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Human Liver Flukes: a Review

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Human Liver Flukes: a Review Research and Reviews ill Parasitology. 57 (3-4): 145-218 (1997) Published by A.P.E. © 1997 Asociaci6n de Parasit61ogos Espafioles (A.P.E.) Printed in Barcelona. Spain HUMAN LIVER FLUKES: A REVIEW S. MAS-COMA & M.D. BARGUES Departamento de Parasitologia. Facultad de Farmacia, Universidad de Valencia, Av. vicent Andres Estelles sin, 46100 Burjassot - Valencia, Spain Received 21 Apri11997; accepted 25 June 1997 REFERENCE:MAS-COMA(S.) & BARGUES(M. D.). 1997.- Human liver flukes: a review. Research and Reviews in Parasitology, 57 (3-4): 145-218. SUMMARY:Human diseases caused by liver fluke species are reviewed. The present knowledge on the following 12 digenean species belonging to the families Opisthorchiidae, Fasciolidae and Dicrocoeliidae is analyzed: Clonorchis sinensis, Opisthorchis feline us, O. viverrini, Fasciola hepa- tica, F. gigantica, Dicrocoelium dendriticum, D. hospes, Eurytrema pancreaticum, Amphimerus pseudofelineus, A. noverca, Pseudamphistomum truncatuin, and Metorchis conjunctus. For each species the following aspects of the parasite and the disease they cause are reviewed: morphology, location and definitive hosts. reports in humans, geographical distribution. life cycle. first intermediate hosts, second intermediate hosts if any, epi- demiology. pathology. symptomatology and clinical manifestations. diagnosis, treatment, and prevention and control. KEY WORDS: Human diseases, Clonorchis sinensis, Opisthorchis felineus, O. viverrini, Fasciola hepatica, F. gigantica,Dicrocoelium dendriticum, D. hospes, Eurytrema pancreaticum, Amphimerus pseudofelineus, A. noverca, Pseudamphistomum truncatum, Metorchis conjunctus, review. CONTENTS Introduction 147 Clonorchis sinensis 148 Morphology .. 148 Location and definitive hosts. 148 Reports in humans .. 149 Geographical distribution 149 Life cycle. 150 First intermediate hosts 151 Second intermediate hosts 152 Epidemiology 152 Pathology, symptomatology and clinical manifestations 153 Diagnosis 154 Treatment. 155 Prevention and control 155 Opisthorchis viverrini 156 Morphology. 156 Location and definitive hosts 157 Reports in humans 157 Geographical distribution 158 Life cycle 158 First intermediate hosts. 159 Second intermediate hosts 159 Epidemiology 160 Pathology, symptomatology and clinical manifestations. 162 Diagnosis. 164 Treatment 165 Prevention and control. 165 Opisthorchis felineus 166 Morphology 166 Location and definitive hosts 166 Reports in humans .. 167 Geographical distribution. 168 Life cycle 168 First intermediate hosts 168 Second intermediate hosts 168 Epidemiology 168 Pathology, symptomatology and clinical manifestations 170 Diagnosis 170 Treatment 171 Prevention and control 171 Fasciola hepatica 171 Morphology .. 171 Location and definitive hosts 172 146 S. MAs-CoMA & M.D. BARGUES Reports in humans. 172 Geographical distribution 173 Life cycle 175 First intermediate hosts . 175 Epidemiology. 176 Pathology, symptomatology and clinical manifestations. 177 Diagnosis. 179 Treatment. 181 Prevention and control. 182 Fasciola gigantica . 182 Morphology. 182 Location and definitive hosts. 183 Reports in humans. 183 Geographical distribution. 184 Life cycle. 184 First intermediate hosts. 184 Epidemiology. 185 Pathology, symptomatology and clinical manifestations . 185 Diagnosis. 186 Treatment. 186 Prevention and control. 186 Dicrocoelium dendriticum . 186 Morphology. 186 Location and definitive hosts. 187 Reports in humans. 187 Geographical distribution. 188 Life cycle. 188 First intermediate hosts . 189 Second intermediate hosts. 189 Epidemiology. 189 Pathology, symptomatology and clinical manifestations . 190 Diagnosis. 191 Treatment. 191 Prevention and control. 192 Dicrocoelium hospes 192 Morphology . 192 Location and definitive hosts. 192 Reports in humans. 192 Geographical distribution. 193 Life cycle. 193 First intermediate hosts. 193 Second intermediate hosts. 193 Epidemiology. 194 Pathology, symptomatology and clinical manifestations . 194 Diagnosis. 194 Treatment. 194 Prevention and control. 194 Eurytrema pancreaticum . 194 Morphology. 194 Location and definitive hosts. 194 Reports in humans. 195 Geographical distribution. 195 Life cycle. 195 First intermediate hosts. 195 Second intermediate hosts. 196 Epidemiology. 196 Pathology, symptomatology and clinical manifestations . 196 Diagnosis. 196 Treatment. 196 Prevention and control. 196 Amphimerus pseudofelineus . 196 Amphimerus noverca . 197 Pseudamphistomum truncatum . 197 Metorchis conjunctus . 197 References. 198 Introduction. 198 Clonorchis sinensis . 198 Human liver flukes: a review 147 Opisthorchis viverrini. 200 Opisthorchis [elineus .. 203 Fasciola hepatica . 205 Fasciola gigantica. 210 Dicrocoelium dendriticum. 212 Dicrocoelium hospes .. 