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Liver fluke infections 

Liver fluke infections

Chapter:
Liver fluke infections
Author(s):

David I. Grove

DOI:
10.1093/med/9780199204854.003.071102_update_001

Update:

Opisthorchiasis and clonorchiasis—tribendimidine is a potential new alternative anthelminthic.

Fascioliasis—artesunate for treatment.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 27 April 2017

Clonorchiasis and related flukes

Clonorchis (syn. Opisthorchis) sinensis is a fluke (flatworm) acquired by ingestion of undercooked freshwater fish in eastern Asia. Larvae in the duodenum enter the biliary tree through the sphincter of Oddi and mature. Most patients are asymptomatic, but there may be right upper abdominal discomfort, and infection can be complicated by bacterial cholangitis and there is an increased risk of cholangiocarcinoma. Diagnosis is suggested by finding eggs in faeces or in duodenal aspirates, but can only be confirmed by examination of adult flukes. Treatment is with praziquantel.

Opisthorchis viverinni in South-East Asia and O. felineus in Eurasia, also acquired from undercooked fish, cause similar infections. Praziquantel is the treatment of choice.

Fascioliasis

Fasciola hepatica and its relative F. gigantica are acquired by eating watercress contaminated with cysts. These hatch in the duodenum, from which larvae pass through the peritoneum and track through the liver parenchyma, causing considerable damage before they mature in the bile ducts. This produces a hepatitis-like syndrome followed months or years later by features of biliary obstruction. Diagnosis is made by finding eggs in stool or duodenal fluid. Triclabendazole and artenusate are the treatments of choice.

Other liver flukes

Dicrocoelium dendriticum is a rare infection acquired by accidental ingestion of infected ants; Metorchis conjunctus infection follows consumption of infected freshwater fish. The clinical features of these infections and diagnostic approaches to them are similar to those of other liver fluke infections. Praziquantel is the treatment of choice.

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