[Clinical value of transient elastography (FibroScan) in detection of clonorchiasis].

OBJECTIVE: To assess the clinical significance of transient elastography (Fibroscan) in detection of clonorchiasis, so as to provide new insights into the assessment of therapeutic efficacy of deworming. METHODS: The liver stiffness measurement (LSM) values were measured in parasitologically diagnosed clonorchiasis patients using FibroScan before and after deworming, and the patients'age, gender, body mass index (BMI), duration of raw fish consumption and total amount of raw fish consumption were collected for correlation analyses. RESULTS: The clonorchiasis patients'age, gender, BMI, duration of raw fish consumption and total amount of raw fish consumption had no associations with pre-treatment LSM values (r/rs = 0.189, 0.073, 0.180; 0.071, -0.098, 0.033; 0.166, 0.309, 0.172; 0.235, 0.247, 0.209; 0.164, 0.277, 0.088; all P values > 0.05). There was a significant difference in the LSM values from the seventh, eighth and ninth intercostal space prior to deworming (F = 3.259, P < 0.05), and no significant difference was detected after deworming (F = 0.851, P > 0.05). The LSM values from the seventh, eighth and ninth intercostal space were significantly lower pre-deworming than post-deworming (t = 6.724, 5.603, 2.884; all P values < 0.05). CONCLUSIONS: FibroScan is feasible to assess the therapuetic efficacy of deworming in patients with clonorchiasis; however, measurement at various sites affects the LSM value.

A Clonorchiasis Case of a Leopard Cat, Prionailurus bengalensis euptilurus, Diagnosed by Ultrasonography and Egg Detection in Republic of Korea.

A clonorchiasis case in a captive leopard cat, Prionailurus bengalensis euptilurus, was confirmed by ultrasonographic findings and egg morphologies found in the bile juice sample in the Korea. The leopard cat was introduced from the wild habitat of Gyeongsangnam-do, to Cheongju Zoo in Cheongju-si, Chungcheongbuk-do, Korea in August 2014. Physical examinations were basically performed for quarantine and check-up health. The cat was comparatively good in health except anorexia. The cyst-like bile duct dilation and the increased echogenicity of gall bladder wall and hepatic parenchyma were observed by ultrasonography. Ultrasound-guided needle biopsy was conducted for collecting bile juice and the specimens were observed under light microscope. The numerous small trematode eggs were detected in the bile juice sample of the light microscopy. The eggs were 25-33 (28±3) µm by 18-22 (20±1) µm in size and showed typical characteristics of Clonorchis sinensis egg, i.e., a dominantly developed operculum, shoulder rim and dust-like wrinkles in surface. To treat the liver fluke infection, 20 mg/kg of praziquantel was orally administered only once to the case. Follow-up studies including fecal examinations were conducted during 2 years after treatment. But no more eggs were detected from the case. In the present study, we described the first clonorchiasis case of leopard cat, which was confirmed by ultrasonographic findings and egg morphologies from the bile juice sample in Korea.

[Discussion on relationship between hepatobiliary pathological changes under B-ultrasound and Clonorchis sinensis infection].

OBJECTIVE: To explore the relationship between the hepatobiliary pathological changes under B-ultrasound examinations and Clonorchis sinensis infection, so as to provide the evidence for further prevention and control. METHODS: The stool test and ELISA were applied to test the pathogeny and antibody to C. sinensis of the suspicious patients who had the hepatobiliary pathological changes under B-ultrasound examinations in People's Hospital of Wuxuan County from Jan. 2010 to Dec. 2013. RESULTS: Totally 113 suspicious patients of C. sinensis infection were investigated, and the positive rates of egg and serum antibody were 64.60% (73 cases) and 66.37% (75 cases) respectively. The positive rates of the male and those aged ≥ 50 years were significantly higher than those of the female and the cases younger than 50 years respectively (χ² = 3.554, 6.267, both P < 0.05). In the C. sinensis infected patients, the degree of pathological changes of hepatobiliary was positively correlated with the infectiosity of C. sinensis (χ² = 64.952, P < 0.01). CONCLUSION: The hepatobiliary pathological changes under B-ultrasound examinations may be resulted from the infection of C. sinensis, and the patients with the changes should be further investigated for the pathogen and antibody to C. sinensis.

