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Hepatic and Intestinal Trematodes
Published in Max J. Miller, E. J. Love, Parasitic Diseases: Treatment and Control, 2020
Infection with liver flukes occurs as a result of inadvertent and/or concomitant ingestion of metacercariae in raw or inadequately prepared fish, vegetable, or insects (ants). As a consequence, dietary habit is a strong determinant of the distribution of these parasites. Sharply localized pockets of high-intensity infection may exist in the midst of parasite-free populations. Traditional dietary habits are strongly resistant to change, accounting in part for the continued problem with these infections. False parasitosis resulting from the ingestion of adult parasites in infected animal livers is a frequent association with Dicrocoelium infection.
Gastrointestinal and liver infections
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
The liver flukes, Clonorchis sinensis and Fasciola hepatica reside within the biliary tract and produce inflammatory and fibrotic reactions, leading to biliary obstruction, often complicated by bacterial cholangitis.127 The treatment of choice for both flukes is praziquantel given as three oral doses of 25 mg/kg during one day. The benzimidazole drugs, mebendazole and albendazole also have activity against these liver flukes, although more prolonged courses of treatment are required. Endoscopic or surgical intervention is often required to provide biliary drainage.
Metorchis
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Mariya Y. Pakharukova, Viatcheslav A. Mordvinov
The basic pathology caused by liver fluke infections is a disease of the liver and is associated with changes in organs of the duodeno-choledocho-pancreatic zone. Therefore, to diagnose liver fluke infection, the clinical instrumental methods used for examining the patients with gastroenterological diseases are employed. Instrumental methods, such as x-ray diagnostics (cholangiography), ultrasonography, computed tomography, and magnetic resonance imaging, can provide data for the preliminary general diagnosis “opisthorchiasis.” Parasitological confirmation of the diagnosis becomes possible when in the duodenal contents and/or feces, “eggs” appear with typical features of trematodes and the size usual for Opisthorchiidae. Nevertheless, it is common knowledge that this routine method does not allow clinicians to distinguish the causative species and is not sensitive enough; that is why it depends on seasonal and physiological fluctuations of the “egg” production of the parasites. For this reason, in recent years, molecular methods for detecting opisthorchiasis agents have been actively developed and show better efficiency, in particular due to the use of serodiagnostics and DNA-based diagnostics.
Ivosidenib in IDH-mutant cholangiocarcinoma: where do we stand?
Published in Expert Review of Precision Medicine and Drug Development, 2021
Alessandro Rizzo, Angela Dalia Ricci, Giovanni Brandi
Cholangiocarcinomas (CCAs) are rare hepatobiliary tumors accounting for approximately 3% of all gastrointestinal malignancies and 10–15% of all primary liver cancers worldwide [1,2]. According to their anatomical classification, CCAs are usually divided into intrahepatic cholangiocarcinomas (iCCAs) and extrahepatic cholangiocarcinomas (eCCAs), with the latter further subclassified as perihilar (pCCAs) and distal cholangiocarcinomas (dCCAs) [3,4]. These tumors have historically reported a low incidence in Western countries [5,6]; however, the incidence of CCA has seen important changes over recent decades, probably due to the rise of intrahepatic forms [7,8]. Traditionally, Asian countries such as China, Thailand, India, Japan, and South Korea, present higher incidence, something that has been associated to the high prevalence of liver fluke infection (e.g. Clonorchis sinensis and Opisthorchis viverrini) in these areas [9,10].
Immunotherapies in clinical development for biliary tract cancer
Published in Expert Opinion on Investigational Drugs, 2021
Arndt Vogel, Melanie Bathon, Anna Saborowski
Cancers of the biliary system (BTC) are highly aggressive tumors that either originate within the liver (intrahepatic cholangiocarcinoma (iCCA)), in the perihilar or distal bile ducts (perihilar or distal CCA), or in the gallbladder [1,2]. In most countries, CCA is considered a ‘rare’ cancer with incidence rates below 6/100.000. However, due to the demographic distribution of different risk factors and probably influenced by ethnic factors, the incidence of CCA ranges from 0.1/100.000 in Australia to more than 110/100.000 in Northeast Thailand. In Europe, most biliary tumors occur sporadically after the age of 50, with a slight predominance of male patients. Risk factors include obesity, viral hepatitis B and C, primary sclerosing cholangitis (PSC) and, for gallbladder carcinoma, gallstones. In Asian countries, infestation with parasitic liver flukes is considered an important risk factor. Surgical resection is the only potentially curative approach and should be offered to patients who are diagnosed at an early stage. However, due to the late manifestation of clinical symptoms, most patients suffer from locally advanced or metastatic disease at the time of diagnosis, and even after successful resection early recurrence is frequent. Most patients are eventually bound to receive palliative treatments, and the dismal median overall survival (mOS) of 11–13 months under systemic palliative therapy with gemcitabine and cisplatin (GemCis) highlights the urgent need to expand the limited therapeutic measures available to date for patients with advanced BTC [3–5].
Ivosidenib: an investigational drug for the treatment of biliary tract cancers
Published in Expert Opinion on Investigational Drugs, 2021
Angelos Angelakas, Angela Lamarca, Richard a Hubner, Mairéad G McNamara, Juan W. Valle
Liver fluke infection is an established risk factor for developing CCA. This fact is of particular relevance for Asian countries, such as Thailand, where the highest incidence rates of liver fluke infection are reported [35]. The drivers proposed to explain this relationship include mechanical damage of the biliary epithelium, immune-mediated reaction, stimulated cell proliferation secondary to parasite products and biliary tract microbiome alterations [35]. Jusakul et al. studied IDH1 mutations in relation to fluke infection and they showed that these are less frequent in fluke-infected patients (1.6–1.9%) compared to non-infected patients (4.2–10.9%) [33]. Another study reported that in non-infected patients, IDH1 mutations were more frequent in iCCA (17.5%) than eCCA (2.3%). In the fluke-infected population, the frequency of IDH1 mutations was similarly low between iCCA and eCCA (1.6% vs 2.2%) [36].