40

Parasitic Diseases of the Liver

.

.

.

(Protozoa) Leishmania donovani, Trypanosoma cruzi, Entamoeba

histolytica, Toxoplasma gonii, Plasmodium falciparum, Pneumocystis cainii, Balantidium coli, Cryptosporidium,

(Nematoda) Strongyloides stercoralis, Ascaris lumbricoides, Toxocara canis, Gnathostoma, Capillaria

hepatica, (Trematoda) Fasciola hepatica, Clonorchis sinensis, Opisthorchis viverinii, Schistosoma

japonicum, mansoni, (Cestoda) Sparganum, Echinococcus granulosus, multilocularis

.

(Clonorchis sinensis) (Opisthorchis viverrini)

(Clonorchis sinensis)

. 2.9%

140 4

.1 (Opisthorchis viverrini) International Agency for

Research on Cancer (IARC) 2 1999

10% ( 8.8%, 10.6%) 2005 11.6%,

22.7% . 2001 2005 10%

( 12%, 6%) .

, 50 . praziquantel

.3

Parasitic Diseases of the Liver

41

1. (Morphology) (Life cycle)

.

, . 8.0-15.0 mm, 1.5-4.0 mm, 1.0 mm

. 22-25 11-19 m ,

. (miracidium) .

2,400, 1,100,

4,000, 330, 2,000-4,000 .4,5

.

1 (Parafossarulus manchouricus, Bulimus,

Alocinma) . sporocyst,

(redia) (cercaria) .

24-48 2 .

. 2

.

(metacercariae) .

.

. (bile

ductule) , 1 .

20-30 .

(gall bladder),

.4-6

(Pseudorasbora parva), , , , , , . 50 5, 70 30, 98 20 , 6 , 6 . 25, 19, 530 ,

48, , , 6 .6,7

,

1/2 .

2. (Pathophysiology) (Clinical manifestation)

, , () .

2012 Single Topic Symposium

42

,

. (epithelial hyperplasia),

, . , , ,

, .

(goblet cell metaplasia),

(adenomatous hyperplasia) 5,6

, .

.

, , , , , , ,

.

,

.8

(biliary cirrhosis)

(cholangiocarcinoma) . 2-3 .

, ,

.9

5-10% , , ,

.

,

.5

3. (Diagnosis)

. , ,

.

1)

. (Kato-Katz method,

Formalin ether concentration technique) ,

Parasitic Diseases of the Liver

43

. .

,

. DNA PCR

.

.10,11

2)

,

.

(ELISA)

.

.

(crude extracts) (excretory

-secretory antigens) .10,11 7 kDa , lysophosphatidic

acid phosphatase, 28 kDa , Myoglobin, Clonorin , 26 kDa 28 kDa glutathione

S-transferases ,

.

cysteine

(81.3-96%) (92.6-96.2%)

.12

3)

(RDT, Rapid Diagnostic

Test) . RDT 5 L . RDT

(colloidal gold particle)

(tracer antigen) . nitrocellulose

(micro-pore) protein A

. . RDT

ELISA 91% .

ELISA , RDT 90%

.13

2012 Single Topic Symposium

44

4)

(76%)

. ,

( 10 mm )

.8

4. (Treatment) (Prevention)

Pyrazinoisoquinoline praziquantel 25 mg/kg 5 1 3

83-85% . praziquantel 40-50 mg/kg 1 91-97% .

praziquantel , , , . 4

.5 , , ,

0.7% ammonium sulfate , 1 , ,

.4

(Fasciola hepatica)

De Brie(1379) Leukert(1883)

. , (, , , , ,

) , .

,

.4,5

1. (Morphology) (Life cycle)

. (cephalic cone)

. spine

20-30 8-13 mm. , .

2 .

. 130-150 63-93 m. 10

.4

,

9-10 . 24 1 Lymnaea ollula,

Parasitic Diseases of the Liver

45

Lymnaea tranculata, L. pervia, sporocyst, ,

(5-7 ). (aquatic vegetation)

(metacercariae) 2 . (watercress),

(alfalfa) , , . ,

. , 6

, , , , 25,000

.5 , , , , .14

2. (Pathophysiology) (Clinical manifestation)

1) (acute and invasive phase)

mm 2 3-5

, , , , , , , , , ,

, , , . , LDH 4

. , , , ,

.

