Aremu SO, Et Al. Putting the Spotlight on Opisthorchiasis: the Dread of the Western Siberian Copyright© Aremu SO, Et Al

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Putting the Spotlight on Opisthorchiasis: The Dread of the Western Siberian Region

Aremu SO1,3*, Zephaniah HS2, Onifade EO3, Fatoke B1 and Bademosi O4 Review Article 1Faculty of General Medicine, Siberian State Medical University, Tomsk, Russian Federation Volume 4 Issue 1 2Department of Biochemistry, University of Nigeria, Nsukka, Enugu State, Nigeria Received Date: February 17, 2020 3Department of Biological Science, Federal University of Agriculture, Makurdi Benue State, Published Date: March 10, 2020 Nigeria DOI: 10.23880/phoa-16000151 4Department of Public Health, University College Dublin, Ireland

*Corresponding author: Stephen Olaide Aremu, Faculty of General Medicine, Siberian State Medical University, Tomsk, Russian Federation, Email: [email protected]

Abstract

Introduction: Opisthorchiasis is no doubt one of the most neglected infectious disease inspite of its huge medical importance in some parts of the World. The past decade have seen a resurgence of interests in research relating to this public health issue, however there is still a lot to be done. Social Model: Not many models have been explored in Western Siberia to deal with the opisthorchiasis epidemic when compared to the different models that have been used for other regions affected by similar disease. Life Cycle: The complex life cycle of Opisthorchis felineus prevalent among the aboriginal population of the Western Siberian because of their habit of eating raw or undercooked fresh has humans and other feline species as definitive host and is really

Diagnosis and Treatment: Diagnosis involve the use of stool microscopy, other methods such as mAb ELISA, LAMP and so on water fish (Cyprinidae) which are intermediate host of the parasite. are used, while the common treatment is the use of 25-40mg of the antihelminthic drug_Praziquantel. Conclusion: The spotlight must be put on O. Felineus.

Keywords: Opisthorchiasis; Life Cycle; Cyprinidae; Western Siberian

Introduction A general feature of all Opisthorchiidae is their high The opisthorchiidae family of the trematode class is of high economic, veterinary and medical importance, with intermediatespecificity to host the for first Opisthorchiidae, intermediate host.whereas Typically, the lists only of over 45 million infected people from all round the globe [1,2]. one or several closely related snail species act as the first Opisthorchis felineus, Opisthorchis viverrini, and Clonorchis to several tens of species [4]. sinensis, three of which belong to the aforementioned family second intermediate and definitive hosts may comprise up though occasionally overlapping in terms of geographical A study by Fedorova et al showed that in the whole of distribution have a distinct pattern: O. felineus is endemic Russian Federation in 2011 to 2013, the average annual in Europe and Russia particularly the arctic region of Western incidence of O. felineus infection was between the range of Siberia; C. sinensis in China, the Republic of Korea, and northern 15.7 to 33.7 cases per 100,000 population [5]. However, the Vietnam; and O. viverrini in Southeast Asia [1,3]. major habitat of O. felineus in Russia is the Ob–Irtysh river

Putting the Spotlight on Opisthorchiasis: The Dread of the Western Siberian Region Public H Open Acc 2 Public Health Open Access basin, which spans the south to north in the Western Siberia due to a widespread opinion in complimentary medicine region. Compare to the European part of Russia and Eastern that indigenous peoples have more genetic resistance to Siberia, the prevalence of O. felineus infection in Western Siberian people has been estimated to be up to 80%, about 100 to 1000 times more [5] In these regions, the prevalence opisthorchiasis than immigrant population. An uspecified rates of opisthorchiasis exceed 100 per 100 000 people [6]: percentage of the population regard treatments (both conservative and complimentary) as more harmful than beneficial,Knowledge whereas of theothers disease regard does them not as “necessary”in anyway [2].affect Khanty-Mansiiskiy Autonomous Region (600 per 100 000 people), Tyumen Region (201 per 100 000 people), Tomsk Region(189 per 100 000 people), and Novosibirsk Region andthe attitudeoften in rawof the or localsundercooked to eating form fish hence, from thethe prevalencelocal river (127Social per 100 Dynamics 000 people) Model[6]. of Western Siberian of(River opisthorchiasis Ob) and very is extremely frequently high (as traditionalamong the staple indigenous food) people [1,6]. Aboriginal population on Opisthorchiasis

