Infection Characteristics of Clonorchis sinensis Metacercariae in Fish from Republic of Korea

Clonorchiasis and opisthorchiasis: epidemiology, transmission, clinical features, morbidity, diagnosis, treatment, and control

Clonorchis sinensis, Opisthorchis viverrini, and Opisthorchis felineus are important liver flukes that cause a considerable public health burden in eastern Asia, southeastern Asia, and eastern Europe, respectively. The life cycles are complex, involving humans, animal reservoirs, and two kinds of intermediate hosts. An interplay of biological, cultural, ecological, economic, and social factors drives transmission. Chronic infections are associated with liver and biliary complications, most importantly cholangiocarcinoma. With regard to diagnosis, stool microscopy is widely used in epidemiologic surveys and for individual diagnosis. Immunologic techniques are employed for screening purposes, and molecular techniques facilitate species differentiation in reference laboratories. The mainstay of control is preventive chemotherapy with praziquantel, usually combined with behavioral change through information, education and communication, and environmental control. Tribendimidine, a drug registered in the People's Republic of China for soil-transmitted helminth infections, shows potential against both C. sinensis and O. viverrini and, hence, warrants further clinical development. Novel control approaches include fish vaccine and biological control. Considerable advances have been made using multi-omics which may trigger the development of new interventions. Pressing research needs include mapping the current distribution, disentangling the transmission, accurately estimating the disease burden, and developing new diagnostic and treatment tools, which would aid to optimize control and elimination measures.

Infection characteristics of Metagonimus species (Digenea: Heterophyidae) metacercariae in fish from major rivers of Korea

This article analyzed the infection characteristics of metacercariae of Metagonimus spp. (MsMc) in fish from 9 major water systems in Korea. A total of 19,568 fish in 87 species were examined over a period of 10 years (2011-2020). MsMc were detected in fish from all 44 survey areas in 9 water systems. Most of the surveyed sites showed very low and low infection levels (66.7%), while 33.3% of the areas, such as Tamjin-gang and Seomjin-gang, revealed moderate and high infection levels. High endemicity depends on the abundance of susceptible fish species, especially sweet smelt (Plecoglosus altivelis). The susceptibility index (SI) with MsMc in index fish, Zacco spp., was very low and low levels in 62.0%, moderate in 28.0%, and high in 10.0% regions. The SI was highest in the following order: Yeongam-cheon (283.8), Hoeng-cheon (192.3), Togyo-jeosuji (131.2), Deokcheon-gang (119.1), and Joyang-gang (106.3). The recent infection status of MsMc in P. altivelis was analyzed by the survey localities. In addition, except for P. altivelis, 9 fish species were highly infected with MsMc in some survey areas, including Zacco platypus, Z. koreanus, Z. temminckii, Opsariichthys uncirostris, Rhynchocypris oxycephalus, Carassius auratus, Acheilognathus rhombeus, Onchorhynchus masou, and Tribolodon hakonensis. In Korea, 74 fish species (15 families) are collectively listed as second intermediate hosts of Metagonimus spp. This review provides several novel characteristics of MsMc infection and clarifies the fish species of second intermediate host of Metagonimus spp. in this country.

Current status of Clonorchis sinensis and clonorchiasis in Korea: epidemiological perspectives integrating the data from human and intermediate hosts

Clonorchis sinensis is a carcinogenic liver fluke that causes clonorchiasis in humans. Clonorchiasis is prevalent in East Asian countries, and approximately 15–20 million individuals are estimated to be infected with this fluke globally. This review highlights the current status of C. sinensis and clonorchiasis in Korea from the epidemiological perspective involving the analysis of humans and intermediate hosts. Despite the recent decline in C. sinensis infection rate in Korea, C. sinensis infections remain endemic in 5 major river basins (Han-gang, Geum-gang, Seomjin-gang, Yeongsan-gang and Nakdong-gang; gang means river) with a high incidence of cholangiocarcinoma. A noticeable pattern involves increasing mild infections among patients diagnosed positive for C. sinensis eggs. The infection rate of C. sinensis metacercariae in the second intermediate host, freshwater fish, is also maintained at a substantial level. Thus, the One Health approach integrating different sectors and disciplines is recommended to accelerate and sustain control of C. sinensis, thereby leading to successful eradication. Health promotion via information dissemination and health education should be extended to prevent the consumption of raw freshwater fish by residents living in high-risk areas.