.

.5,8,14

2) (chronic phase)

. , , . 6

10 .

, spine

.8 , , ,

. , ,

, , , GGT .

GGT alkaline phosphatase . GGT

9 18 .14,15 50%

.

,

cathepsin L1 .16

2012 Single Topic Symposium

46

3. (Diagnosis)

.

1)

(1)

Fas2-ELISA(cathepsin L1-based antibody) 92.4%, 83.6%,

97.2% 16 tricla-

bendazole 3-5 .5

(2)

, ,

.

, , .

, 2-10 mm

. tunnels and caves sign , ,

. T1

, T2 .8

2)

10

, ELISA , , .

(1)

,

Kato-Katz rapid sedimentation technique (RST) .

3-4

.5

(2)

, , , , , ,

, (14%) 8

12 .

. .14

Parasitic Diseases of the Liver

47

3. (Treatment) (Prevention)

Tubulin microtubules triclabendazole 10 mg/kg

1 90% , Artemether

. Bithionol 30-50 mg/kg 15 .

, , , (molluscacide)

.5

(Schistosoma japonicum)

1. (Morphology) (Life cycle)

gonochorism.

(canalis gynecophorus) . 15-25 0.5 mm,

10-19 0.3 mm . ,

. , ,

. 6-8 1 .

50-300 . ,

. 90 70 m .4

, , , , , , . 2 .

, 2 . , .

, , , .

.

, .

. 9-10 .

Oncomelania nosophora (), Oncomelania formosana (), Oncomelania

hupensis (), Oncomelania quardrasi (),

sporocyst, , .

, .

. 6-8

3,000 . 4.5 20-30 .4,20

2012 Single Topic Symposium

48

2. (Pathophysiology) (Clinical manifestation)

(Larva migrans)

,

.

. .

.

(biological incubation period) , ,

. , , , , ,

, , , , .

, ,

, , , .

17 , .18

3. (Diagnosis)

1-2g formalin-ether concentration

, 20-50 mg

Kato-Katz . 37 , .

. IgG, IgM, IgE Scistosoma egg Ag

(SEA) CD4+, CD8+ . SEA IgG4

.17

, .19

. ,

, .

.

.20

4. (Treatment) (Prevention)

Praziquantel 20 mg/kg 1 3 100%.

(), ( , ) benzyl benzonata

Parasitic Diseases of the Liver

49

diethylphthalate

.4

(Echinococcus granulosus)

, , ,

, , , , , (hydatid cyst) .

.4

1. (Morphology) (Life cycle)

2.5-9.0 mm . 0.3 mm 4

2 30-36 . 3-4 ,

, . 30-38 m

.4

, ,

, , (oncosphere larva)

(hydatid cyst) (metacestodes)

. , , , , . ,

, (osseous cyst) . 1 mm, 5 10

mm . (mother cyst) 1-7 cm .

(germinal layer) . 1 (brood

capsule) .

. () ,

(unilocular vesicles) (granulomatous

host reaction) (; pericyst) . 1

(protoscolices) (daughter cysts) .

30-80

. (hydatid sand) (scolices) (daughter cysts) .21,22

2. (Pathophysiology) (Clinical manifestation)

5-20

. , , (cell-mediated response)

2012 Single Topic Symposium

50

. IgE, IgG2,

IgG4 IgE , ,

(anaphylactic shock) .23 TH1 TH2

TH1 cytokine interferon-, TH2 cytokine IL-4, IL-5 IL-6 .

.21

, .

, 20-40% .

, . ,

,

.

.

, , , ,

, (bronchobiliary fistula) 5-40%

90% .23

3. (Diagnosis)

.

.

(cysts) , , , (vitality)

. WHO . CL: potentially parasitic

cyst (very early stage of parasite development), CE1: unilocular, simple cyst with wall, CE2: multivesicular,

multiseptated cyst with daughter cyst, CE3a: detachment cyst membrane and/or partial degeneration of cyst content,

without daughter cysts, CE3b: partial degeneration of daughter cysts. CE4: heterogenous or hypere