The social dynamics model of O. felineus transmission Indigenous knowledge on prevention and treatment in Western Siberia was designed for preparing and developing options for opisthorchiasis include Thermal processing of an integrated opisthorchiasis control programme in the region hands, dishes and surfaces that have come in contact with dynamics in Western Siberia instead of using the one size fish (boiling, freezing, frying), salting. Thorough washing of [5]. The model attests to the specificity of transmission natural antiseptic for cleaning surfaces. Local medicine of understanding this public health issue as embedded in suchfish andas swallowing disinfection. of Bogsphagnumgallbladder of pike, was saiddrinking to be extract good fits all approach. The model also underpins the importance of pinenuts in alcohol, or extract of aspen bark can help linkages between ways of life, food and health cultures, alleviate opistarchiasis. health-caresocial networks systems, and animatedeconomies, by and a variety landscapes of locally-specific [5,6].

Information in different suburbs and villages of disease of degree, i.e. opisthorchiasis becomes a disease only Western Siberia obtained via semi-structured interviews These model summaries are: (1) that opisthorchiasis is a and questionnaires with people of indigenous background in different studies revealed that Opisthorchiasisis is a well iswhen not necessarythere are tooin Western many parasites Siberia which in the isbody a total (infection deviation is known disease by the locals and is generally regarded as fromnot equal what to is Disease), observed and with (2) chronic that use infection of anthelmintic of O. viverreni drugs a chronic mild disease by indigenous peoples [1]. This is and C. Sinensis in Northeast Asia [6] (Figure 1).

Figure 1: Social dynamic model of O. felineus transmission adapted from [5].

Life Cycle and foremost, belonging to the order Carnivora: domestic cats,comprises dogs, 33wolves, species foxes, and bears subspecies and badgers. of mammals, Hence, it first is carrying the metacercariae of O. felineus results in human also known as Cat Liver Flukes [1,10]. The ingested larvae Feeding from raw or undercooked fresh water fish develop further and moves to the bile ducts by chemotaxis, where the biliary epithelia and biliary contents of the gall infection [4,7,8] (Table 1). Opisthorchis viverrini bladder is fed upon by the adult worms. The larvae are well Latin name Local name prepared to survive the harsh weather condition as they contain, miracidia, which allows for maintaining viability in Cyclocheilichthys apogon Sai Tan Ta Daeng freshwater aquatic bodies for up to 3 months if they get into Labiobarbus leptocheilus Sa these bodies in the early part of spring. Moreover, they are Puntius brevis Taphian Jut able to survive the period of water freezing–thawing during the overall winter and retain their viability to the July of the Barbonymus gonionotus Taphian Khao next summer if they entered these water bodies in the late Henicorhynchus siamensis Soi Khao fall [1]. Henicorhynchus ornatipinnis Soi Peek Daeng Hampala dispar Kra Sup Jut After about 25-30 days, the adult worms reach sexual Hampala macrolepidota Kra Sup Khit eggs by the adult worms which enter the gastrointestinal Osteochilus hasselti Soi Nokkhao tractmaturity and (maritae)are passed and out there alongside is production faeces to of the numerous outside Opisthorchis felineus Latin name Common name into the waterbodies and are ingested by freshwater snails of Leuciscus idus Ide theenvironment family Bithyniidae. [1,11,2,4]. Before These the eggs mid released 20th century, find their Bithynia way L. cephalus Chub felineus; later, it was discovered that there are four species: L. leuciscus Dace B.leachileachi was, B.troscheli regarded, asB. inflatathe only and first B. intermediate sibirica host for O. Rutilus rutilus Roach species are susceptible to O. felineus. Blicca bjorkna Silver bream .The first three Carassius carassius Crucian carp The O. felineus miracidia passes through several stages C. auratus gibello Silver crucian carp Abramis brama Common bream of all development Opisthorchiidae. via asexualPlethora developmentof free-swimming (transforming cercariae A. ballerus Blue bream arethrough produced sporocysts from theto rediae)rediae ofin O.the felineus snail,, whichwhich isleave typical the A. sapa White-eye bream snail for their second inter-mediate host and, following the Chondrostoma nasus Nase release of the miracidia from the eggs, for the next 3 weeks to 2 months, several development stages take place within Scardinius erythrophtalamus Common rudd the snail until cercariae have developed. Shed cercariae can Pelecus cultratus Ziege Cyprinus carpio Common or European carp localized to the subcutaneous fat and muscle tissues at a Tinca tinca Tench depthpenetrate of 1-2 freshwater mm. However, fish, localization encystation to takes unusual place sites and such are Gobio gobio Gudgeon Alburnus alburnus Bleak as gills,The gut O. felineus walls or metacercariae pectoral fins are are not tolerant uncommon to drying, [11]. high Phoxinus phoxinus Minnow salt concentration, and low temperatures and can be killed Ph. chekanowskii Chekanovsky minnow only by a high temperature [1]. According to Pakharukova Aspius aspius Asp and Mordvinov the typical sources of O. felineus infection in Russia are undercooked, sun-dried, light-salted, and light- Barbus borysthenicus Barbel Leucaspius delineatus Sunbleak Cobitis taenia Spined loach pickled fish [1]. In addition, indigenous people of Western Table 1: SiberiaWithin traditionally the genus eat cold-served Opisthorchis slices, O .of felineus frozen fish species [1,2]. has the highest zoonotic potential, which has important Local Name and Common Name of fish intermediate implications in terms of maintenance of transmission to hosts of the Liver fluke Culled from [9]. humans even under high hygienic standards in which the

