Medicine:Opisthorchiasis

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Opisthorchiasis

Opisthorchiasis is a parasitic disease caused by certain species of genus Opisthorchis (specifically, Opisthorchis viverrini and Opisthorchis felineus). Chronic infection may lead to cholangiocarcinoma, a cancer of the bile ducts.

Medical care and loss of wages caused by Opisthorchis viverrini in Laos and in Thailand costs about $120 million annually.[1] In Asia, infection by Opisthorchis viverrini and other liver flukes affects the poorest people.[2] Along with other foodborne trematode infections such as clonorchiasis, fascioliasis and paragonimiasis,[3] opisthorchiasis is listed among the World Health Organization's list of neglected tropical diseases.[2]

Signs and symptoms

Symptoms of opisthorchiasis/clonorchiasis

Symptoms of opisthorchiasis are indistinguishable from clonorchiasis.[4] About 80% of infected people have no symptoms, though they can have eosinophilia.[1] Asymptomatic infection can occur when there are less than 1000 eggs in one gram of feces.[1] Infection is considered heavy when there are 10,000-30,000 eggs in one gram of feces.[1] Symptoms of heavier infections may include diarrhea, epigastric and right upper quadrant pain, lack of appetite, fatigue, yellowing of the eyes and skin and mild fever.[1]

These parasites are long-lived and cause heavy chronic infections that may lead to accumulation of fluid in the legs (edema) and in the peritoneal cavity (ascites),[1] enlarged non-functional gallbladder[1] and also ascending cholangitis, which can lead to periductal fibrosis, cholecystitis and cholelithiasis, obstructive jaundice, hepatomegaly and/or portal hypertension.[citation needed]

Chronic opisthorchiasis and cholangiocarcinoma

Incidence of cholangiocarcinoma and O. viverrini in Thailand from 1990–2001.

Both experimental and epidemiological evidence strongly implicates Opisthorchis viverrini infections in the etiology of a malignant cancer of the bile ducts (cholangiocarcinoma) in humans which has a very poor prognosis.[5] Clonorchis sinensis and Opisthorchis viverrini are both categorized by the International Agency for Research on Cancer (IARC) as Group 1 carcinogens.[6]

In humans, the onset of cholangiocarcinoma occurs with chronic opisthorchiasis, associated with hepatobiliary damage, inflammation, periductal fibrosis and/or cellular responses to antigens from the infecting fluke.[5] These conditions predispose to cholangiocarcinoma, possibly through an enhanced susceptibility of DNA to damage by carcinogens. Chronic hepatobiliary damage is reported to be multi-factorial and considered to arise from a continued mechanical irritation of the epithelium by the flukes present, particularly via their suckers, metabolites and excreted/secreted antigens as well as immunopathological processes. In silico analyses using techniques of genomics and bioinformatics is unraveling information on molecular mechanisms that may be relevant to the development of cholangiocarcinoma.[7]

In regions where Opisthorchis viverrini is highly endemic, the incidence of cholangiocarcinoma is unprecedented.[5] For instance, cholangiocarcinoma represents 15% of primary liver cancer worldwide, but in Thailand's Khon Kaen province, this figure escalates to 90%, the highest recorded incidence of this cancer in the world. Of all cancers recorded worldwide in 2002, 0.02% were cholangiocarcinoma caused by Opisthorchis viverrini.[5] Cancer of the bile ducts caused by opisthorchiasis occurs in the ages 25–44 years in Thailand.[8] A few cases have appeared in later life among U.S. veterans of the Vietnam War, who consumed poorly cooked fish from streams in endemic areas near the border of Laos and Vietnam.[9]

Diagnosis

The medical diagnosis is usually established by finding eggs of Opisthorchis viverrini in feces[1] using the Kato technique.[8] Alternatively, an antigen of Opisthorchis viverrini can be detected by ELISA test.[1] A polymerase chain reaction test that can be performed on faeces has been developed and evaluated in a rural community in central Thailand.[10]

