Clonorchis sinensis

Chinese or oriental liver fluke

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Geographical distribution:
 Far East, especially

China,
Japan
Korea
and Taiwan.

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 Morphology:

 Adult: Spindle-shaped
10-25 X 3-5 mm
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 …….Morphology: Egg
Eggplant-shaped
thick eggshell
light yellowish-brown in color

Content: mature miracidium

small operculum, shoulders at the narrow end

and small knob at the other end
The size is 30 X 15 m.

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 Life cycle, rout of migration and
habitat:
 The eggs passed out mature and when enter water
they don’t hatch but eaten or ingested by the snail
host Parafossarulus or Bithynia spp. (1st I. H.).

 Miracidium hatches in the snail and develops into

sporocyst, rediae then many cercariae.

 Cercaria leaves the snail into water and penetrates

under the scales or into the flesh of certain fresh
water fishes (2nd I. H.) and encysts there to
produce metacercaria.
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…….Life cycle, rout of migration and
habitat:
 When raw fishes are eaten by human or animals
(mainly cats and dogs), the metacercaria excysts
in the upper small intestine (duodenum).

 Then migrate along the ampulla of vater (opening

of common bile duct and pancreatic duct) to the
bilary tract to become an adult in less than one
month.

 When the number of parasites is large, they may

be seen in pancreatic duct and duodenum.
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 Clinical aspects:
 In the majority of cases the infection is
asymptomatic.

 The mechanical irritation and metabolites from the

worm cause chronic inflammation, which may
obstruct the bile duct as the epithelium
proliferates and the wall of the bile duct thickens
as a result of fibrosis.

 The liver might enlarge in the beginning, and then

becomes smaller due to cirrhosis.
 ? Is there an acute stage? No
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 Diagnosis

A- Clinical diagnosis

epigastric pain,
Jaundice,
Cholecystitis,
liver abscess
and cirrhosis.

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 B- Laboratory diagnosis

 Stool examination for egg detection.

Which techniques?

 Examination of duodenal aspiration (not common)

 Eosinophilia

 Immunological test, e.g. ELISA.

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 Control

 Treatment of infected animals and human.

 Health education:
DO NOT eat raw fishes
DO NOT defecate in or near fresh water
 Snail control
 Water sanitation improvement.

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