The total list of definitive host species for this parasite Aremu SO, et al. Putting the Spotlight on Opisthorchiasis: The Dread of the Western Siberian Copyright© Aremu SO, et al. Region. Public H Open Acc 2020, 4(1): 000151. 4 Public Health Open Access risk of freshwater contamination by human faeces is low among chronically infected individuals in a pathway as well as in vereinary medicine [12]. The morbidities similar to that caused by O. viverrini and C. Sinensis [2,4]. associated with opisthorchiasis are largely hepatobiliary, Cholangiocarcinoma, a generally incurable and, hence, fatal bile duct cancer [3,12], which has resulted in the intraepithelialspecifically stemming neoplasia, from and cholangiofibrosis are expressed and in a cholangitis, variety of manifestations,hepatobiliary such inflammation, as abdominal cholangiocyte pain, nausea, obstructive dysplasia, classification of these parasites to the Group 1 carcinogens jaundice hepatomegaly and even cholangiocarcinoma by the International Agency for Research on Cancer (IARC) especially in endemic regions [13-15] (Figure 2).

Figure 2:

The life cycle of Opisthorchis felineus as a representative for Fish-borne Zoonotic Trematode (FZT) species [16]. Pathophysiology of Opisthorchiasis-Associated histopathologically changes such as hyperplasia, Cholangiocarcinoma In long term infections and inflammations, can be seen in the bile duct epithelium via different adenomatous formations, and granulomatous inflammation by OpisthorchiasisAcute inflammation [17]. However,of the hepatic several bile studies ducts andon animal portal to mechanical damage and metabolic products such as modelsconnective have tissue proven are thethat first multiple effect stagesof acute of infection carcinogenesis caused oxysterol,microscopic catechol methods estrogen [19]. The quinone-like aetiology foretc theseexcreted is dueby example, In a model of experimental infection of a hamster Mechanical injury occurs during the processes of feeding the liver flukes which are injurious to the cell of the host. withis an O offshoot. felineus , ofthere chronic was a infectionsclear cut evidence and inflammation. of precancerous For and migration, leading to ulceration of the periductal tissue. neoplasia of up to the III grade [17,18]. lesions, e.g., inflammation, fibrosis, and biliary intraepithelial This allows for the infiltration of fluke eggs into the tissue resulting in granulomatous inflammation of the tissue Aremu SO, et al. Putting the Spotlight on Opisthorchiasis: The Dread of the Western Siberian Copyright© Aremu SO, et al. Region. Public H Open Acc 2020, 4(1): 000151. 5 Public Health Open Access around them. Hyperplasia of the bile duct epithelium may killing the parasite [20,24-26]. Immune mediated response to the parasites activate cells such as neutrophils, eosinophils and macrophages in the early stage while mononuclear be induced as a result of interaction with fluke metabolic subtypes including lymphocytes, macrophages, plasma cells products which may be immunogenic or toxic [19-31]. and mast cells to synthesize NO in the later stages, which is – both cytotoxic and genotoxic [24-31]. NO can react with O2 Infiltration of inflammatory cells has been linked to the – presence of specific antigens of the liver flukes [29]. It’s been that can cause oxidative and nitrative DNA damage through andhypothesized later it was that demonstrated this inflammation that elevated could be IL-6 mediated to O. spp by to produce (ONOO ) peroxynitrate, a more reactive molecule excretory/secretoryparasite-specific inflammatory substance cytokinelevels were interleukin linked to (IL)-6 an increased risk of 63% for developing advanced periductal the formation of DNA adducts such as 8-oxo-7,8-dihydro-2′- deoxyguanosineThis resultant (8oxodG) DNA damageand 8-nitroguanine has been [4].linked to an production had a 127% higher risk of developing advanced indirect cause of carcinogenesis via an increase in cell fibrosis (APF) and that individuals in the third quartile of IL-6 proliferation caused by proliferating cell nuclear antigen of IL-6 production [4]. It is now well established that chronic periductal fibrosis (APF) than individuals in the first quartileO. spp infections plays a large part in the development of many of direct(PCNA) causal accumulation link between in the NO bileand ductcarcinogenesis epithelium through (more theinflammation factors and causedevents that by lead long-term to cholangiocarcinoma, or recurrent most inhibitoncommon withof DNA recurrent repair infections) and apoptosis. [31-38]. Bursts As well of asNO a produced, as a result of chronic opisthorchiasis infection [20,26-38]. notably due to the surge of production of nitric oxide (NO) the endogenous synthesis of N-nitrosamines, such as the and inflammation, may also increase the potential for – 2 NDMA Reactive nitrogen species, such as nitric oxide (NO), and carcinogeniclevels is a well N-dimethylnitrosamine known biomarker as it is (NDMA) often detected [24-34]. in This the reactive oxygen species such as superoxide (O ) are produced reactionurine of infected occurs withinindividuals. the inflamed bile duct [24]. in chronically inflamed tissues (using inducible NO synthase, or iNOS, in the case of NO) as an immune response aimed at

Figure 3: Hypothesized pathways of pathogenesis of opisthorchiasis-associated cholangiocarcinoma. Adapted from ref [36].