Prevention

Cholangiocarcinoma is typically incurable at diagnosis.[11][12] Because of this, intervention strategies are focused on the prevention or treatment of liver fluke infection. Prevention can be accomplished through education (by persuading people not to consume raw or undercooked fish), but the ancient cultural custom to consume raw, undercooked or freshly pickled fish persists in endemic areas. One community health program, known as the Integrated Opisthorchiasis Control Program, has achieved success in the Lawa Lakes region south of Khon Kaen.[13]

Cooking or deep-freezing (-20 °C for 7 days)[14] of food made of fish is an effective method of prevention.[1] Methods for prevention of Opisthorchis viverrini in aquaculture fish ponds have also been proposed.[15]

Treatment

Treatment of opisthorchiasis is usually accomplished with praziquantel. A single dose of praziquantel of 40 mg/kg is effective against opisthorchiasis (and also against schistosomiasis).[8] Despite the efficacy of this compound, the lack of acquired immunity to infection predisposes humans to reinfection in endemic regions. In addition, under experimental conditions, the treatment of Opisthorchis viverrini-infected hamsters with praziquantel induced a dispersion of parasite antigens, resulting in adverse immunopathological changes following re-infection with Opisthorchis viverrini, a process which has been proposed to initiate and/or promote the development of cholangiocarcinoma in humans.[7] Albendazole can be used as an alternative.[16]

A randomized controlled trial published in 2011 showed that tribendimidine, a broad-spectrum anthelmintic, appears to be at least as efficacious as praziquantel.[17] Artemisinin was also found to have anthelmintic activity against Opisthorchis viverrini.[18]

Epidemiology

Opisthorchiasis is prevalent where raw cyprinid fishes are a staple of the diet.[19] Prevalence rises with age; children under the age of 5 years are rarely infected by Opisthorchis viverrini. Males may be affected more than females.[20][21] The WHO estimates that foodborne trematodiases (infection by worms or "flukes", mainly Clonorchis, Opisthorchis, Fasciola and Paragonimus species) affect 56 million people worldwide and 750 million are at risk of infection.[22][23] 80 million people are at risk of opisthorchiasis (67 million from infection with Opisthorchis viverrini in Southeast Asia and 13 million from Opisthorchis felineus in Kazakhstan, Russia, and Ukraine).[24][25] In the lower Mekong River basin, the disease is highly endemic, and more so in lowlands,[19] with a prevalence up to 60% in some areas of northeast Thailand. However, estimates using polymerase chain reaction-based diagnostic techniques indicate that prevalence is probably grossly underestimated.[26] In one study from the 1980s, a prevalence of over 90% was found in persons greater than 10 years old in a small village near Khon Kaen in northeast Thailand in the region known as Isan.[27] Sporadic cases have been reported from Malaysia, Singapore, and the Philippines.[23] Although the overall prevalence has declined since initial surveys performed in the 1950s, an increase has occurred since the 1990s in some areas, possibly related to large increases in aquaculture.[25]

