title: 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 area presents a major public health concern in Laos. However, definitive diagnosis of Opisthorchis-related severe sequelae including CCA is urgently needed to gauge the burden of this deadly disease in Laos.
authors.affiliation: National Institute of Public Health, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic; Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.
authors.forename: Phonepasong
authors.initials: P
authors.lastname: Ayé Soukhathammavong
authors.affiliation: Faculty of Basic Science, University of Health Science, Vientiane Capital, Lao People's Democratic Republic.
authors.forename: Virasack
authors.initials: V
authors.lastname: Rajpho
authors.affiliation: National Institute of Public Health, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic; Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.
authors.forename: Khampheng
authors.initials: K
authors.lastname: Phongluxa
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland; Faculty of Basic Science, University of Health Science, Vientiane Capital, Lao People's Democratic Republic.
authors.forename: Youthanavanh
authors.initials: Y
authors.lastname: Vonghachack
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Hattendorf
authors.affiliation: National Center of Malariology, Parasitology and Entomology (CMPE), Ministry of Health, Vientiane, Lao People's Democratic Republic.
authors.forename: Bouasy
authors.initials: B
authors.lastname: Hongvanthong
authors.affiliation: Mahosot Hospital, Ministry of Health, Vientiane, Lao People's Democratic Republic.
authors.forename: Oroth
authors.initials: O
authors.lastname: Rasaphon
authors.affiliation: Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand; Liver Fluke and Cholangiocarcinoma Research Centre, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.
authors.forename: Banchob
authors.initials: B
authors.lastname: Sripa
authors.affiliation: National Institute of Public Health, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic.
authors.forename: Kongsap
authors.initials: K
authors.lastname: Akkhavong
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland; Institute of Social and Preventive Medicine, University of Zürich, Zürich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.affiliation: Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland. Electronic address: peter.odermatt@unibas.ch.
authors.forename: Peter
authors.initials: P
authors.lastname: Odermatt
mesh_terms: D000328:Adult; D000818:Animals; D001650:Bile Duct Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood; D018281:Cholangiocarcinoma / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007812:Laos / Q000453:epidemiology; D008109:Liver Diseases, Parasitic / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009889:Opisthorchiasis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D009891:Opisthorchis; D015849:Plasminogen Inactivators / Q000097:blood; D015995:Prevalence; D012720:Severity of Illness Index; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; C508600:IL6 protein, human; D015850:Interleukin-6; D015849:Plasminogen Inactivators
keywords: Cholangiocarcinoma; Hepatobiliary morbidity; Laos; Opisthorchis viverrini; Ultrasonography