Treatment

You may well ask, once you've got me, how do you get rid of me?

First of all, the following diagnostic tests can help a victim be SURE that he or she is suffering from clonorchiasis. A medical history should be taken including questions on diet, travel, and regions where the patient has previously resided. A physical assessment will include gentle palpation of the liver. An Elisa blood test (77% sensitive) may be admistered.

Medical tests may include endoscopy and examination of a stool (faeces) sample for eggs. Microscopic demonstration of eggs in the stool or in duodenal aspirate is the most practical diagnostic method. Radiological and sonographic assesments are also becoming increasingly popular, but different imaging modalities present various risks, including a high number of false positives. The adult fluke can also be recovered surgically.

There are a number of anthelmintic medications which work in different ways. In most cases a single dose is used, but for severe infections or more resilient worms, longer-term treatment may be required. Praziquantel or albendazole are the drugs of choice to manage clonorchiasis (by eradicating the parasite) and of course treatment for the secondary effects of parasitemia may be necessary.

• Albendazole (Brands: Eskazole, Zental) is used to treat hydatid disease and larval taeniasis (beef tape worm) infection, and for some tapeworm infections by adult worms. It works by inhibiting metabolism in the cells of the worm, leading to their immobilization and death. The dead worms are broken down by the body’s immune system.

• Praziquantel (Brands: Biltricide) is used to treat blood flukes, lung flukes, liver flukes and intestinal flukes, and the majority of tapeworms. It is the drug of choice for treating clonorchiasis. This drug increases cell membrane permeability in susceptible worms, resulting in loss of their intracellular calcium, massive contractions, and paralysis of the worm's musculature. This is followed by attachment of phagocytes to the parasite and its subsequent death.

The praziquantel tab should be swallowed whole with some liquid during meals. Keeping the tab in mouth may result in a bitter taste, which can produce nausea or vomiting.

Cholangitis is treated with intravenous antibiotics. Other complications resulting from clonorchiasis may require additional interventions, including surgery.