Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis.
OBJECTIVE
Hepatobiliary flukes--Fasciola, Opisthorchis, Clonorchis- are a major public health problem in east Asia, east Europe, Africa and Latin America. The present review focuses on current knowledge of clinical, diagnostic and treatment aspects caused by hepatobiliary flukes that can be applied to current protocols in endemic areas.


RESULTS
Specific risk factors and geographic areas for these flukes have been heavily reported recently, with millions of people infected worldwide. Human cases in nonendemic areas, related to immigration and the international food trade (i.e. raw vegetables and fish), have also been reported. Diagnostic imaging changes include track-like lesions that are a characteristic feature of acute fascioliasis on computed tomography scanning of the liver. Newly available diagnostic serological tests may detect early infection and, therefore, help reduce severe clinical complications such as recurrent cholangitis, cholecystitis, hepatic tumours, cysts, calcification, cholelithiasis, pancreatitis, most importantly, cholangiocarcinoma related to Opisthorchis viverrini and possibly Clonorchis sinensis, and liver fibrosis associated with Fasciola hepatica infections. Highly effective antiparasitic treatment is available for all flukes.


CONCLUSIONS
There is a better understanding of risk factors, clinical manifestations and complications, novel diagnosis tests and effective treatment, which together should help reduce the morbidity and mortality of these infections.
Marcos
Luis A
LA
Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Terashima
Angelica
A
Gotuzzo
Eduardo
E
D000818:Animals; D001659:Biliary Tract / Q000469:parasitology* / Q000473:pathology; D003003:Clonorchiasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology*; D004451:Echinostomiasis / Q000469:parasitology; D005211:Fascioliasis / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D009889:Opisthorchiasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology*; D014200:Trematoda; D014201:Trematode Infections / Q000188:drug therapy* / Q000209:etiology / Q000469:parasitology*