A misdiagnosis of clonorchiasis as gallstone, leading to an unnecessary cholecystectomy: a case report.

This case report describes an unusual presentation of Clonorchissinensis infection. In this rare case, a clonorchiasis infection that had been latent for decades was misdiagnosed as acute calculous cholecystitis.Exploratory surgery and a cholecystectomy were performed. Therefore,in the course of diagnosis of hepatic and gall diseases, we cannot neglect parasite infections such as clonorchiasis.

[Current methods for the diagnosis of human and animal clonorchiasis].

The paper briefly reviews the current techniques for the diagnosis of human and animal clonorchiasis, which involve visual, immunological, and polymerase chain reaction-based methods, including those extensively used in medical practice and devised in experimental research laboratories.

Human infections with liver and minute intestinal flukes in Guangxi, China: analysis by DNA sequencing, ultrasonography, and immunoaffinity chromatography.

The prevalence of liver and intestinal fluke infections was determined by surveying inhabitants of Hengxuan, Fusui, and Shanglin villages which were known to be endemic for liver flukes in Guangxi, China in May 2010. A total of 718 people were examined for helminth eggs by the Kato-Katz thick smear technique, ultrasonography, immunoaffinity chromatography, and DNA sequencing. The overall egg positive rate was found to be 59.6% (28.0-70.6%) that included mixed infections with liver and intestinal flukes. Cases showing higher than 20,000 eggs per gram of feces (EPG) were detected between 1.3% and 16.2%. Ultrasonographic findings exhibited overall 28.2% (72 of 255 cases) dilatation rate of the intrahepatic bile duct. Clonorchis sinensis infection was detected serologically in 88.3% (38 of 43 cases) among C. sinensis egg positive subjects by the immunoaffinity chromatography using a specific antigen for C. sinensis. For differential diagnosis of the liver and intestinal flukes, more precise PCR and nucleotide sequencing for copro-DNA were performed for 46 egg positive cases. Mixed infections with C. sinensis and Metagonimus yokogawai were detected in 8 of 46 egg positive cases, whereas 29 specimens were positive for Haplorchis taichui. Ultrasonographic findings and immunoaffinity chromatography results showed usefulness, even in a limited way, in figuring out of the liver fluke endemicity.

[Correlation between liver sonographic findings and clinical manifestations of clonorchiasis].

OBJECTIVE: To study the correlation between sonographic findings of the intrahepatic bile duct and liver and clinical symptoms and signs of clonorchiasis. METHODS: The data of sonographic findings of intrahepatic bile duct and liver and clinical symptoms and signs of 98 patients with clonorchiasis were collected and analyzed. RESULTS: There were 40 cases in light degree of the II , III intrahepatic bile duct dilatation, 27 cases in middle degree, and 31 cases in heavy degree. There were 4 cases of intrahepatic bile duct dilatation and liver patchy or nodular lesions of slightly stronger echo. The mild expansion of intrahepatic bile duct was found in the patients with no obvious clinical signs and symptoms. The middle and heavy degrees of expansion were found in the patients with obvious clinical signs and symptoms. There were significantly difference between them (chi2 = 43.57, P < 0.05). The incidence of middle and heavy degrees of expansion in patients with cholecystitis, pancreatitis, liver cirrhosis and hepatocellular carcinoma and cholangiocarcinoma was much higher than that in patients with intrahepatic bile duct stones (chi2 = 4.873, P < 0.05). CONCLUSION: Bile duct dilatation is closely correlated with the clinical symptoms and signs. This connection helps the diagnosis of clonorchiasis.

Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation.

