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Table of Contents
MINI REVIEW
Year : 2017  |  Volume : 6  |  Issue : 5  |  Page : 227-228

Acute opisthorchiasis: What about the clinical manifestation?


1 TWS Primary Care Center, Bangkok, Thailand
2 Hianan Medical University, China; Faculty of Medicine, University of Nis, Serbia; Joseph Ayobabalola University, Nigeria; Dr DY Patil Medical University, India

Date of Submission13-Jun-2017
Date of Decision10-May-2017
Date of Acceptance08-Jun-2017
Date of Web Publication7-Dec-2017

Correspondence Address:
Pathoom Sukkaromdee
TWS Primary Care Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2221-6189.219619

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  Abstract 


Opisthorchiasis or liver fluke infestation is a common parasitic infestation in tropical countries. In chronic infection, the malignant transformation of hepatobiliary cell can be seen. Its high prevalence in Indochina is relating to the high incidence of cholangiocarcinoma in that area. Nevertheless, the acute clinical problem due to opisthorchiasis is also existed but little mentioned. In this short article, the authors review and discuss on the clinical manifestation of acute opisthorchiasis.

Keywords: Acute, Opisthochiasis, Clinical


How to cite this article:
Sukkaromdee P, Wiwanitkit V. Acute opisthorchiasis: What about the clinical manifestation?. J Acute Dis 2017;6:227-8

How to cite this URL:
Sukkaromdee P, Wiwanitkit V. Acute opisthorchiasis: What about the clinical manifestation?. J Acute Dis [serial online] 2017 [cited 2022 Jan 20];6:227-8. Available from: http://www.jadweb.org/text.asp?2017/6/5/227/219619




  1. Introduction Top


Opisthorchiasis or liver fluke infestation is a common parasitic infestation in tropical countries. The main pathogen is Opisthorchis viverrini, a trematode. The infective metacercariae in fresh water fish becomes the important contaminant in poorly cooked fish dishes[1],[2]. The human beings can get the infection due to intake of poorly cooked or raw fish. The infection usually occurs at hepatobiliary tract of the patients.

In chronic infection, the malignant transformation of hepatobiliary cell can be seen. Its high prevalence in Indochina is relating to the high incidence of cholangiocarcinoma in that area[l-2], Nevertheless, the acute clinical problem due to opisthorchiasis is also existed but little mentioned. In this short article, the authors review and discuss on the clinical manifestation of acute opisthorchiasis.


  2. Acute opisthorchiasis Top


In acute opishorchiasis, the clinical problem of the biliary tract can be seen. The cholecystocholangitis is possible but is usually self- limited[3]. In animal model study, Udomsuk et al. mentioned for the “the promising chemo-protective and antioxidant activities of andrographolide via suppression of the specific EROD and MROD reactions and lipid peroxidation against acute opisthorchiasis in the BNF-exposed hamsters[4].”

Focusing on the clinical presentation of acute opisthorchiasis, “acute abdominal pain in the right upper quadrant and signs of cholestasis” is the common in symptomatic case[5]. Sometimes, the clinical symptom is severe. The patient might have fever and “complications such as liver and bile duct abscesses and cholangitis” might be observed[6]. In case that the acute opisthorchiasis occurs in a case with underlying disease, a more serious clinical presentation can be expected. Navrotsky noted that “The patient with acute opisthorchiasis concurrent with hemolytic anemia was found to have a preponderance of clinical and laboratory manifestations of hepatocholangitis in the early stages of the disease and a prevalence of subfebrility with progressive eosinophilia in the presence of regressive symptoms[7].”

For treatment of acute opisthorchiasis, the praziquantel is effective[5]. Pakharukova et al. reported that “In vitro, the drug caused destruction and vacuolisation of the tegument of Opisthorchis felineus (O. felineus), contractions of the worm musculature, paralysis, and irreversible changes in morphology[8].”

