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Clonorchis Sinensis

Clonorchis Sinensis. Lida Shaygan. What is Clonorchis Sinensis?. Chronic infection caused by the liver fluke Parasitic worm 10-25 mm long Lives in bile ducts of liver in humans and other mammals Acquired by eating fresh water fish containing fluke larvae.

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Clonorchis Sinensis

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  1. Clonorchis Sinensis Lida Shaygan

  2. What is Clonorchis Sinensis? • Chronic infection caused by the liver fluke • Parasitic worm 10-25 mm long • Lives in bile ducts of liver in humans and other mammals • Acquired by eating fresh water fish containing fluke larvae. • One of the most severe food-borne parasitic diseases in China

  3. Taxonomy & Morphology Morphology Hermaphrodite Digenetic Unsegmented Leaf- shaped Bilaterally symmetrical excretory system Bear 2 suckers Ventral Oral Oblong shaped Flat (platyhelminthes) relatively small 10-25 mm in length Taxonomy Kingdom: Animalia Class: Platyhelminthes Order: Trematoda Family: Opisthorchiidae Genus: Clonorchis Species: Sinensis

  4. MORPHOLOGY

  5. Egg • oval-shaped, 26-30 micrometers in length, has a thick yellow-brown shell surrounding it. • Embryonated eggs are discharged in the biliary ducts and in the stool

  6. The Snail 1st Intermediate Host • Eggs are ingested by a suitable snail intermediate host • there are more than 100 species of snails that can serve as intermediate hosts. 

  7. Developmental Stages Each egg releases a miracidia , which goes through several developmental stages:

  8. Metacercariae • After a short period of free-swimming time in water, cercariae come into contact and penetrate the flesh of freshwater fish, where they encyst as metacercariae

  9. Adult Fluke • Metacercariae excyst in the duodenum and ascend the biliary tract • 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. 

  10. Life Cycle • Eggs passed on through feces • Miracidia • Sporocysts • Eggs ingested by snail • Rediae • Cercaria • Free floating cercariae encyst • Metacercaria in skin or flesh of fish • Metacercaria ingested by human host • Excyst in duodenum & adults in biliary duct

  11. Life Cycle

  12. Reproduction • Reciprocally Inseminating Simultaneous Hermaphrodite • Polyembryonic proliferation of miricidia to metacercaria • The sporocyst and redia stages asexually reproduce. • A juvenile adult reaches the bile ducts within 4-7 hours after ingestion • It will then be one month before it is mature enough to start producing eggs.

  13. Hosts • 1st intermediate host: snail • 2nd intermediate host: numerous freshwater fish • Hosts ingest metacerariae • Humans and animals (dogs, pigs, cats, rats)

  14. Transmission Factors & Modes of Transmission 1. Eating raw fish or “porridge with raw fish” 2. Eating under-cooked small fish and shrimps • Infection due to using metacercaria-contaminated utensils or hands

  15. Symptoms • Asymptomatic • Nonspecific symptoms • Acute phases: abdominal pain, nausea, diarrhea, and eosinophilia

  16. Pathogenic Effects • Inflammation & intermittent obstruction of biliary ducts • Dwelling in bile ducts induces • Inflammatory reaction • Hyperplasia • Cholangiocarcinoma (glandular cancer of bile ducts) • Possibility of adult metacercaria to consume all of bile duct in liver • Inhibits host from digesting food • Overcrowding of common bile duct • Risk of bile duct and gallbladder exploding within human body

  17. Detrimental Effects • Eggs and worms that somehow migrate out of the biliary system may become nuclei of eventual gallstones. • Metacercariae travelling through the body can cause high fevers in the host. • May lead to possible disturbance of normal hepatic functions • Clonorchis Sinensis in rabbits leads to higher levels of potassium and cholesterol, lower calcium levels, lipid metabolism and glycogen synthesis are impaired.

  18. Where is it found? • Endemic areas are Asia including Korea, China, Taiwan, and Vietnam. • Occasionally reported in non-endemic areas (including the United States).

  19. Epidemiology • 19 million are infected in heavily populated regions of China • Southern provinces, Taiwan, Hong Kong, Red River, Korea, Japan • Cases also reported in Europe, United States, Middle East, China, Japan, and Africa. • Usually caused by immigrants from regions in China • Acquired by Hawaiians by eating raw, frozen, or salted fish shipped from China or Japan.

  20. New Epidemiological Characteristics • change in diet from mainly grain and vegetable to fish and meats in China • The difference of infection rate between urban and rural areas is reducing. • Endemic area tends to expand gradually.

  21. What Can be Done? • Health education • Environmental modification • Reform of traditional farming and fishing techniques • Mass screening and chemotherapy • Management of domestic animals are needed in developing control strategies to decrease spreading • Controlling the use of "night soil" (fertilizer contaminated with human feces), used to fertilize fish ponds • Avoid eating raw fish and using contaminated water for consumption.

  22. Diagnosis • Depends on recovering and identifying the parasite’s eggs in stool sample. • Diagnostic Tests: medical history, physical assessment (palpation of the liver), ELISA blood test • Medical Tests: endoscopy and examination of stool sample, radiological and sonographic assessments, surgery

  23. Medications • Praziquantel • Drug of choice for treatment • Increases cell membrane permeability in worms, resulting in paralysis of worm’s musculature • Attachment of phagocytes and death • Cons: bitter taste may cause nausea • Albendazole • Inhibits metabolism in worm’s cells • Immobilization & death of worm follow

  24. Bibliography • Eckroad, E. and H. Lee. 2001. "Clonorchis sinensis" (On-line), Animal Diversity Web. Accessed October 07, 2006 at <http://animaldiversity.ummz.umich.edu/site/accounts/information/Clonorchis_sinensis.html> • Brusca, R., G. Brusca. 1990. Invertebrates. Sunderland, Massachusetts: Sunauer Associates, Inc.. • Buchsbaum, M., R. Buchsbaum, V. Pearse, J. Pearse. 1987. Living Invertebrates. Boston, Massachusetts: Blackwell Scientific Publications. • Chappell, L. 1979. Physiology of Parasites. New York: John Wiley and Sons.

  25. Bibliography • Clay, T., M. Rothschild. 1952. Fleas, Flukes and Cuckoos. New York: The MacMillan Company. • Swellengrebel, N., M. Sterman. 1961. Animal Parasites in Man. Princeton: D. Van Nostrand Company, Inc.. • von Brand, T. 1952. Endoparasitic Animals. New York: Academic Press Inc., Publishers. • http://tmcr.usuhs.mil/tmcr/chapter21/intro.htm • www.dpd.cdc.gov/dpdx/HTML/Frames/A-F/Clonorchiasis • www.cdc.gov/nvidod/eid/vol3no3/hotez.htm • http://www.biosci.ohio-state.edu/~parasite/digenetic_trematodes.html • http://www.dpd.cdc.gov/dpdx/HTML/Clonorchiasis.htm • http://clonorchiasis.blogspot.com/ • http://tmcr.usuhs.mil/tmcr/chapter21/epidemiology.htm • http://www.kstate.edu/parasitology/625tutorials/Trematodes08.html • http://www.kstate.edu/parasitology/625tutorials/Clonor01.html

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