Intrahepatic cholangiocarcinoma is the second most common primary hepatic tumor. Various risk factors have been reported for intrahepatic cholangiocarcinoma, and the radiologic and pathologic findings of this disease entity may differ depending on the underlying risk factors. Intrahepatic cholangiocarcinoma can be classified into three types on the basis of gross morphologic features: mass-forming (the most common), periductal infiltrating, and intraductal growth. At computed tomography (CT), mass-forming intrahepatic cholangiocarcinoma usually appears as a homogeneous low-attenuation mass with irregular peripheral enhancement and can be accompanied by capsular retraction, satellite nodules, and peripheral intrahepatic duct dilatation. Periductal infiltrating cholangiocarcinoma is characterized by growth along the dilated or narrowed bile duct without mass formation. At CT and magnetic resonance imaging, diffuse periductal thickening and increased enhancement can be seen with a dilated or irregularly narrowed intrahepatic duct. Intraductal cholangiocarcinoma may manifest with various imaging patterns, including diffuse and marked ductectasia either with or without a grossly visible papillary mass, an intraductal polypoid mass within localized ductal dilatation, intraductal castlike lesions within a mildly dilated duct, and a focal stricture-like lesion with mild proximal ductal dilatation. Awareness of the underlying risk factors and morphologic characteristics of intrahepatic cholangiocarcinoma is important for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions.

Changes in sonographic findings after treatment of patients with clonorchiasis in a heavy endemic area.

We measured changes in sonographic findings of patients with clonorchiasis after a treatment in a highly endemic area. A total of 347 residents showed positive stool results for Clonorchis sinensis eggs in a village in northeastern China, and were treated with praziquantel. Of them, 132 patients underwent abdominal sonography both before and 1 year after treatment, and the changes in sonographic findings of 83 cured subjects were compared. Diffuse dilatation of intrahepatic bile ducts (DDIHD) was found in 82 patients (98.2%) before and 80 (96.4%) after treatment, which was improved in 3, aggravated in 1, and unchanged in 79 patients. Increased periductal echogenicity (IPDE) was observed in 42 patients (50.6%) before and 45 (54.2%) after treatment, which was improved in 5, aggravated in 8, and unchanged in 70 patients. Floating echogenic foci in the gallbladder (FEFGB) was detected in 32 patients (38.6%) before and 17 (20.5%) after treatment, which was improved in 20, aggravated in 5, and unchanged in 58 patients. Improvement of FEFGB only was statistically significantly (P = 0.004). The present results confirm that DDIHD and IPDE persist but FEFGB decreases significantly at 1 year after treatment. In a heavy endemic area, the sonographic finding of FEFGB may suggest active clonorchiasis 1 year after treatment.

Imaging diagnosis of clonorchiasis.

Among several diagnostic tools for clonorchiasis (Clonorchis sinensis infection), radiologic examinations are commonly used in clinical practices. During the 2 past decades, many reports regarding imaging findings of clonorchiasis were introduced. The basic imaging finding of clonorchiasis is diffuse dilatation of the peripheral intrahepatic bile ducts, without dilation of the large intrahepatic or extrahepatic bile ducts. By this finding, however, active clonorchiasis cannot be differentiated from cured infection. Some recent radiologic studies suggested specific findings of active clonorchiasis. Besides direct demonstration of worms, increased periductal echogenicity on sonography and periductal enhancement on dynamic contrast-enhanced CT or MR imaging possibly represent active clonorchiasis. Those images of the liver clonorchiasis are known to be correlated with worm burdens (EPG counts) in their frequency and also severity. The images of cholangiocarcinoma associated with clonorchiasis show both the tumor with obstruction images and diffuse dilatation of the peripheral intrahepatic bile ducts. Radiological images can be a good practical alternative diagnostic method of clonorchiasis.

Hepatic parasitic abscess caused by clonorchiasis: unusual CT findings of clonorchiasis.

Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.

Hepatic Parasitic Abscess Caused by Clonorchiasis: Unusual CT Findings of Clonorchiasis

Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.

Recurrent pyogenic cholangitis due to chronic infestation with Clonorchis sinensis (2006: 8b).