point of care diagnostic assays is still a vision for healthcare researchers [2]. effectsLipid of lipid peroxidation peroxidation (LPO) can be islinked another to cytotoxic effect and of genotoxicinflammation-linked properties of ROS/RNS the secondary [20,35]. aldehyde The harmfulspecies is the second molecular diagnostic techniques that have been provenLoop-mediated to be faster when isothermal compared amplification to the traditionally (LAMP) method used (4- Hydroxynonenal (HNE) and Malone dialdehyde6-etheno- (MDA) that result from lipid peroxidation4 chain reactions. and instrumentation, with results available by reading with Productswhich are suchproducts as etheno-DNA of the reaction adducts of DNA (εdA) bases 1,N with the thePCR, naked it is sensitive, eye. This specific method and has requiringbeen used minimal for the detection processing of 2′-deoxyadenosine and (εdC) 3,N -etheno-2′-deoxycytidine the O. viverreni and C. Sinensis and its application to detection These oxidative lesions can initiate carcinogenesis through of O. felineus is being established [2]. oxidized lipids (such as trans-4-hydroxy-2-nonenal) [33-38]. serve as biomarkers in the leukocytes of Opisthorchiasis Additionally, use of imaging techniques such as specific base pair substitutions and have been shown to infected individuals, alongside 8-oxodG [38] (Figure 3). containingUltrasound, the Computer parasite. Imaging Tomography methods (CT) are and also Magnetic used to Diagnosis determineResonance the Imaging extent of (MRI) the hepatobiliary can sometimes disease reveal [20]. cystsBoth CT and MRI can determine malignancy, but MRI provides superior soft-tissue resolution, can determine periductal Detection of fluke eggs in stools represent the gold ofstandard low worm method burden. and definitiveMore than diagnosis one stool of sampleopisthorchiasis may be can identify small lesions to a higher degree than CT. An infiltration and the extent of localization of a tumor, and neededHowever, to identify it’s becoming the eggs. increasingly The eggs of Opisthorchis unreliable in are cases very similar to those of Clonorchis is used to image the biliary tree while also obtaining biliary endoscopic retrograde cholangiopancreatography (ERCP) distinguished by microscopic features. This is because the brushings and bile samples for histopathology and cytology. method relies on the parasites, another having reachedliver fluke, maturity but can level be required to release eggs into the gastrointestinal tract, which magnetic resonance imaging scan optimized for the biliary andMagnetic pancreatic resonance ducts cholangiopancreatography and is increasingly preferred (MRCP) as isthe a an infection [4]. diagnostic test of choice due to its noninvasive nature as leads to a low specificity as eggs may not be present despite opposed to ERCP. All current available biomarkers lack Monoclonal antibodies enzyme linked immunosorbent assay have been used to detect O. spp antigens in the feces, or specificity and sensitivity [4]. coproantigens, and have been proven to be more sensitive Treatment than microscopy as it does not cross-react with flukes, when compared with indirect antibody enzyme linked The main treatment for Opisthorchiidae is