Sonographic findings of active Clonorchis sinensis infection

Abstract

Increased periductal echogenicity and floating echogenic foci in the gallbladder were identified as the 2 most significant findings for the sonographic diagnosis of active C. sinensis infection.

Single Nucleotide Polymorphisms of Cytokine Genes are Associated with Fibrosis of the Intrahepatic Bile Duct Wall in Human Clonorchiasis

“…Inflammation sites in the ductal wall contain numerous inflammatory or immune cells which secrete multiple cytokines, and the cytokines are mixed in the tissue and may modulate tissue reactions in complicated ways according to genotype polymorphisms. Complicated tissue reactions in the liver may explain the reason that liver ultrasonography in infected humans have displayed low sensitivity and specificity [6,14]. A small proportion of clonorchiasis patients will have negative liver scans on ultrasonography as false negatives.…”

“…A small proportion of clonorchiasis patients will have negative liver scans on ultrasonography as false negatives. Conversely, some egg negative individuals from endemic areas will show IHDD on scans as false positives [6]. Most ultrasonographic false positives may have residual bile duct fibrosis after treatment although a portion may be actively infected but found egg negative.…”

“…Intrahepatic duct dilatation (IHDD) and periductal echogenicity (PDE) were ultrasonographically identified as previously described [6].…”

Human liver flukes

“…The findings of hepatomegaly, gallstones, sludge, intrahepatic duct stones, poorly-functioning gall bladder, increased portal vein diameter, intrahepatic bile duct dilatation, increased splenic thickness, or high hepatic pulsation index are non-specific but supportive (87,88) . The most specific finding for clonorchiasis and opisthorchiasis are visualisation of aggregates of flukes as floating echogenic foci (89) and periductal fibrosis. Degree of periductal fibrosis measured by echogenicity is associated with burden of disease.…”

Gallbladder infection by trematodes

“…Sonography can indeed show two specific findings in the case of active C. sinensis infection, such as the presence of increased periductal echogenicity (IPDE) (sensitivity 35 %, specificity 91 %; p \ 0.001, R = 0.11) and floating echogenic foci in the gallbladder (FEFGB) (sensitivity 28 %, specificity 94 %; p \ 0.001, R = 0.09). Others, such as diffuse dilatation of the intrahepatic bile ducts (DDIHD) and gallbladder distension, appear to have a lower diagnostic accuracy but can be useful as additional clues (sensitivity 67 %, specificity 48 %; p \ 0.01, R = 0.03; and sensitivity 3 %, specificity 100 %; p \ 0.05, R = 0.02, respectively) [4]. Furthermore, evident sonographic findings seem to have a linear and positive correlation with heavier infections, and their resolution may result in successful treatment (improvement of FEFGB, p = 0.004).…”