Update on hepatobiliary flukes: fascioliasis,... : Current Opinion in Infectious Diseases (original) (raw)

Gastrointestinal infections: Edited by Nicholas J. Beeching and A. Clinton White

Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis

aInstitute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru

bInternal Medicine Department, University of Texas Health Science, Houston, Texas, USA

Correspondence to Eduardo Gotuzzo, MD, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia. Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru and Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Nacional Cayetano Heredia, Lima, Peru Tel: +51 1 482 3910; fax: +51 1 482 3404; e-mail: [email protected]

Abstract

Purpose of review

Hepatobiliary flukes – _Fasciola, Opisthorchis, Clonorchis_– are a major public health problem in east Asia, east Europe, Africa and Latin America. The present review focuses on current knowledge of clinical, diagnostic and treatment aspects caused by hepatobiliary flukes that can be applied to current protocols in endemic areas.

Recent findings

Specific risk factors and geographic areas for these flukes have been heavily reported recently, with millions of people infected worldwide. Human cases in nonendemic areas, related to immigration and the international food trade (i.e. raw vegetables and fish), have also been reported. Diagnostic imaging changes include track-like lesions that are a characteristic feature of acute fascioliasis on computed tomography scanning of the liver. Newly available diagnostic serological tests may detect early infection and, therefore, help reduce severe clinical complications such as recurrent cholangitis, cholecystitis, hepatic tumours, cysts, calcification, cholelithiasis, pancreatitis, most importantly, cholangiocarcinoma related to Opisthorchis viverrini and possibly Clonorchis sinensis, and liver fibrosis associated with Fasciola hepatica infections. Highly effective antiparasitic treatment is available for all flukes.

Summary

There is a better understanding of risk factors, clinical manifestations and complications, novel diagnosis tests and effective treatment, which together should help reduce the morbidity and mortality of these infections.