based on immunosorbent assay, but it only detects current infections, giving praziquantel at 25-40 mg/kg body weight [17] some while indirect antibody ELISA can detect past infections, as researchers have suggested the use of albendazole at 10 antibodies persist in body fluids following treatment with mg/kg body weight. Praziquantel is marketed under many praziquantel. Indirect antibody ELISA is used when only a brand names depending on the manufacturer, for example blood or urine sample is available. While antibody levels are Biltricide and Droncid from Bayer for clinical and veterinary higher in serum, urine is a noninvasive alternative that does uses, respectively. Data from studies on praziquantel in not require rapid processing or a trained phlebotomist [21]. the O. felineus animal model and in vitro on juvenile and adult worms, have revealed the effectiveness of the praziquantel drug. Molecular detection on faecal samples by Polymerase The mode of action of this drug is that it disrupts calcium ion Chain Reactor have been described in different researches homeostasis and antagonizes voltage-gated calcium channels in several parts of the World. At the Tomsk Opisthorchiasis leading to distortion of parasite motility, viability, tegument damage as well as death of the parasite [1,2,4,5]. [2]. Two molecular techniques were highlighted which includesConsortium the (TOPIC) Taqman-based held in real-time Tomsk, Russian PCR which Federation was However, research have shown that without praziquantel treatment, 8-nitroguanine and 8-oxodG were shown to when working with faeces collected from experimental remain present in the epithelium of hamsters six months animalreported models to have infected a high withdegree local of specificitystrains of Oand felineus sensitivity. This after they were infected [20]. The amount of the DNA adducts is similar to results obtained from the molecular diagnosis is also significantly lowered by antiparasitic drug treatment and of O. viverrini and C. sinensis in different studies and reliable can also be measured in the urine [4]. diagnostic differentiation of O. felineus infection. Providing

However, reinfection was shown to increase the rate 80oC kills all metacercariae. Alternatively, cold smoking has similar effects to those of drying and salting. The same is true epithelium, production of NO, and formation of 8-nitroguanine andof inflammatory 8oxodG with each cell reinfection-ultimately infiltration, iNOS expression increasing in DNA the 100% of metacercariae remain viable and infectious after 24 damage and risk of cancer development [4]. This raises the hrs.for treating fish with vinegar where it has been shown that question as to whether or not it is best to treat individuals who are at a high risk of reinfection with praziquantel, as it could do Control more harm than good. There are many societal, ethical and legal complications to this question. However, until this question Interrupting the life cycle of the parasite has always been is answered, it is suggested that praziquantel must be given regarded as a promising way of disease control, for example to only those who are not at risk of reinfection [4]. application of molluscicides to control snail populations.

