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Endemicity of Opisthorchis Viverrini Liver Flukes, Vietnam, 2011–2012

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Endemicity of Opisthorchis Viverrini Liver Flukes, Vietnam, 2011–2012 LETTERS Endemicity of for species identification of Opisthor- A total of 4 fish species were in- chis fluke metacercariae 7( ). fected with O. viverrini metacercariae Opisthorchis Fish were collected from Tuy (online Technical Appendix Table 1, viverrini Liver Hoa City and from the districts of Hoa wwwnc.cdc.gov/EID/article/20/1/13- Flukes, Vietnam, Xuan Dong, Tuy An, and Song Hinh; 0168-Techapp1.pdf). Metacercariae these 3 districts are areas of large prevalence was highest (28.1%) 2011–2012 aquaculture production of freshwater among crucian carp (Carasius aura- To the Editor: Fishborne zoo- fish. Fresh fish from ponds, rice fields, tus). Specific identification was con- notic trematodes are highly prevalent rivers, and swamps were purchased at firmed by morphologic appearance of in many Asian communities (1,2). Al- local markets from April 2011 through adult worms recovered from hamsters though presence of the liver flukeClo - March 2012. The fish sellers provided (Figure) and PCR and sequence anal- norchis sinensis is well documented information about the source of the ysis of the partial metacercarial CO1 in Vietnam (3), evidence of the pres- fish (e.g., type of water body). Fish gene, amplified by CO1-OV-Hap- ence of the more common liver fluke were transported live with mechani- F&R primers (7). Infected fish origi- of Southeast Asia, Opisthorchis viver- cal aeration to the Research Institute nated predominantly from so-called rini, is only circumstantial. Surveys of for Aquaculture No. 3 in Nha Trang, wild water (i.e., swamps, rice fields, human fecal samples have frequently where they were examined for meta- rivers). The prevalence of O. viverrini reported O. viverrini fluke eggs in hu- cercariae by use of whole individual metacercariae in crucian carp varied mans in southern and central Vietnam fish pepsin digestion (8). seasonally (online Technical Appen- (4); however, identifications based on Recovered metacercariae were dix Table 2). fecal eggs are notoriously unreliable examined microscopically, and those Crucian carp are cultured in some for differentiating species of liver and identified morphologically as Opis- countries but not in Vietnam. However, intestinal flukes (5). The few reports thorchis spp. flukes (9) were isolated. the high prevalence and mean inten- of surgical recovery of adult O. viver- A subset of these metacercariae were sity of O. viverrini metacercariae (28.3 rini flukes from humans do not elimi- fixed in 70% alcohol and examined metacercariae/fish) is of public health nate the possibility of infection having by PCR and sequence analysis of the concern because wild species such as been acquired during travel in neigh- CO1 gene (7) at the Department of crucian carp are often eaten raw, mari- boring fluke-endemic countries. Helminthology, Mahidol University, nated, or lightly cooked. In contrast, in- Metaceraria from fish in the Me- Bangkok. For the purpose of obtain- fected barb (Puntius brevis) and rasbo- kong Delta have been tentatively iden- ing adult worms, 3 hamsters were in- ra (Rasbora spp.) fish (online Technical tified as Opisthorchis spp., but this oculated with the Opisthorchis meta- Appendix Table 1) are not eaten raw. identity has not been confirmed (6). cercariae (15, 30, or 45 metacercariae/ However, barb fish are invasive in farm Specific identification is necessary for hamster). The adult worms were re- fish ponds and can persist as a self-re- an understanding of the liver fluke di- covered from the infected hamsters cruiting species; the presence of barb is versity in Vietnam, especially because 25–30 days after infection and were an indication that pond management is O. lobatus flukes, a related species fixed and stained for morphologic de- insufficient to prevent invasive species that infects ducks, have been reported termination of species (10). of fish. Furthermore, barb fish are often from nearby Laos (7). To clarify the status of fishborne liver flukes in Vietnam, during 2011– 2012, we conducted a survey for liver fluke metacercariae in fish from Phu Yen Province. We selected this prov- ince because the local populations have a strong preference for raw fish and because previous surveys of hu- man fecal samples conducted there indicated high prevalence of fishborne parasites (4). We chose to investigate metacercariae in fish to avoid the un- Figure. Morphologic appearance of different stages of Opisthorchis viverrini flukes. A) certainty of identifications based on Encysted metacercariae. Scale bar indicates 30 μm. B) Metacercariae released from cyst. fecal eggs and because of the avail- Scale bar indicates 30 μm. C) Adult worm from experimentally infected hamster. Scale bar ability of recent molecular methods indicates 1 mm. 152 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 1, January 2014 LETTERS fed to farm cats, which