any symptoms;sixty one (100%) with CAg (+),98.33% (59160) with eosinophilic granulocytes increased and 65.00% (39/60) with ALT increased.B-mode ultrasonography revealed 61 cases with dilated and thickened walls of intrahepatic bile duct,and blurred patchy echo acoustic image in liver.Twenty-six cases had stones in the bile duct,39 cases had slightly enlarged liver with diffuse coarse spots in liver parenchyma.Twenty cases had enlarged gallbladder with thickened coarse wall and image of floating plagues,9 cases had slightly enlarged spleen.By analysis of epidemiological data,we found that the ecologic environment was favorable for the epidemiology of clonorchiasis.Most patients with clonorchiasis were lack of knowledge about the disease.Their living environment, hygienic habits,eating habits and their occupations were the related factors that caused the prevalence of the disease. CONCLUSION:The clinical symptoms of clonorchiasis are non-specific,and the main evidences for diagnosis of clonorchiasis should be provided by etiologic examination, B-mode ultrasonography and clinical history.The infection of clonorchis sinensis is related to occupations,bad eating habits and lack of knowledge about prevention of the disease.

Studie über eine alte Leiche von der Zeit der Streitenden Reiche aus dem Grab Nr. 1 am Guo-Jia-Gang in Stadt Jingmen der Provinz Hubei

Durch die systematische Untersuchung und grundliche Studie uber eine Leiche von der Zeit der Streitenden Reiche aus dem Grab Nr. 1 am GuoJia-Gang in der Stadt Jingmen der Provinz Hubei wurde festgestellt , daβdiese Leiche vor mehr als 2300 Jahren, namlich in dem mittleren Zeitabschnitt der Streitenden Reiche Chinas , in einem Holzsarg beerdigt wurde und die alteste unter allen bisher in China gefundenen alten Sargleichen ist. Sie gehort grundsatzlich auch zu dem Typ der jeweils 1972 in Changsha und 1975 in Jiangling gefundenen alten Leichen der Westlichen Han-Dynastie. Die kollagenen Bindegewebsfasern aus allen Korperteilen dieser Leiche zeigten eine sehr gut erhaltene Ultrastruktur mit ganz deutlichen, ordentlichen, periodischen Querstreifungen. Zwischen den Kollagenfibrillen war interessanterweise wie bei den beiden Leichen der Westlichen HanDynastie auch eine Menge von Bakteriensporen vorhanden. Auβerdem wurde noch eine groβe Menge von Clonorchis sinensis-und Trichuris trichiura-Eier in dem Darminhalt der alten Leiche gefunden. Uber den Erhaltungszustand und die Faktoren der guten Erhaltung der Leiche wurde diskutiert. Unserer Ansicht nach sei die Erhaltung der Leiche ein Resultat aus einem kombiniertem Effekt von internen und externen Faktoren der Leiche.

The global epidemiology of clonorchiasis and its relation with cholangiocarcinoma

This paper reviews the epidemiological status and characteristics of clonorchiasis at global level and the etiological relationship between Clonorchis sinensis infection and cholangiocarcinoma(CCA).A conservative estimation was made that 15 million people were infected in the world in 2004,of which over 85%distributed in China.The epidemiology of clonorchiasis is characterized by rising trend in its prevalence,variability among sexes and age,as well as endemicity in different regions.More data indicate that C.sinensis infection is carcinogenic to human,and it is predicted that nearly 5000 CCA cases attributed to C.sinensis infection may occur annually in the world decades later,with its overall odds ratio of 4.47.Clonorchiasis is becoming one major public health problem in east Asia,and it is worthwhile to carry out further epidemiological studies.

Time to tackle clonorchiasis in China

Recent publication of the global epidemiology of clonorchiasis and its relationship with cholangiocarcinoma in the journal of Infectious Diseases of Poverty has stressed the importance of Clonorchis sinensis infection.To further demonstrate its threat on public health,especially in China,comparisons between clonorchiasis and hepatitis B are made in terms of epidemiology,clinical symptoms and carcinogenicity,disability,as well as changing trends.Furthermore,major problems and prioritized researches are argued,from basic biology to intervention.Imbalance between the majority of infected population and the minority of researches in China urges for more work from Chinese scientists and international cooperation.

Clonorchiasis control: starting from awareness

Clonorchiasis is caused by infection with food-borne liver fluke,namely Clonorchis sinensis,which is also considered to be a neglected tropical disease.It is estimated that over 10 million people are infected with C.sinensis in China and,subsequently,several thousand new cholangiocarcinoma cases occur annually.On May 18,2014,China Central Television broadcasted an episode on the habit of raw-fish eating and its potential to cause clonorchiasis in a programme called Health on the tip of the tongue.Here,I briefly introduce the content of the episode and discuss its significance for clonorchiasis control in China.