Prevention uninfectedLow concentrations ones, and ofpresumably certain molluscicides nontoxic forother (e.g., phenasal animals. Beforeand niclosamide) the discovery are of lethal praziquantel for infected anti-helminthic snails, sublethal activity, for among the aboriginal population of Western Siberia to date application of molluscicides was practiced for some time in The campaign for reduction of raw fish consumption as its always met with stiff resistance as inherent culture is on the ecology of the water body. The economic feasibility of has proven ineffective and difficult to implement in practice usingRussia. molluscicides The disadvantage is only of thispractical approach for smallis it’s adversewater bodies effect since the costs of treating big areas are extremely high and really difficult to change. This is further-1 complicated by the do require repeated treatments as it has been shown that highas the sensitivity problem ofand reinfection specificty highlighted detecting infectedearlier. Despite cases that the snail populations are restored in about 5 years, Therefore, invariablyhuge amount have of light people infection infected (egg and g atfeces risk < of 1000) infection, as well in decontamination of aquatic bodies has been abandoned in infection, require the devotion of time and resources to developaddition and to the implement economic control losses and resulting prevention from livermeasures. fluke RussiaThe [9]. control efforts are primarily focused on the reduction Ideally, improvements in hygiene and sanitation practices and elimination of parasite transmission by ensuring proper prevent transmission of eggs from feces, which disrupts the food preparation, promoting the development of improved diagnostic techniques, providing chemotherapy, and and long-lasting, prevention programs require broad improving sanitation. A combination of health education, communitycycle of fluke acceptance maturation and and participation. transmission. To be successful

The easiest and most promising way of preventing alsomass been treatment, placed on and the governmental younger generation aid could and significantly foreigners inreduce school liverfluke as a part infection. of the conventional Emphasis oncurriculum. health education So far, this is theonly source of infection for humans. A multitude of studies has been very effective as there are increasing number of haveopisthorchiasis examined isthe decontaminating viability of metacercariae fish, as metacercariae under various are foreign students in the Western Siberian region particularly environmental conditions and it is known that they remain in Tomsk region which play hosts to seven Universities, most viable when frozen at -20oC for up to 30 days. Temperatures of which have different program for International students of >50oC kill metacercariae in a few minutes, however, It is and has no known record of any of International students suffering from Opisthorchiasis. than 30 mins to ensure that metaccercariae are killed in generally recommended to cook fish in boiled water for more is not such a easy task but this approach is been pursed by frozen pieces of fish they must be cooked for a long time. Very researchersThe possibility although of developingno success hasa vaccine been recordedagainst liver thus fluke far. 48popular hrs. It fish has dishes been proven of dried that and metacercariae salted fish are remain not safe viable for The genome mapping for all the Liver Flukes is expected to underconsumption. high salt Salted concentrations fish is generally for up considered to 14 days. ready Therefore, in 24- in this regard, the popular dish of the Western Siberia in disciplinaryfacilitate vaccine approach development is required. and tests for it’s control. To ensure the success of liver fluke control programs, trans Russia and eastern Europe of slightly salted fish is not safe at Recent Public Health Interventions For O. all. The same is true for dried fish where greater than 12 days of drying are required to kill 99% of meta-cercariae. Given Felineus in Western Siberian Region remainthat the dangerous weight of fishfor consumption.and the temperature Hot smoking of drying is a reliableare not As at present, no continous disease control programme constant even at fish plants or after 12-day period, dried fish has been developed and implemented in the region by both method of fish decontamination. A period of 2-2.5 hrs at 70- Aremu SO, et al. Putting the Spotlight on Opisthorchiasis: The Dread of the Western Siberian Copyright© Aremu SO, et al. Region. Public H Open Acc 2020, 4(1): 000151. 8 Public Health Open Access