Recurrent pyogenic cholangitis is a common disease in Southeast Asia, where an association with the liver fluke Clonorchis sinensis is postulated. It is characterised by repeated attacks of cholangitis with multiple recurrences of bile duct stones and strictures. We present a case of recurrent pyogenic cholangitis due to chronic infestation with Clonorchis sinensis in a young Asian immigrant, describing its radiological appearances and also therapeutic strategies with a review of additional examples from the literature.

Cholangiocarcinoma and Clonorchis sinensis infection: a case-control study in Korea.

BACKGROUND/AIMS: The authors conducted a hospital-based case-control study to evaluate the role of Clonorchis sinensis infection as a risk factor for the development of cholangiocarcinoma (CC), including extrahepatic CC, in Korea. METHODS: Cases of 185 patients with CC (intrahepatic, 51; hilar, 53; and distal extrahepatic, 81) and matched controls underwent stool microscopy, pathological examinations, serologic test for C. sinensis using ELISA, skin test for C. sinensis, radiologic examinations, and interview concerning history of eating raw freshwater fish. RESULTS: Radiologic evidence of C. sinensis, history of eating raw freshwater fish, and positive serologic result for C. sinensis were found to be related to an increased risk of CC, with the odds ratios (OR)=8.615 (95% confidence interval [CI]=5.045-16.062), OR=2.385 (95% CI=1.527-3.832), and OR=2.272 (95% CI=1.147-4.811), respectively. The risk factors for distal extrahepatic CC were radiologic evidence of C. sinensis (OR=6.571; 95% CI=3.170-15.943) and history of eating raw freshwater fish (OR=2.6; 95% CI=1.294-5.66). CONCLUSIONS: Radiologic evidence of C. sinensis, history of eating raw freshwater fish and positive serologic result for C. sinensis were significantly associated with CC, including extrahepatic CC.

Correlation between sonographic findings and infection intensity in clonorchiasis.

This prospective study was performed to evaluate the diagnostic usefulness of sonography in terms of the intensity of Clonorchis sinensis infection. Total 1,384 residents were subjected to this study at an endemic area in China, in which a clonorchiasis control program had been performed. History taking, fecal examination, and sonography were performed, and 87.8% of the subjects were found to be egg positive. Sonography showed intrahepatic bile duct dilatation (IHDD) in 68.4% of the subjects, increased periductal echogenicity (IPDE) in 24.5%, and gallbladder sludge (GBS) in 20.8%. Moreover, the grades of these sonographic findings were higher in subjects with heavier infections as determined by egg counts. IHDD was found to be the most accurate sonographic indicator of any infection degree (76.3), whereas IPDE and GBS were useful only in cases of heavy infection. Subjective symptoms were found to be only poorly correlated with sonographic findings or infection intensity.

Clonorchiasis and cholangiocarcinoma: etiologic relationship and imaging diagnosis.

Despite a gradual decrease in prevalence, clonorchiasis is still prevalent in East Asia. A large and compelling body of evidence links clonorchiasis and cholangiocarcinoma, although the mechanisms involved are not completely understood. Clonorchiasis induces biliary epithelial hyperplasia and metaplasia, and this could facilitate at least one stage of the carcinogenesis, which is promoting effect. In areas of endemic infection, more clonorchiasis cases are now diagnosed incidentally during radiological examinations such as cholangiography, ultrasonography, and computed tomography. Radiological findings are regarded as pathognomonic for clonorchiasis since they reflect the unique pathological changes of this disorder. These radiological examinations currently play important roles in the diagnosis, staging, and decision-making process involved in the treatment of cholangiocarcinoma. The morphological features and radiological findings of clonorchiasis-associated cholangiocarcinoma are essentially combinations of the findings for the two diseases. The morphological features of clonorchiasis- associated cholangiocarcinoma, observed in radiological examinations, do not differ from those of the usual cholangiocarcinoma. In patients diagnosed with or suspected to have clonorchiasis, radiological findings should be carefully scrutinized for occult cholangiocarcinoma.