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Opisthorchiasis hepatitis
Medical expert of the article
Last reviewed: 12.07.2025
[ How does opisthorchiasis hepatitis develop?
After entering the human gastrointestinal tract, metacercariae penetrate the bile ducts, gall bladder and pancreatic ducts. Opisthorchiasis is found in the intrahepatic bile ducts in 100% of infected individuals, in the gall bladder in 60%, and in the pancreas in 36%.
Metacercariae that have penetrated the hepatobiliary system reach sexual maturity after 3-4 weeks and then begin to lay eggs.
A distinction is made between acute opisthorchiasis (from several days to 4-8 weeks), associated with the migration of parasite larvae and the development of toxic-allergic syndrome to metabolites caused by the larvae, and chronic opisthorchiasis (lasts 15-25 years).
The leading factor of pathogenesis in the acute phase of opisthorchiasis is a combination of developing allergic reactions of immediate and delayed types, arising as a result of sensitization of the human body by the products of metabolism and decay of opisthorchis and the parasites' own tissues damaged. In addition, opisthorchis mechanically damages the walls of the bile ducts and pancreatic ducts. Accumulations of parasites, their eggs, mucus, and desquamated epithelium in the ducts of the hepatopancreatic system create an obstacle to the outflow of bile and pancreatic secretion. Stasis of bile contributes to the development of a secondary infection, whose pathogens penetrate the body by ascending (through the bile ducts) and descending (hematogenous) routes.
Morphology of opisthorchiasis hepatitis
The most pronounced morphological changes in opisthorchiasis occur in the liver and intrahepatic bile ducts.
Macroscopically: the liver is enlarged, with a leathery anterior edge, has adhesions with the diaphragm, and subcapsular cholangioectasis.
Microscopically, various dystrophic, atrophic changes in the parenchyma are revealed, occasionally - foci of necrosis. Hepatocytes located near the bile ducts are most affected. Disturbances in the nuclear apparatus and organelles of hepatocytes are detected at the ultramicroscopic and cytogenetic level in the form of gross destructive changes in organelles, up to lysis and necrosis. Bile ducts have thickened walls and unevenly wide lumens, contain opisthorchiasis; cylindrical or saccular cholangioectasis, productive cholangitis with proliferation of the duct epithelium, accompanied by the formation of alveolar-tubular structures, whose cells are rich in mucus with a high content of mucopolysaccharides, are characteristic. In parallel with the proliferation of bile duct epithelial cells, the surrounding connective tissue grows, which leads to a significant thickening of the duct walls.
Intrahepatic cholangioectasis is most often located on the visceral surface of the left lobe of the liver subcapsularly, showing through as whitish, twisted stripes.
Hyperplastic processes in chronic opisthorchiasis affect the entire biliary duct system, including the extrahepatic bile ducts, which leads to the formation of various strictures of the common bile duct and cystic duct.
Symptoms of opisthorchiasis hepatitis
The incubation period for opisthorchiasis is from 4 to 35 days. The disease begins acutely, with a rise in body temperature to febrile values, the fever lasts from several days to 2 months; intoxication occurs, expressed in malaise and weakness.
In children, in most cases, the onset of the disease is subacute, with a background of subfebrile temperature, abdominal pain, usually in the right hypochondrium and epigastrium, and malaise.
In adults and children in the acute phase of opisthorchiasis, the liver is enlarged in size, painful on palpation, the spleen can be palpated from the hypochondrium. In some cases, jaundice appears, from mild to intense, which is often associated with congestion: in the biliary system.
Allergic symptoms in the form of various skin rashes, itching, and Quincke-type edema are extremely characteristic of acute opisthorchiasis.
In addition to damage to the hepatobiliary system, other pathological processes may also be observed (from the gastrointestinal tract, kidneys, etc.).
A biochemical blood test reveals an increase in aminotransferase activity by 2-7 times compared to the norm, an increase in the level of bilirubin, often conjugated.
The clinical blood test picture shows leukocytosis, eosinophilia (from 20 to 60%) and increased ESR.
The course of opisthorchiasis hepatitis
The acute stage of opisthorchiasis, as a rule, does not resolve, the process becomes chronic. In the local population, in the foci of opisthorchiasis, the primary chronic form of opisthorchiasis is observed. The duration of the disease is from 2 to 20 years or more. With the combined course of opisthorchiasis and viral hepatitis, an increase in the frequency of moderate and severe forms of the disease, significant severity of pain syndromes from the liver and gallbladder are recorded. With the occurrence of hepatitis B. C and D in children with opisthorchiasis, the frequency of fatal outcomes increases, while with a monoinvasion of opisthorchiasis, fatal outcomes in children are not observed.