Federationthe regional this government may not be of unconnected the affected with regions the (Westernfact that 2. 110(1): 28-36. OpisthorchiasisSiberian) as well caused as the by central O. felineus government is a chronic of the illness Russian and even assymptomatic in a sizeable number of population [4]. Ogorodova LM, Fedorova OS, Sripa B, Mordvinov VA, However a lot of researchers of local and international repute Katokhin AV, et al. (2015) Opisthorchiasis: An Overlooked 3. are beginning to pay attention to this neglected disease. Hence Danger. PLoS Negl Trop Dis 9(4). Opisthorchis felineus, an emerging infection in Italy different models are been proposed including the Social andPozio its E, implication Armignacco for O, the Ferri European F, Gomez Union. MMA Acta (2013) Trop programme puts into consideration sociocultural processes Dynamic Model (SDM) discussed earlier in this article. The that animate the transmission of the O. felineus parasite 4. 126(1):Thomas 54-62.H, Connor TO, Anchalee T, Nisana N, Watcharin is planned and not only the biomedical components of in Southeast Asia: an unresolved problem. Int J Gen Med theand disease.the specificities This is ofsimilar the local to such context integrated where interventionapproaches 10:L, et 227-237. al. (2017) Opisthorchiasis and cholangiocarcinoma illustrated by; for example the history of opisthorchiasis 5. interventions for zoonotic tapeworm Taenia solium in control in Thailand [39] and by the experiences with andFedorova cholangiocarcinoma OS, Kovshirina in YV, the Kovshirina Russian Federation: AE, Fedotova a MM, Deev IA, et al. (2017) Opisthorchis felineus infection NorthernNoteworthy Lao People’s is the attentionDemocratic paid Republic by scientists [40]. in the mid part of the last decade from Russia, Southeast Asia, Europe, 6. review of medical statistics. Parasitol Int 66(4): 365-371. and the United States who came together in a city in Western Olga Z, Peter O, Ekaterina AG, Marina MF, Yulia VK, et al. (2018) Life by the river: neglected worm infection in control,Siberia (Russia) to conduct to form research a Tomsk and OPIsthorchiasis to raise awareness Consortium on Western Siberia and pitfalls of a one-size-fits-all control (TOPIC). The initiative was designed to strengthen integrated 7. approach. Critical Public Health 28(5): 534-545. regions of East Asia but also in temperate and semi-arctic ELISAGomez for MMA, the diagnosis Ludovisi of A,Opisthorchis Amati M, felineus Pozio E infection (2013) areasOpisthorciasis of Europe afflicting and Asia populations [1]. The TOPIC not consortium only in the adoptedtropical inValidation humans from of an low excretory/secretory trematode endemic areas. antigen PLoS based- One used previously and is based on using the EcoHealth the “Lawa model,” as a template which has been successfully 8. 8(5).Sripa B, Kaewkes S, Sithithaworn P, Mairiang E, Laha T, et systemsapproach and at the cultural lake Lawa sensitivities region of inNortheast other endemic Thailand areas, [39]. butThis not method differing is to inbe essencemodified of according involving to trans-disciplinary local health care al. (2007) Liver fluke induces cholangiocarcinoma. PLoS and stakeholder participation at every level. This initiative 9. MedSithithaworn 4(7). P. Andrews, R. Khon Kaen University, Khon was supported as Private and Public Partnerships. However, there is still much to be done in translating research and 170-178. theoretical approaches into practical realities in the Public Kaen, Thailand SV Shekhovtsov, et al. [Eds.], Elsevier, pp: health Intervention for this chronic disease. 10. Mordvinov VA, Yurlova NI, Ogorodova LM, Katokhin AV Conclusion (2012) Opisthorchis felineus and Metorchis bilis are the main agents of liver fluke infection of humans in Russia. 11. Petney TN, Andrews RH, Saijuntha W, Wenz Mucke A, it is still one of the most neglected disease probably due to Parasitol Int 61(1): 25-31. the factDespite that the it is significant responsible global for aburden chronic of illness,Opisthorchiasis, however Sithithaworn P (2013) The zoonotic, fish-borne liver the publication aims to achieve with much empasis on its flukes Clonorchis sinensis, Opisthorchis felineus and it’s time to start putting on the spotlight on it, one of which 1046. distribution in the Western Siberian region. Opisthorchis viverrini. Int J Parasitol 43(12-13): 1031- 12. References infectionMaksimova and GA, dimethylnitrosamine Pakharukova MY, Kashina administration EV, Zhukova on 1. theNA, inductionKovner AV, of et cholangiocarcinoma al. (2017) Effect of Opisthorchis in Syrian hamsters. felineus

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