2.3 Febrile eosinophilic syndrome with cholestasis and O. felineus

In addition to the common acute opisthorchiasis due to Opisthorchis viverrini, the opisthorchiasis can result from other pathogen such as O. felineus. In acute opisthorchiasis due to O. felineus, febrile eosinophilic syndrome with cholestasis is he common problem. Traverso et al. noted that “a large outbreak of O. felineus in Italy suggests that opisthorchiasis develops as a febrile eosinophilic syndrome with cholestasis rather than a hepatitis-like syndrome[9].” The famous situations of outbreaks were reported from Italy. Almost half of the infected cases are asymptomatic. Focusing on the symptoms of the symptomatic cases, mild fever, nausea, abdominal pain, and myalgias are observable and the eosinophilia is common[10].


  3. Conclusion Top


Acute opisthorchiasis is an important problem due to liver fluke infection. It is little mentioned in the literature and might be forgotten in the endemic area. Without early recognition of the problem, the chronic infection is possible and it will final result in unwanted complication, cholangiocarcinoma.

Conflict of interest statement

The authors report no conflict of interest.



 
  References Top

1.
Hughes T, O'Connor T, Techasen A, Namwat N, Loilome W, Andrews RH, et al. Opisthorchiasis and cholangiocarcinoma in Southeast Asia: an unresolved problem. Int J Gen Med 2017;10:227-237.  Back to cited text no. 1
    
2.
Pakharukova MY, Mordvinov VA. The liver fluke Opisthorchis felineus: biology, epidemiology and carcinogenic potential. Trans R Soc Trop Med Hyg 2016;110(1):28-36.  Back to cited text no. 2
    
3.
Tret'iakov AM, Lozitskiî IA, Tret'iakova OA. Acute opisthorchiatic cholecystocholangitis. Khirurgiia (Mosk) 1977;3:35-39.  Back to cited text no. 3
    
4.
Udomsuk L, Chatuphonprasert W, Jarukamjorn K, Sithithaworn P. Andrographolide ameliorates beta-naphthoflavone-induced CYP1A enzyme activity and lipid peroxidation in hamsters with acute opisthorchiasis. J Med Assoc Thai 2016;99 (Suppl) 1:S22-S27.  Back to cited text no. 4
    
5.
Lindner A, Weber C, Rittweger M, Stocker H, Arastéh K. A 55-year old Thai male patient with acute right upper quadrant abdominal pain. Internist (Berl) 2015;56(8):944-948.  Back to cited text no. 5
    
6.
Vondeling AM, Lobatto S, Kortbeek LM, Naus H, Dorigo-Zetsma JW. Fever, malaise and eosinophilia after consumption of raw fish in Italy: infection by a liver fluke (Opisthorchis felineus). Ned Tijdschr Geneeskd 2012;156(5):A3873.  Back to cited text no. 6
    
7.
Navrotsky AN. A case of acute opisthorchiasis concurrent with chronic hereditary hemolytic anemia. Ter Arkh 2014;86(11):84-86.  Back to cited text no. 7
    
8.
Pakharukova MY, Shilov AG, Pirozhkova DS, Katokhin AV, Mordvinov VA. The first comprehensive study of praziquantel effects in vivo and in vitro on European liver fluke Opisthorchis felineus (Trematoda). Int J Antimicrob Agents 2015;46(1):94-100.  Back to cited text no. 8
    
9.
Traverso A, Repetto E, Magnani S, Meloni T, Natrella M, Marchisio P, et al. A large outbreak of Opisthorchis felineus in Italy suggests that opisthorchiasis develops as a febrile eosinophilic syndrome with cholestasis rather than a hepatitis-like syndrome. Eur J Clin Microbiol Infect Dis 2012;31(6):1089-1093.  Back to cited text no. 9
    
10.
Armignacco O, Caterini L, Marucci G, Ferri F, Bernardini G, Natalini Raponi G, et al. Human illnesses caused by Opisthorchis felineus flukes, Italy. Emerg Infect Dis 2008;14(12):1902-1905.  Back to cited text no. 10
    




 

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Abstract
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