The trematode Clonorchis sinensis (Chinese or oriental liver fluke).
Embryonated eggs are discharged in the biliary ducts and in the stool . Eggs are ingested by a suitable snail intermediate host . Each egg releases a miracidia , which go through several developmental stages (sporocysts , rediae , and cercariae . The cercariae are released from the snail and after a short period of free-swimming time in water, they come in contact and penetrate the flesh of freshwater fish, where they encyst as metacercariae Infection of humans occurs by ingestion of undercooked, salted, pickled, or smoked freshwater fish . After ingestion, the metacercariae excyst in the duodenum and ascend the biliary tract through the ampulla of Vater Maturation takes approximately 1 month. The adult flukes (measuring 10 to 25 mm by 3 to 5 mm) reside in small and medium sized biliary ducts. In addition to humans, carnivorous animals can serve as reservoir hosts.
Endemic areas are in Asia including Korea, China, Taiwan, and Vietnam. Clonorchiasis has been reported in non endemic areas (including the United States). In such cases, the infection is found in Asian immigrants, or following ingestion of imported, undercooked or pickled freshwater fish containing metacercariae.
Most pathologic manifestations result from inflammation and intermittent obstruction of the biliary ducts. In the acute phase, abdominal pain, nausea, diarrhea, and eosinophilia can occur. In long-standing infections, cholangitis, cholelithiasis, pancreatitis, and cholangiocarcinoma can develop, which may be fatal.
Clonorchis sinensis eggs.
Figure A: C. sinensis egg: the small knob at the abopercular end is visible in this image.
Figure B: C. sinensis egg. Note the operculum resting on "shoulders;" image taken at 400× magnification.
Figure C: C. sinensis egg; images taken at 400× magnification.
Figure D: C. sinensis egg; images taken at 400× magnification.
C. sinensis adults.
Figure A: Adult of C. sinensis.
Figure B: Adult of C. sinensis stained with carmine. Clearly visible in this image are the oral sucker (OS), pharynx (PH), ceca (CE), acetabulum, or ventral sucker (AC), uterus (UT), vitellaria (VT) and testes (TE).
Snail intermediate hosts of C. sinensis.
Figure A: Shells of Parafossarulus manchouricus, the most common snail host of C. sinensis in endemic areas in southeast Asia. Image courtesy of the Web Atlas of Medical Parasitology and the Korean Society for Parasitology.
Figure B: Bithynia sp., another common intermediate host of C. sinensis. Image courtesy of Michal Maňas.
Microscopic demonstration of eggs in the stool or in duodenal aspirate is the most practical diagnostic method. The adult fluke can also be recovered at surgery.
Serologic testing is currently not available for clonorchiasis in the United States.
Praziquantel, adults, 75mg/kg/day orally, three doses per day for 2 days; the pediatric dosage is the same. Praziquantel should be taken with liquids during meals.
Albendazole* is an alternative drug; the dosage for adults is 10mg/kg/day for 7 days. The pediatric dosage is the same. Albendazole should be taken with food; a fatty meal increases the bioavailablility.
Oral praziquantel is available for human use in the United States.
Note on Treatment in Pregnancy
Oral albendazole is available for human use in the United States.
Note on Treatment in Pregnancy
Note on Treatment During Lactation
*Not FDA-approved for this indication
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DPDx is an education resource designed for health professionals and laboratory scientists. For an overview including prevention and control visit www.cdc.gov/parasites/.
- Page last reviewed: May 3, 2016
- Page last updated: May 3, 2016
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