Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand.
Department of Parasitology and Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Adv Exp Med Biol. 2024;1454:239-284. doi: 10.1007/978-3-031-60121-7_7.
Clonorchis sinensis, Opisthorchis viverrini and O. felineus are liver flukes of human and animal pathogens occurring across much of Europe and Asia. Nevertheless, they are often underestimated compared to other, better known neglected diseases in spite of the fact that many millions of people are infected and hundreds of millions are at risk. This is possibly because of the chronic nature of the infection and disease and that it takes several decades prior to a life-threatening pathology to develop. Several studies in the past decade have provided more information on the molecular biology of the liver flukes which clearly lead to better understanding of parasite biology, systematics and population genetics. Clonorchiasis and opisthorchiasis are characterized by a chronic infection that induces hepatobiliary inflammation, especially periductal fibrosis, which can be detected by ultrasonography. These chronic inflammations eventually lead to cholangiocarcinoma (CCA), a usually fatal bile duct cancer that develops in some infected individuals. In Thailand alone, opisthorchiasis-associated CCA kills up to 20,000 people every year and is therefore of substantial public health importance. Its socioeconomic impacts on impoverished families and communities are considerable. To reduce hepatobiliary morbidity and CCA, the primary intervention measures focus on control and elimination of the liver fluke. Accurate diagnosis of liver fluke infections in both human and other mammalian, snail and fish intermediate hosts is important for achieving these goals. While the short-term goal of liver fluke control can be achieved by praziquantel chemotherapy, a comprehensive health education package targeting school children is believed to be more beneficial for a long-term goal/solution. It is recommended that transdisciplinary research or multisectoral control approach including one health and/or eco health intervention strategy should be applied to combat the liver flukes and hence contribute to reduction of CCA in endemic areas.
华支睾吸虫、肝片形吸虫和猫后睾吸虫是人畜共患的肝吸虫病原体，分布于欧洲和亚洲的大部分地区。尽管有数百万人感染，数亿人面临感染风险，但与其他更为人熟知的被忽视疾病相比，这些疾病往往被低估。这可能是因为感染和疾病具有慢性特征，而且要在数十年后才会发展为危及生命的病理。过去十年的几项研究提供了更多关于肝吸虫分子生物学的信息，这些信息显然有助于更好地了解寄生虫生物学、系统发生学和种群遗传学。华支睾吸虫病和肝片形吸虫病的特征是慢性感染，可引起肝胆炎症，特别是胆管周围纤维化，这可通过超声检查检测到。这些慢性炎症最终导致胆管癌（CCA），这是一种在一些感染个体中发生的通常致命的胆管癌。仅在泰国，每年就有多达 20000 人死于与肝片形吸虫病相关的 CCA，因此它对公共卫生具有重要意义。它对贫困家庭和社区的社会经济影响相当大。为了降低肝胆疾病发病率和 CCA，主要的干预措施侧重于控制和消除肝吸虫。准确诊断人类和其他哺乳动物、蜗牛和鱼类中间宿主的肝吸虫感染对于实现这些目标非常重要。虽然吡喹酮化疗可以实现肝吸虫的短期控制目标，但针对学龄儿童的全面健康教育套餐被认为更有利于长期目标/解决方案。建议应用跨学科研究或多部门控制方法，包括一个健康和/或生态健康干预策略，以对抗肝吸虫，从而有助于减少流行地区的 CCA。