Research

Using CRISPR gene editing technology in animal models, researchers have been able to eliminate the genes responsible for symptoms of opisthorchiasis, which may lead to further research toward novel treatment and control of this disease and its sequelae.[28]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Muller R. & Wakelin D. (2002). Worms and human disease. CABI. page 43-44.
  2. ↑ 2.0 2.1 Sripa, B. (2008). Loukas, Alex. ed. "Concerted Action is Needed to Tackle Liver Fluke Infections in Asia". PLOS Neglected Tropical Diseases 2 (5): e232. doi:10.1371/journal.pntd.0000232. PMID 18509525. .
  3. ↑ "Foodborne trematode infections". WHO. https://www.who.int/foodborne_trematode_infections/en/. 
  4. ↑ King, S.; Scholz, T. Š. (2001). "Trematodes of the family Opisthorchiidae: A minireview". The Korean Journal of Parasitology 39 (3): 209–221. doi:10.3347/kjp.2001.39.3.209. PMID 11590910. 
  5. ↑ 5.0 5.1 5.2 5.3 Sripa, B; Kaewkes, S; Sithithaworn, P; Mairiang, E; Laha, T; Smout, M; Pairojkul, C; Bhudhisawasdi, V et al. (July 2007). "Liver fluke induces cholangiocarcinoma.". PLOS Medicine 4 (7): e201. doi:10.1371/journal.pmed.0040201. PMID 17622191.  open access
  6. ↑ "IARC Monographs on the Evaluation of Carcinogenic Risks to Humans". http://monographs.iarc.fr/index.php. 
  7. ↑ 7.0 7.1 Young, ND; Campbell, BE; Hall, RS; Jex, AR; Cantacessi, C; Laha, T; Sohn, WM; Sripa, B et al. (22 June 2010). "Unlocking the transcriptomes of two carcinogenic parasites, Clonorchis sinensis and Opisthorchis viverrini". PLOS Neglected Tropical Diseases 4 (6): e719. doi:10.1371/journal.pntd.0000719. PMID 20582164.  open access
  8. ↑ 8.0 8.1 8.2 World Health Organization (1995). Control of Foodborne Trematode Infection. WHO Technical Report Series. 849. PDF part 1, PDF part 2. page 89-91.
  9. ↑ "Still Fighting: Vietnam Vets Seek Help for Rare Cancer". The New York Times. 11 November 2016. https://www.nytimes.com/aponline/2016/11/11/us/ap-us-vietnam-vets-liver-flukes-abridged.html?_r=0. 
  10. ↑ Traub, R. J.; MacAranas, J.; Mungthin, M.; Leelayoova, S.; Cribb, T.; Murrell, K. D.; Thompson, R. C. A. (2009). Sripa, Banchob. ed. "A New PCR-Based Approach Indicates the Range of Clonorchis sinensis Now Extends to Central Thailand". PLOS Neglected Tropical Diseases 3 (1): e367. doi:10.1371/journal.pntd.0000367. PMID 19156191. .
  11. ↑ Zhang, Tan; Zhang, Sina; Jin, Chen et al. (2021). "A Predictive Model Based on the Gut Microbiota Improves the Diagnostic Effect in Patients with Cholangiocarcinoma". Frontiers in Cellular and Infection Microbiology 11: 751795. doi:10.3389/fcimb.2021.751795. PMID 34888258. 
  12. ↑ "Bile Duct Cancer (Cholangiocarcinoma) Treatment". 23 September 2020. https://www.cancer.gov/types/liver/hp/bile-duct-treatment-pdq#section/all. 
  13. ↑ Head, Jonathan (13 June 2015). "Deadly dish: the dinner that can give you cancer". https://www.bbc.com/news/health-33095945. 
  14. ↑ World Health Organization (2004). REPORT JOINT WHO/FAO WORKSHOP ON FOOD-BORNE TREMATODE INFECTIONS IN ASIA. Report series number: RS/2002/GE/40(VTN). 55 pp. PDF. pages 15-17.
  15. ↑ Khamboonruang, C.; Keawvichit, R.; Wongworapat, K.; Suwanrangsi, S.; Hongpromyart, M.; Sukhawat, K.; Tonguthai, K.; Lima Dos Santos, C. A. (1997). "Application of hazard analysis critical control point (HACCP) as a possible control measure for Opisthorchis viverrini infection in cultured carp (Puntius gonionotus)". The Southeast Asian Journal of Tropical Medicine and Public Health 28 (Suppl 1): 65–72. PMID 9656352. .
