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Clonorchis Sinesis /Chinese Liver Fluke Parasite

Clonorchis Sinesis /Chinese Liver Fluke Parasite. By: Gladys Y. Fontanez BSN,RN TVOPC Outpatient Clinic 1/31/2019. Clonorchis Sinesis / Chinese Liver Fluke Parasite. A parasite found in freshwater fish in many areas of Vietnam.

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Clonorchis Sinesis /Chinese Liver Fluke Parasite

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  1. ClonorchisSinesis/Chinese Liver Fluke Parasite By: Gladys Y. Fontanez BSN,RN TVOPC Outpatient Clinic 1/31/2019

  2. ClonorchisSinesis/ Chinese Liver Fluke Parasite • A parasite found in freshwater fish in many areas of Vietnam. • Humans can become infected by ingesting uncooked, salted, smoked, or pickled fish. • After ingestion, this parasite implants and grows in the duodenum and ascends to the biliary tract (CDC, 2018) . • Flukes do not live more than 25 years. • The fluke parasite can cause scarring in the biliary tract and lead to cancer.

  3. (CDC, 2018)

  4. VHA Facts • Some of the articles regarding the liver fluke parasite refer to a pilot study that was not reviewed or published and occurred in one VA Medical Center. • The reliability of that study has not been verified. • The laboratory testing that was used during the study was performed in South Korea and is not approved by the US Food and Drug Administration (FDA). • There is no current verified data linking the Liver Fluke Parasite and cholangiocarcinoma (CCA) among the US Veterans. • At this time, the rate of Vietnam Veterans and the overall rate of CCA is not known. • The Northport VA Medical Center Infectious Disease team conducted a pilot study to see if there was evidence of exposure to the liver fluke parasite in Vietnam Veterans in 2017. • The VA is in the process of working to validate the South Korean testing and is considering on working with a larger study. • Additional information about this disease can be found at https://www.publichealth.va.gov/exposures/infectious-diseases/cholangiocarcinoma.asp. • Questions about this study, please contact Dr. Ralph Erickson, Chief Consultant for Post Deployment Health Services @ Ralph.Erickson@va.gov

  5. Cholangiocarcinoma (CCA) • Cancer in the biliary duct system. • Liver fluke infection is considered an extremely rare cause of CCA in the US. • There is no scientific evidence to prove that the risk of CCA is higher in Vietnam Veterans than in other Veterans. • There are 8000 cases of CCA diagnosed each year in the US. • There is a greater risk of developing liver cancer with Hepatitis B and/or C infection.

  6. Testing for CCA related to Liver Fluke Infection • Veteran’s should be tested for Hepatitis B/C. • Stool examination is not indicated. Liver fluke does not live >25 years. • There is not an approved lab test in the US to check for liver fluke infection past/present. • Genetic factors, Hepatitis B/C, alcoholic cirrhosis, and chronic inflammation of the bile ducts can increase the risk of developing CCA. • Primary sclerosing cholangitis, obesity, ulcerative colitis also increase the risk of developing CCA. • Signs and Symptoms: jaundice and pruritus

  7. Patient Management • Providers should perform a thorough military and health history. • Patients with signs or symptoms of liver disease should have LFT’s, Abdominal Ultrasound, and other imaging tests. • Stool tests are not recommended. • Veterans should be bested for Hepatitis B/C. • Asymptomatic patients should be educated and reassured. If Veterans are concerned, they should focus on lifestyle modifications such as avoiding alcohol, smoking cessation, and weight loss. • Refer the patient to https://www.publichealth.va.gov /exposures/infectious-diseases/cholangiocarcinoma.asp for resources. • Patients can also be referred to GI or Liver clinic within the VA.

  8. References • Centers for Disease Control and Prevention. (2018). About Clonorchis. Retrieved from: https://www.cdc.gov/parasites/clonorchis/faqs.html. • Department of Veteran Affairs. (2017). Liver flukes and cholangiocarcinoma: Background and Veteran Guidelines.

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