No abstract available.
Animals ; Biopsy ; Clonorchiasis/diagnosis/*parasitology ; Clonorchis sinensis/*isolation & purification ; Cystadenoma, Mucinous/*parasitology/pathology/surgery ; Foodborne Diseases/diagnosis/*parasitology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms/*parasitology/pathology/surgery ; Seafood/*parasitology ; Tomography, X-Ray Computed ; Treatment Outcome

The main causes of biliary obstruction are stones and cancers. Fascioliasis is a very rare case which causes biliary obstruction. Fascioliasis is a zoonosis caused by Fasciola hepatica which infects herbivores like sheep and cattle. F. hepatica lives in the biliary system or the liver parenchyma of a host. In Korea, the occurrence of this infection in human is very rare and only few cases have been reported. A 32-year-old male presented with upper abdominal pain and jaundice. His laboratory finding revealed elevated liver transaminases. Abdomen CT scan showed mild left intrahepatic bile duct dilatation. On ERCP, adult F. hepatica worms were found and were thus removed. Concurrently, clonorchiasis was diagnosed by stool exam and serologic enzyme-linked immunosorbent assay test. Clonorchiasis was treated with praziquantel. Herein, we report a case of intrahepatic bile duct dilatation due to F. hepatica infection with concurrent Clonorchis sinensis infestation.
Adult ; Animals ; Anthelmintics/therapeutic use ; Benzimidazoles/therapeutic use ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis/complications/*diagnosis/drug therapy ; Clonorchis sinensis/immunology/isolation & purification ; Enzyme-Linked Immunosorbent Assay ; Fasciola/isolation & purification ; Fascioliasis/complications/*diagnosis/parasitology ; Humans ; Liver/enzymology ; Male ; Praziquantel/therapeutic use ; Tomography, X-Ray Computed ; Transaminases/metabolism

Praziquantel is the drug of choice for clonorchiasis. Since clonorchiasis is endemic in most river basins, praziquantel has been widely used for 30 years in Korea. A 54-year-old Korean woman suffered from hypersensitive reactions, such as nausea, dyspnea, rash, and urticaria after taking the first dose of praziquantel to treat clonorchiasis. She ingested one dose again and the same symptoms appeared, and she was treated at a clinic with anti-histamines. She tried one more dose with anti-histamines but found the same symptoms. Later, she was found to pass eggs of Clonorchis sinensis and medicated with flubendazole. The hypersensitive reaction to praziquantel is rare but occurs. This is the 5th case report in the world.
Animals ; Anthelmintics/*administration & dosage/*adverse effects ; Clonorchiasis/*complications/*drug therapy ; Clonorchis sinensis/isolation & purification ; Drug Hypersensitivity/*diagnosis/drug therapy/pathology ; Feces/parasitology ; Female ; Histamine Antagonists/administration & dosage ; Humans ; Mebendazole/administration & dosage/analogs & derivatives ; Middle Aged ; Praziquantel/*administration & dosage/*adverse effects ; Republic of Korea

We describe an unusual presentation of Clonorchis sinensis infection with obstructive jaundice due to duodenal papillitis which was relieved dramatically by endoscopic sphincterotomy. A 26-yr-old male presented with complaints of fatigue, weight loss and painless jaundice. The history was significant for frequent ingestion of raw freshwater fish. The patient underwent endoscopic retrograde cholangiopancreatography for evaluation of obstructive jaundice. The duodenal papilla was markedly edematous with a bulging configuration and hyperemic changes at the orifice. Cholangiography revealed mild bile duct dilatation and irregular wall changes with multiple indentations. However, there were no biliary stricture or stones noted as the cause of obstructive jaundice. We performed an endoscopic sphincterotomy for effective bile drainage through the duodenal papilla. After the sphincterotomy, the patient's jaundice was dramatically improved. Pathology of the duodenal papilla showed eosinophilic infiltration of the mucosa. Parasitic eggs, consistent with the diagnosis of C. sinensis, were found in the bile sample.
Adult ; *Ampulla of Vater ; Animals ; Anthelmintics/therapeutic use ; Bile/parasitology ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis/*diagnosis/parasitology/pathology ; Clonorchiasis/*diagnosis ; Clonorchis sinensis/drug effects/isolation & purification ; Duodenum/pathology ; Humans ; Jaundice, Obstructive/*diagnosis/etiology ; Male ; Praziquantel/therapeutic use ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed

Liver fluke disease is a chronic parasitic inflammatory disease of the bile ducts. Infection occurs through ingestion of fluke-infested, fresh-water raw fish. The most well-known species that cause human infection are Clonorchis sinensis, Opisthorchis viverrini and Opisthorchis felineus. Adult flukes settle in the small intrahepatic bile ducts and then they live there for 20-30 years. The long-lived flukes cause long-lasting chronic inflammation of the bile ducts and this produces epithelial hyperplasia, periductal fibrosis and bile duct dilatation. The vast majority of patients are asymptomatic, but the patients with heavy infection suffer from lassitude and nonspecific abdominal complaints. The complications are stone formation, recurrent pyogenic cholangitis and cholangiocarcinoma. Approximately 35 million people are infected with liver flukes throughout the world and the exceptionally high incidence of cholangiocarcinoma in some endemic areas is closely related with a high prevalence of liver fluke infection. Considering the impact of this food-borne malady on public health and the severe possible clinical consequences, liver fluke infection should not be forgotten or neglected.
Animals ; Bile Duct Neoplasms/*diagnosis/epidemiology/*parasitology ; Bile Ducts, Intrahepatic/*parasitology ; Biological Markers/analysis ; Cholangiocarcinoma/*diagnosis/epidemiology/*parasitology ; Cholangitis/diagnosis/parasitology ; Clonorchiasis/*complications/*diagnosis/epidemiology/parasitology ; Clonorchis sinensis ; Humans ; Incidence ; Opisthorchiasis/*complications/*diagnosis/epidemiology/parasitology ; Opisthorchis

No abstract available.
Animals ; Bile Duct Neoplasms/*diagnosis/parasitology/pathology ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*diagnosis/parasitology/pathology ; Clonorchiasis/*complications/pathology ; Clonorchis sinensis/*isolation & purification ; Humans ; Male ; Middle Aged

We report two cases of hepatocellular carcinoma with prominent lymphocytic infiltration, which has been described as a subtype of hepatocellular carcinoma with good prognosis. One case showed lymphoid follicles and dense lymphocytic infiltrates within the tumor and its periphery, and the other case showed marked lymphocytic infiltration in the cancerous tissue. Piecemeal necrosis of cancer cells and atypical reactive changes were evident. The two cases were seronegative for hepatitis B surface antigen, antibody to hepatitis C virus, and Epstein-Barr virus DNA. One of the cases showed Clonorchis infestation. The prognostic significance of lymphocytic stroma in hepatocellular carcinoma requires further investigation.
Animals ; Carcinoma, Hepatocellular/*diagnosis/pathology ; Clonorchiasis/diagnosis/parasitology ; Clonorchis sinensis ; Diagnosis, Differential ; Female ; Humans ; Liver Neoplasms/*diagnosis/pathology ; Lymphocytes, Tumor-Infiltrating/*pathology ; Male ; Middle Aged ; Tomography, X-Ray Computed

Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.
Tomography, X-Ray Computed/*methods ; Middle Aged ; Male ; Liver Abscess/*parasitology/*radiography/surgery ; Humans ; Diagnosis, Differential ; Clonorchiasis/*radiography/surgery ; Animals

Among several diagnostic tools for clonorchiasis (Clonorchis sinensis infection), radiologic examinations are commonly used in clinical practices. During the 2 past decades, many reports regarding imaging findings of clonorchiasis were introduced. The basic imaging finding of clonorchiasis is diffuse dilatation of the peripheral intrahepatic bile ducts, without dilation of the large intrahepatic or extrahepatic bile ducts. By this finding, however, active clonorchiasis cannot be differentiated from cured infection. Some recent radiologic studies suggested specific findings of active clonorchiasis. Besides direct demonstration of worms, increased periductal echogenicity on sonography and periductal enhancement on dynamic contrast-enhanced CT or MR imaging possibly represent active clonorchiasis. Those images of the liver clonorchiasis are known to be correlated with worm burdens (EPG counts) in their frequency and also severity. The images of cholangiocarcinoma associated with clonorchiasis show both the tumor with obstruction images and diffuse dilatation of the peripheral intrahepatic bile ducts. Radiological images can be a good practical alternative diagnostic method of clonorchiasis.
Bile Ducts/parasitology/pathology ; *Cholangiography ; Clonorchiasis/*diagnosis/ultrasonography ; Humans

The Kato-Katz (KK) method is a well-known method of fecal examination for helminthiases. Its diagnostic sensitivity was found very high for clonorchiasis. The present study evaluated the correlation of Clonorchis sinensis egg counts by the KK method with those by direct smear and formalin-ether (FE) technique. The egg counts obtained by the KK method (Y) were correlated with the counts by direct smear (X) with the equation of Y = 659.4 + 0.266X (r2= 0.738), but not with those by the FE method. The present study demonstrated that the KK method and direct smear were useful for both qualitative and quantitative diagnosis of clonorchiasis, especially in the field.
Animals ; Cellophane ; Clonorchiasis/*diagnosis/parasitology ; Clonorchis sinensis/*isolation & purification ; Comparative Study ; Ether, Ethyl ; Feces/parasitology ; Formaldehyde ; Humans ; Parasite Egg Count/*methods ; Sensitivity and Specificity