If opisthorchiasis lasts more than 5 years, severe complications arise in the form of stricture of the cystic duct, stenosis of the large duodenal papilla, chronic cholestatic hepatitis, cysts and abscesses of the liver, etc.
Clinical classification
There are acute and chronic opisthorchiasis. Acute opisthorchiasis is divided into larval (larval) and parasitic in the form of the following syndromes: febrile, typhoid-like, arthralgic, hepatopancreatic, bronchopulmonary and mixed.
Chronic opisthorchiasis occurs in the following variants: latent, subclinical. angiocholecystitis, hepatocholecystitis, gastroangiocholecystitis, hepatocholecystopancreatitis, associated. Chronic opisthorchiasis is clinically manifested mainly by symptoms of chronic cholecystitis and pancreatitis. The cholecystopathic variant of the disease has a picture of chronic recurrent cholecystitis, cholangiocholecystitis, cholestatic hepatitis.
The leading clinical syndromes are abdominal pain and dyspeptic. In the vast majority of patients, pain is localized in the right hypochondrium and epigastrium. The pain is constant, characterized as pressing, aching, of varying intensity. Hepatomegaly is a constant symptom; the spleen may be enlarged at the same time. Dyspeptic symptoms are expressed in loss of appetite, belching, vomiting, intolerance to fatty foods, and stool instability.
Almost all patients with chronic opisthorchiasis have an expressed asgenovegetative syndrome in the form of weakness, lethargy, headaches, dizziness,
The presence of inflammatory and dyskinetic phenomena in the biliary system is recorded during instrumental studies: ultrasound of the liver and gallbladder, fractional chromatic duodenal sounding, hepatobiliary scintigraphy.
A biochemical blood test often reveals an elevated level of bilirubin, mainly conjugated, an increase in the activity of alkaline phosphatase and GGT, with normal activity of ALT and AST.
In a clinical blood test, as in the acute stage of opisthorchiasis, eosinophilia is revealed.
Diagnosis of opisthorchiasis hepatitis
For the diagnosis of opisthorchiasis, information about staying in the opisthorchiasis outbreak and eating uncooked carp fish is of great importance. Among the clinical symptoms, attention is paid to the acute onset of the disease with fever, allergic rash and abdominal pain mainly in the right hypochondrium; among laboratory tests - to changes in the peripheral blood in the form of leukocytosis and pronounced eosinophilia.
Parasitological diagnostics of acute opisthorchiasis is impossible, since helminths begin to release eggs only 6 weeks after invasion. Serological testing is recommended to detect antibodies to opisthorchiasis using RIGA and ELISA.
The main criterion for diagnosing opisthorchiasis is the detection of opisthorchis eggs in feces and duodenal contents. Usually, helminth eggs are detected no earlier than 1 month after the onset of the disease, and only after multiple studies.
Differential diagnostics of opisthorchiasis with viral hepatitis must be carried out due to the significant similarity of the clinical picture of the diseases,
Viral hepatitis will be indicated by fever or prolonged subfebrile temperature with severe intoxication, very moderate activity of aminotransferases, damage to the biliary tract confirmed by ultrasound data, and severity of pain in the right hypochondrium.
If there is no viral hepatitis associated with opisthorchiasis, then serological markers for hepatitis viruses will be negative.
Treatment of opisthorchiasis hepatitis
When treating patients with opisthorchiasis, the principle of stage-by-stage treatment, pathogenetic therapy (ursosan), specific treatment (praziquantel (biltricid, azinox)) and rehabilitation therapy aimed at restoring the impaired functions of the hepatobiliary system, pancreas and gastrointestinal tract should be observed.
Specific therapy is carried out using praziquantel (biltricide). Biltricide is used in the acute and chronic stages of the disease. The drug is active against mature and immature forms of the parasite. Biltricide is prescribed in a dose of 60-75 mg per 1 kg of the patient's body weight per course of treatment.
The domestic drug Azinox is not inferior in effectiveness to Biltricid; it is prescribed in a dose of 30-40 mg per 1 kg of body weight.
The indicated drugs lead to complete deworming in 86.2% of patients with opisgorchiasis.
The effectiveness of specific treatment is assessed 3 months after the course and another 6-12 months later. The criteria for freedom from the parasite are negative results of triple coproovoscopy and single duodenal sounding.
Prevention of opisthorchiasis hepatitis
Prevention of opisthorchiasis includes several areas. It is necessary to identify foci of opisthorchiasis and treat patients with opisthorchiasis in foci; conduct sanitary and educational work among the population in natural foci; deworming of domestic carnivores; control of intermediate hosts of opisthorchiasis. Disinfection of carp infested with metacercariae of the parasite at home is carried out for 32 hours at - 28 ° C, salting with 20% salt solution - for 10 days, boiling - at least 20 minutes from the moment of boiling.
There is no specific prevention.