Long-Lived Liver Flukes: Subtle Findings, Serious Consequences

Biliary liver fluke infections, common in parts of Asia, are unfamiliar to most U.S. clinicians. Chronic infections, especially those caused by Opisthorchis viverrini, predispose individuals to cholangiocarcinoma, a malignancy that is nearly always fatal. Humans become infected by eating raw, pickled, salted, or dried fish containing the parasites. Intermittent right upper quadrant abdominal discomfort is commonly an initial symptom, followed by low-grade fever, diarrhea, and flatulence. Now, investigators have retrospectively reviewed all cases of liver fluke infection from 1993 through 1998 at a Minnesota clinic serving refugees and immigrants.

Among 1291 stool specimens found positive for potentially pathogenic organisms, 17 (1.3%) contai…