Ultrasonography assessment of hepatobiliary abnormalities in 3359 subjects with Opisthorchis viverrini infection in endemic areas of Thailand

Abstract

A cross sectional study on hepatobiliary abnormalities in opisthorchiasis was performed in 8,936 males and females aged from 20 to 60 years from 90 villages of Khon Kaen province, Northeast Thailand. All were stool-examined for Opisthorchis viverrini infection by standard quantitative formalin/ethyl acetate concentration technique. Of these, 3,359 participants with stool egg positive were underwent ultrasonography of the upper abdomen. The hepatobiliary abnormalities detected by ultrasound are described here. This study found a significantly higher frequency of advanced periductal fibrosis in persons with chronic opisthorchiasis (23.6%), particularly in males. Risks of the fibrosis included intensity of infection, and age younger than 30 years. Height of left lobe of the liver, cross-section of the gallbladder dimensions post fatty meal, sludge, and, interestingly, intrahepatic duct stones were significantly associated with the advanced periductal fibrosis. Eleven suspected cholangiocarcinoma (CCA) cases were observed. This study emphasizes the current status of high O. viverrini infection rate and the existence of hepatobiliary abnormalities including suspected CCA in opisthorchiasis endemic areas of Thailand.

Human liver flukes

“…The findings of hepatomegaly, gallstones, sludge, intrahepatic duct stones, poorly-functioning gall bladder, increased portal vein diameter, intrahepatic bile duct dilatation, increased splenic thickness, or high hepatic pulsation index are non-specific but supportive (87,88) . The most specific finding for clonorchiasis and opisthorchiasis are visualisation of aggregates of flukes as floating echogenic foci (89) and periductal fibrosis.…”

“…Degree of periductal fibrosis measured by echogenicity is associated with burden of disease. (88) . Computed Tomography (CT) provides similar information, and is more sensitive in detecting dilated and thickened small bile ducts associated with recurrent cholangitis (90) .…”

Opisthorchis viverrini (liver fluke) as the lot of baleful parasite of tropical region-A replete synopsis

“…The ratio between hepatocellular carcinoma and cholangiocarcinoma without opisthorchiasis was 8:1, whereas the ratio was reversed among those with fluke infection [22] . There have been several cross-sectional studies regarding the incidence of cholangiocarcinoma in patients with O. viverrini infection in Thailand [23,24].…”

Raw fish consumption in liver fluke endemic areas in rural southern Laos

“…Severe hepatobiliary disease is associated with long-lasting infections (Mairiang and Mairiang, 2003;Mairiang et al, 2012). Both liver fluke species were recognised as carcinogenic agents by WHO and may lead to cholangiocarcinoma (CCA), a bile duct cancer with a very poor prognosis .…”

“…Of major public health concern is infection with the liver fluke Opisthorchis viverrini, a food-borne trematodiasis transmitted through the consumption of raw or insufficiently cooked fish. O. viverrini infection may lead to severe hepatobiliary pathologies, depending on the duration and intensity of infection (Mairiang and Mairiang, 2003;Mairiang et al, 2012;Sayasone et al, 2012). A most severe complication is cholangiocarcinoma, a fatal bile duct cancer (Sripa et al, 2011;.…”