Subtle to severe hepatobiliary morbidity in Opisthorchis viverrini endemic settings in southern Laos

Abstract

Evidence of severe hepatobiliary morbidity associated with Opisthorchis viverrini liver fluke infection including cholangiocarcinoma (CCA) is scarce in Laos although O. viverrini infection is highly prevalent. We assessed hepatobiliary morbidity using abdominal ultrasonography (US) in O. viverrini adult patients in Saravan province, Southern Laos. A random sample of 431 O. viverrini patients from 10 villages underwent abdominal US. Mild, moderate and markedly advanced periductal fibrosis was diagnosed in 7.0%, 66.5%, and 17.0% of patients, respectively. Normal liver parenchyma was seen in only 9.5% of patients. Presence of gall stones (13.2%), sludge (1.4%), gall wall thickening (1.2%), bile duct dilatation (1.6%), fatty liver (12.0%), kidney stones (8.6%) and cysts (7.9%) were diagnosed in considerable frequencies. In five patients (1.2%) hepatobiliary lesions suggesting CCA were diagnosed. Tumour markers, i.e. Interleukin-6, plasminogen activator inhibitor and carbohydrate antigen 19-9 were within normal range. The number of CCA suspected liver masses and hepatobiliary morbidity diagnosed among clinically asymptomatic adult patients in O. viverrini endemic areas presents a major public health concern in Laos. However, definitive diagnosis Opisthorchis-related severe sequelae including CCA is urgently needed to gauge the burden of this deadly disease in Laos.

The role of evolutionary biology in research and control of liver flukes in Southeast Asia

“…In Southeast Asia, more than 90 million people are at risk of infection, and at least 10 million people are estimated to be infected with Ov (Andrews et al, 2008; Sripa et al, 2010; Sithithaworn et al, 2012a). In Lao PDR, high endemicity and prevalence rates to up to 90% in certain communities have been observed (Rim et al, 2003; Sayasone et al, 2009; Ayé Soukhathammavong et al, 2015). Reliable national data from Cambodia and southern Vietnam are lacking but local prevalence estimates can be high in each of these countries (Sithithaworn et al 2012a).…”

“…While no studies to our knowledge have formally investigated resistance to PZQ, or reported evidence for its occurrence in the case of Ov (but see Ayé Soukhathammavong et al 2015), resistance to PZQ in schistosomes infection treatment has been relatively thoroughly investigated. To date, there is no evidence to suggest that schistosomes have already developed and/or established resistance to PZQ under field conditions, even within China where praziquantel-based chemotherapy has reached more than 50 million people since 1992 (Doenhoff et al, 2002; Liang et al, 2011; Seto et al, 2011; Wang et al, 2010; 2012).…”

Opisthorchiasis: Diagnostics, Clinical Manifestations, and Management

“…«крышечкой» и определенные размеры -22-32 × 10-19 мкм [20]. При малоинтенсивной инвазии рекомендуют использовать провокационную пробу -исследование дуоденального содержимого и фекалий через 1-2 дня после однократного приема 1 таблетки празиквантела (600 мг): часть взрослых особей паразитов погибает или обездвиживается и может быть найдена в кале или желчи вместе с яйцами [21].…”

“…Метод нативного мазкасамый простой, но его эффективность при средней и высокой интенсивности инвазии составляет от 44% до 63% и еще меньше при низкой интенсивности инвазии. Более информативен метод Като -метод толстого мазка под целлофаном [21]. Толстый мазок представляет собой слой неразбавленных фекалий на предметном стекле, спрессованный под листком тонкого гигроскопичного целлофана, предварительно пропитанного глицерином.…”

Infection with CagA+Helicobacter pyloriinduces epithelial to mesenchymal transition in human cholangiocytes

“…The International Agency for Research on Cancer of the World Health Organization classifies infection with the liver flukes O. viverrini and Clonorchis sinensis as well as H. pylori as Group 1 carcinogens [6]. In northern and northeastern Thailand and Laos, opisthorchiasis is the major documented risk factor for CCA [6][7][8][9]. Given the elevated prevalence of CCA in this region where infection with liver fluke prevails, and given evidence of linkages between infection by Helicobacter during opisthorchiasis, these two biological carcinogens together may orchestrate the pathogenesis of opisthorchiasis and bile duct cancer.…”