are major res- especially because aquaculture is a University, Bangkok, Thailand (J. Waikagul); ervoir hosts for fishborne liver and in- growing industry in Vietnam. Research Institute for Aquaculture No. testinal trematodes. Infections (preva- 1, Bac Ninh, Vietnam (B.N. Thanh); and lence 8.3%) in snakehead fish (Channa Acknowledgments University of Copenhagen, Copenhagen, spp.) also represent a food safety risk, We thank Henry Madsen for his ex- Denmark (K.D. Murrell) because snakehead fish are cultured in pert ecologic and malacologic advice, DOI: http://dx.doi.org/10.3201/eid2001.130168 Vietnam and are sometimes eaten raw Jesper Clausen for his valuable assistance, or inadequately cooked. In addition PhanThi Van and Anders Dalsgaard for References to O. viverrini flukes, metacercariae their strong support and advice, and the of the zoonotic intestinal flukes Cen- staff of the Research Institute for Aquacul- 1. Chai JY, Murrell KD, Lymbery AJ. trocestus formosanus, Haplorchis tai- ture No.3 for their support and contribu- Fish-borne parasitic zoonoses: status and chui, and H. yokogawi were recovered issues. Int J Parasitol. 2005;35:1233–54. tions in the field and laboratory. http://dx.doi.org/10.1016/j.ijpara.2005. from snakehead and barb fish (online This study is part of the research 07.013 Technical Appendix Table 1), all of 2. Sithithaworn P, Andrews RH, Nguyen VD, which are common throughout South- capacity building project “Fishborne Zoo- Wongsaroj T, Sinuon M, Odermatt P, east Asia (1). notic Parasites in Vietnam” (www.fibozo- et al. The current status of opisthor- chiasis and clonorchiasis in the Mekong The results of this study demon- pa2.ria1.org; project no. 91140), financial- ly supported by the Danish International Basin. Parasitol Int. 2012;61:10–6. http:// strate that the human liver fluke O. dx.doi.org/10.1016/j.parint.2011. 08.014 viverrini is endemic to Vietnam and Development Assistance. 3. Trung Dung D, Van De N, Waikagul that it is being naturally transmitted J, Dalsgaard A, Chai JY, Sohn WM, et al. Fishborne zoonotic intestinal to fish species that are often con- Vo The Dung, Jitra Waikagul, trematodes in Vietnam. Emerg Infect sumed raw or inadequately cooked. Bui Ngoc Thanh, Dis. 2007;13:1828–33. http://dx.doi. For determination of the prevalence, Dung Thi Vo, Duy Nhat Nguyen, org/10.3201/eid1312.070554 distribution, and epidemiology of O. and K. Darwin Murrell 4. De NV, Murrell KD, Cong le D, Cam PD, Chau le V, Toan ND, et al. The food-borne viverrini flukes in fish, humans, and Author affiliations: Research Institute for trematode zoonoses of Vietnam. South- reservoir hosts (e.g., cats and dogs), Aquaculture No. 3, NhaTrang, Vietnam eastern Asian J Trop Med Public Health. these results need to be extended, (V.T. Dung, D.T. Vo, D.N. Nguyen); Mahidol 2003;34(Suppl 1):12–34. etymologia Opisthorchis [o″pis-thor′kis] rom the Greek opisthen (behind) and orchis (tes- Gurlt published a textbook that included a drawing of a Fticle), Opisthorchis is a genus of trematode flat- fluke that was almost certainlyOpisthorchis . By the end worms whose testes are located in the posterior end of of the 19th century, Distoma contained so many spe- the body. Rivolta is generally credited with discovering cies that Blanchard introduced the genus Opisthorchis the first opisthorchid, which he named Distoma felin- for elongated flat flukes with testes in the posterior end eus, in a cat in Italy in 1884. However, the fluke may of the body. He chose Rivolta’s Opisthorchis felineus as have been mentioned by Rudolphi in 1819, and in 1831, the type species. Sources 1. Bowman DD, Hendrix CM, Lindsay DS, Barr SC. Opisthor- 3. Fantham HB, Stephens JWW, Theobald FV. The animal parasites chidae. In: Feline clinical parasitology. Ames (IA): Iowa State of man. New York: William Wood and Company; 1920. p. 252. University Press; 2002. p. 150–62. 4. Schuster RK. Opisthorchiidosis—a review. Infect Disord Drug 2. Dorland’s Illustrated Medical Dictionary. 32nd ed. Philadelphia: Targets. 2010;10:402–15. http://dx.doi.org/10.2174/ 18715 Elsevier Saunders; 2012. 2610793180902 Address for correspondence: Ronnie Henry, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E03, Atlanta, GA 30333, USA; email: [email protected] DOI: http://dx.doi.org/10.3201/eid2001.ET2001 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 1, January 2014 153 LETTERS 5. Ditrich O, Giboda M, Sterba J. Species Foodborne In August 2011, a 54-year-old determination of eggs of opisthorchiid woman in the Netherlands with no and heterophyid flukes using scanning Trematodiasis electron microscopy. Angew Parasitol. relevant medical history sought medi- 1990;31:3–9. and Opisthorchis cal care for fever, chills, and myalgia 6. Thu ND, Dalsgaard A, Loan LT, felineus lasting 2 weeks. Symptoms began after Murrell KD. Survey for zoonotic liver the patient returned from a vacation in and intestinal trematode metacercariae Acquired in Italy in cultured and wild fish in An Giang Tuscany. Physical examination showed Province, Vietnam.
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