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.

Ultrasonic diagnosis of patients with clonorchiasis and preliminary study of pathogenic mechanism

Objective:To discuss the liver function damage mechanism of patients with clonorchiasis by analyzing the ultrasound characteristics,liver function,change of the serum inflammatory factors and cell apoptosis factors.Methods:Color Doppler ultrasound technique was adopted to detect the portal vein and blood flow change of patients with clonorchiasis;ELISA was used to determine the level of different serum inflammatory factors.The levels of serum total bilirubin,serum albumin and glutamic-pyruvic transaminase were detected by automatic biochemical analyzer.Western blot was used to determine the expression of proteins relevant to apoptosis.Results:Compared with the health control group,the trunk diameter of portal vein and the thickness of spleen,as well as the hepatic artery pulsation index of clonorchiasis patients increased obviously,the mean blood flow velocity of portal vein(P<0.05 or P<0.01) decreased.The content of total bilirubin and transaminase in plasma increased significantly,but albumin decreased(P<0.05).Levels of TNF-α,IL-6 and IFN-γ increased remarkably,and the level of every factor was significantly different among patients with Child-Pugh Ⅰ,Child-Pugh Ⅱ and Child-Pugh Ⅲ classification of liver function(P<0.05 or P<0.01).With the exacerbation of liver dysfunction,levels of TNF-α,IL-6 and IFN-γ gradually increased(P<0.05).Compared with the healthy control group,the expression quantity of apoptosis protein Fas,FasL,Bax and Caspase-3 increased significantly(P<0.05 or P<0.01),but Bcl-2 decreased(P<0.05).Conclusions:Changes of ultrasonic characteristics and liver dysfunction,caused by liver fluke infection,may be related to that both inflammatory response and apoptosis response have participated in the pathogenic process and liver damage course of clonorchiasis.

Synergistic Action of Clonorchiasis,HBV Infection and Alcohol Consumption on Primary Hepatocellular Carcinoma

OBJECTIVE It has been recognized that HBV infection and alcohol consumption are two important risk factors for primary hepatocellular carcinoma （HCC）. Recently, the role of clonorchiasis as a risk factor for HCC is controversial. We aimed to investigate whether these factors increase the risk of HCC in Guangxi, China. METHODS A hospital-based, case-control study of HCC was conducted from July 2005 to July 2007. We enrolled 500 consecutive patients with HCC as an experimental group and 500 patients without tumor in liver as a control group. The risk factors that the patients were exposed to were assessed. RESULTS Comparing the risks of developing the HCC, we found out the following results. The risk of developing HCC for the patients with clonorchiasis was 5 folds of that for the patients without clonorchiasis （OR = 5.0; 95% CI： 3.1-8.1）, and the risk for the patients with alcohol consumption was 3 folds of that for the patients without drinking alcohol （OR = 3.4; 95% CI： 2.3-4.9）, and similarly, the risk for the patients with HBV infection was 21 times of that for the patients without HBV infection （OR = 20.6; 95% CI： 14.3-29.7）. According to crossover analysis, there was significant interaction among clonorchiasis, HBV infection and alcohol consumption, with synergistic indices greater than 1. The etiologic fractions attributed to these interactions [EF （A × B）] are 0.7465, 0.5789 and 0.5506, respectively. CONCLUSION Clonorchiasis, HBV infection and heavy alcohol consumption are independent risk factors for developing HCC in our population in Guangxi, and as they can interact synergistically, the risk of developing HCC is increased. Data from this study may indicate new prevention strategies of developing HCC in high-risk individuals.

SERODIAGNOSIS OF CLONORCHIASIS BY ENZYME—LINKED IMMUNOSORBENT ASSAY WITH HRP—SPA

In thes paper the authors used the Horseradish peroxidase labelledstaphylococcal protein A(HRP—SPA)in ELISA,for the detection of Clo-norchis sinensis infection.Serum tests were made on 116 confirmed cases ofclonorchiasis,103(88.8%)of them showed positive,while only 6(4.4%)werepositive among 138 healthy people.Samples were collected on filter paperstrips,111(95.7%)cases were positive among 116 comfirmed cases tested,but only 2(1.5%)were positive out of 138 healthy persons.The resultswere similar to those obtained by sheep antihuman IgG.Animal experimentalso showed that the SPA—ELISA can be used for the diagnosis ofclonorchiasis.In an endemic area,stool egg positive rate was 8.8%(62/703).whenchecked with SPA—ELISA,the rate of conformity in both filter paperstrips and stool examinations was 90.3(56/62).Among 641 serum testsfrom individuals negative in stool examinations,only 35(5.5%)reactedpositively.The authors suggested—that SPA—ELISA with soluble Clo-norchis antigens could be used in a large scale seroepidemiological surveyin endemic areas.

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.

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.

Natural variables separate the endemic areas of Clonorchis sinensis and Opisthorchis viverrini along a continuous,straight zone in Southeast Asia

Background Clonorchiasis and opisthorchiasis,caused by the liver flukes Clonorchis sinensis and Opisthorchis viverrini respectively,represent significant neglected tropical diseases(NTDs)in Asia.The co-existence of these pathogens in overlapping regions complicates effective disease control strategies.This study aimed to clarify the distribution and interaction of these diseases within Southeast Asia.Methods We systematically collated occurrence records of human clonorchiasis(n=1809)and opisthorchiasis(n=731)across the Southeast Asia countries.Utilizing species distribution models incorporating environmental and climatic data,coupled machine learning algorithms with boosted regression trees,we predicted and distinguished endemic areas for each fluke species.Machine learning techniques,including geospatial analysis,were employed to delineate the boundaries between these flukes.Results Our analysis revealed that the endemic range of C.sinensis and O.viverrini in Southeast Asia primarily spans across part of China,Vietnam,Thailand,Laos,and Cambodia.During the period from 2000 to 2018,we identified C.sinensis infections in 84 distinct locations,predominantly in southern China(Guangxi Zhuang Autonomous Region)and northern Vietnam.In a stark contrast,O.viverrini was more widely distributed,with infections documented in 721 locations across Thailand,Laos,Cambodia,and Vietnam.Critical environmental determinants were quantitatively analyzed,revealing annual mean temperatures ranging between 14 and 20°C in clonorchiasis-endemic areas and 24-30°C in opisthorchiasis regions(P<0.05).The machine learning model effectively mapped a distinct demarcation zone,demonstrating a clear separation between the endemic areas of these two liver flukes with AUC from 0.9 to1.The study in Vietnam delineates the coexistence and geographical boundaries of C.sinensis and O.viverrini,revealing distinct endemic zones and a transitional area where both liver fluke species overlap.Conclusions Our findings highlight the critical role of specific climatic and environmental factors in influencing the geographical distribution of C.sinensis and O.viverrini.This spatial delineation offers valuable insights for integrated surveillance and control strategies,particularly in regions with sympatric transmission.The results underscore the need for tailored interventions,considering regional epidemiological variations.Future collaborations integrating eco-epidemiology,molecular epidemiology,and parasitology are essential to further elucidate the complex interplay of liver fluke distributions in Asia.

飞行员华支睾吸虫病一例

一、临床资料患者男性，46岁，运输机飞行员，飞行时间3000h。因体检时发现嗜酸性细胞增多1个月，于2010年4月人我院。患者在2010年3月疗养体检时，血常规嗜酸性细胞0．174，嗜酸性细胞计数1．8×10。／L。入院后查体：体温35．80C，心率78次／min，呼吸16次／min，血压120／80mmHg（1mm Hg=0．133kPa）。

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.