215 Eurytrema pancreaticum .. 216 Amphimerus pseudofelineus . 217 Amphimerus noverca .. 217 Pseudamphisiomum truncatum .. 217 Metorchis conjunctus. 217 INTRODUCTION cal importance owing to the large number of people in- fected (the estimated number of people infected can be Among digenean parasites affecting the liver of hu- counted in millions in each case), allowing us to really man beings, the following 12 species belonging to three speak of human endemic areas (see RIM et al., 1994). trematode families are involved: The species D. dendriticum, F. gigantica and D. hospes, A) Opisthorchiidae: Clonorchis sinensis (Cobbold, 1875) in this order, constitute an intermediate group according Looss, 1907; Opisthorchis felineus (Ri volta, 1884) to their importance in humans, human cases being relati- Blanchard, 1895; Opisthorchis viverrini (Poirier, 1886) vely numerous but usually isolated (the estimated num- Stiles et Hassall, 1896; Amphimerus noverca (Braun, ber of people infected can be counted in hundreds in 1902) Barker, 191I; Amphimerus pseudofelineus each case). Finally, E. pancreaticum, P. truncatum, A. (Ward, 1901) Barker, 1911 (= Opisthorchis guayaqui- pseudofelineus, A. noverca and M. conjunctus have been lensis Rodrfguez G6mez et Montalvan, 1949); Metor- reported in humans only very sporadically (less than ten chis conjunctus (Cobbold, 1860) Looss, 1899; and published cases for each parasite), although recent stu- Pseudamphistomum truncatum (Rudolphi, 1819) Liihe, dies in the former USSR have shown that P. truncatum 1908; may be more prevalent (KHAMIDULLI et al., 1991). At B) Fasciolidae: Fasciola hepatica (Linnaeus, 1758); and any rate, all these diseases are undoubtedly largely unde- Fasciola gigantica Cobbold, 1855; restimated, for different reasons: A) they develop subcli- C) Dicrocoeliidae: Dicrocoelium dendriticum (Rudolphi, nically or only with mild symptoms when parasite num- 1819) Looss, 1899 (= Fasciola lanceolata Rudolphi, ber is scarce, which may be the situation in numerous 1803; = Dicrocoelium lanceatum Stiles et Hassall, cases, so that infected persons do not attend specialists; 1898); Dicrocoelium hospes Looss, 1907; and Eury- B) the diseases they cause can be confused with infec- tretna pancreaticum (1anson, 1889) Looss, 1907. tions of different etiology; C) not all diagnosed cases are All these species have in common the hepatic location finally published. (bile ducts, gall bladder) of the adult stage of the parasite Several of these liver fluke diseases have a geographi- at the level of the definitive host (ectopic forms are ho- cal distribution including endemies in several countries wever frequent in humans, mainly in fasciolids), but in in Eastern Europe and in Asia, in which important politi- the case of E. pancreaticum the main location of the cal changes in recent years have led to an increasing adults is in the pancreas and less frequently in the bile opening. That is why these diseases have recently acqui- ducts. red new relevance, efforts being made today by concer- These are the species already confirmed affecting the ned institutions to recognize the serious, yet neglected, human liver, but this does not mean that they are all. problems associated with these trematode infections. There are also other digenean species whose adult stages RIM et al. (1994) appropriately allude to this question are hepatic and whose potentiality to infect humans ap- with the terms of «ignored or emerging» and emphasize pears evident. For instance, Metorchis albidus (Braun, the significant economic impact associated with these 1893) Looss, 1899, an hepatic parasite of carnivorous infections: absenteeism, hospitalization, treatments and mammals in the Holarctic and which is transmitted th- repeated treatments, direct cost to health-care systems, rough rnetacercariae in fish, is considered as a potential disability and agricultural economic losses. source of infection to man, at least in Kazakhstan (SIDO- Moreover, the actual frame can change in the near fu- ROY & BELY AKOYA, 1972) and Lithuania (L1 NIK, ture if appropriate control measures are not undertaken, 1983). Another species, Pseudamphistomum aethiopi- owing to the recently signed GATT international agree- cum Pierantoni, 1942, a member of a genus whose spe- ment, replaced by the World Trade Organization (WTO) cies are all hepatic parasites in mammals (Y AMAGUTI, in 1995. All these twelve fluke diseases are food-borne 1971), has already been found in humans in Ethiopia, infections and the significant increase of international but causing cyst-like nodules in the internal wall of the food exchange which can be expected in the future as the small intestine (CACCIAPUOTI,1947). consequence of facilitated export/import activities bet- Among the human liver fluke species, C. sinensis, O. ween
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