  16. ↑ "Opisthorchiasis - Treatment Information". 2013-11-29. https://www.cdc.gov/dpdx/opisthorchiasis/tx.html. 
  17. ↑ Soukhathammavong, P.; Odermatt, P.; Sayasone, S.; Vonghachack, Y.; Vounatsou, P.; Hatz, C.; Akkhavong, K.; Keiser, J. (2011). "Efficacy and safety of mefloquine, artesunate, mefloquine–artesunate, tribendimidine, and praziquantel in patients with Opisthorchis viverrini: A randomised, exploratory, open-label, phase 2 trial". The Lancet Infectious Diseases 11 (2): 110–118. doi:10.1016/S1473-3099(10)70250-4. PMID 21111681. https://edoc.unibas.ch/22124/1/20170913102834_59b8ec3290166.pdf. 
  18. ↑ Keiser, J.; Utzinger, J. R. (2007). "Artemisinins and synthetic trioxolanes in the treatment of helminth infections". Current Opinion in Infectious Diseases 20 (6): 605–612. doi:10.1097/QCO.0b013e3282f19ec4. PMID 17975411. .
  19. ↑ 19.0 19.1 Sithithaworn, P; Andrews, RH; Nguyen, VD; Wongsaroj, T; Sinuon, M; Odermatt, P; Nawa, Y; Liang, S et al. (March 2012). "The current status of opisthorchiasis and clonorchiasis in the Mekong Basin.". Parasitology International 61 (1): 10–6. doi:10.1016/j.parint.2011.08.014. PMID 21893213. 
  20. ↑ Farrar, Jeremy; Hotez, Peter; Junghanss, Thomas; Kang, Gagandeep; Laloo, David; White, Nicholas (2013). Manson's tropical diseases. (New ed.). Philadelphia: Saunders [Imprint]. ISBN 978-0702051012. 
  21. ↑ Kaewpitoon, N; Kaewpitoon, SJ; Pengsaa, P (21 April 2008). "Opisthorchiasis in Thailand: review and current status.". World Journal of Gastroenterology 14 (15): 2297–302. doi:10.3748/wjg.14.2297. PMID 18416453. 
  22. ↑ "Foodborne trematodiases". World Health Organization. https://www.who.int/mediacentre/factsheets/fs368/en/. 
  23. ↑ 23.0 23.1 Sripa, B; Kaewkes, S; Intapan, PM; Maleewong, W; Brindley, PJ (2010). "Food-borne trematodiases in Southeast Asia epidemiology, pathology, clinical manifestation and control.". Advances in Parasitology 72: 305–50. doi:10.1016/S0065-308X(10)72011-X. PMID 20624536. 
  24. ↑ Keiser, J; Utzinger, J (July 2009). "Food-borne trematobiases". Clinical Microbiology Reviews 22 (3): 466–83. doi:10.1128/cmr.00012-09. PMID 19597009. 
  25. ↑ 25.0 25.1 Keiser, J; Utzinger, J (October 2005). "Emerging foodborne trematodiasis.". Emerging Infectious Diseases 11 (10): 1507–14. doi:10.3201/eid1110.050614. PMID 16318688. 
  26. ↑ Johansen, MV; Sithithaworn, P; Bergquist, R; Utzinger, J (2010). "Towards improved diagnosis of zoonotic trematode infections in Southeast Asia.". Advances in Parasitology 73: 171–95. doi:10.1016/S0065-308X(10)73007-4. ISBN 9780123815149. PMID 20627143. 
  27. ↑ Upatham, ES; Viyanant, V; Kurathong, S; Brockelman, WY; Menaruchi, A; Saowakontha, S; Intarakhao, C; Vajrasthira, S et al. (November 1982). "Morbidity in relation to intensity of infection in Opisthorchiasis viverrini: study of a community in Khon Kaen, Thailand.". The American Journal of Tropical Medicine and Hygiene 31 (6): 1156–63. doi:10.4269/ajtmh.1982.31.1156. PMID 6983303. 
  28. ↑ "CRISPR/Cas9 shown to limit impact of certain parasitic diseases" (in en). https://www.bionity.com/en/news/158791/crispr-cas9-shown-to-limit-impact-of-certain-parasitic-diseases.html. 

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