Background Stool examination by counting eggs per gram of feces (EPGs) is the best method to estimate worm burden of Clonorchis sinensis in infected humans. The present study investigated a correlation between EPGs and worm burden in human clonorchiasis. Methods and Findings A total of 60 residents, 50 egg-positive and 10 egg-negative, in Sancheong-gun, Korea, participated in this worm collection trial in 2006–2009. They were diagnosed by egg positivity in feces using the Kato-Katz method. After administration of praziquantel, they were purged with cathartics on the next day, and then discharged adult worms were collected from their feces. Their EPGs ranged from 0 to 65,544. Adult worms of C. sinensis were collected from 17 egg-positive cases, and the number of worms ranged from 1 to 114 in each individual. A positive correlation between EPGs and numbers of worms was demonstrated (r = 0.681, P<0.001). Worm recovery rates were 9.7% in cases of EPGs 1–1,000 and 73.7% in those of EPGs over 1,000. No worms were detected from egg-negative subjects. Maximum egg count per worm per day was roughly estimated 3,770 in a subject with EPGs 2,664 and 106 collected worms. Conclusions The numbers of the worms are significantly correlated with the egg counts in human clonorchiasis. It is estimated that at least 110 worms are infected in a human body with EPGs around 3,000, and egg productivity of a worm per day is around 4,000.
References
[1]
Rim HJ (2005) Clonorchiasis: an update. J Helminthol 79: 269–281. doi: 10.1079/JOH2005300
[2]
Choi MH, Park SK, Li Z, Ji Z, Yu G, et al. (2010) Effect of control strategies on prevalence and re-infection of clonorchiasis in endemic areas of China. PLoS Negl Trop Dis 4: e601. doi: 10.1371/journal.pntd.0000601
[3]
Kim DW, Kim JY, Moon JH, Kim KB, Kim TS, et al. (2010) Transcriptional induction of minichromosome maintenance protein 7 (Mcm7) in human cholangiocarcinoma cells treated with Clonorchis sinensis excretory-secretory products. Mol Biochem Parasitol 173: 10–16. doi: 10.1016/j.molbiopara.2010.03.005
[4]
Cho SH, Lee KY, Lee BC, Cho PY, Cheun HI, et al. (2008) Prevalence of clonorchiasis in southern endemic areas of Korea in 2006. Korean J Parasitol 46: 133–137. doi: 10.3347/kjp.2008.46.3.133
[5]
Choi D, Jeon YH, Lee GC, Choi MH, Hong ST (2009) Changes in sonographic findings after treatment of patients with clonorchiasis in a heavy endemic area. Korean J Parasitol 47: 19–23. doi: 10.3347/kjp.2009.47.1.19
[6]
Hong ST, Choi MH, Kim CH, Chung BS, Ji Z (2003) The Kato-Katz method is reliable for diagnosis of Clonorchis sinensis infection. Diagn Microbiol Infect Dis 47: 345–347. doi: 10.1016/S0732-8893(03)00113-5
[7]
Lee MK, Hong SJ, Kim HR (2010) Seroprevalence of tissue invading parasitic infections diagnosed by ELISA in Korea. J Korean Med Sci 25: 1272–1276. doi: 10.3346/jkms.2010.25.9.1272
[8]
Elkins DB, Sithithaworn P, Haswell-Elkins M, Kaewkes S, Awacharagan P, et al. (1991) Opisthorchis viverrini: relationships between egg counts, worms recovered and antibody levels within an endemic community in Northeast Thailand. Parasitology 102: 283–288. doi: 10.1017/S0031182000062600
[9]
Rim HJ (1986) The current pathobiology and chemotherapy of clonorchiasis. 24. Korean J Parasitol. pp. 1–114.
[10]
Shen C, Kim J, Lee JK, Bae YM, Choi MH, et al. (2007) Collection of Clonorchis sinensis adult worms from infected humans after praziquantel treatment. Korean J Parasitol 45: 149–152. doi: 10.3347/kjp.2007.45.2.149
[11]
Katz N, Chaves A, Pellegrino J (1972) A simple device for quantitative stool thick-smear technique in Schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14: 397–400.
[12]
Keiser J, Duthaler U, Utzinger J (2010) Update on the diagnosis and treatment of food-borne trematode infections. Curr Opin Infect Dis 23: 513–520. doi: 10.1097/QCO.0b013e32833de06a
[13]
van den Enden E (2009) Pharmacotherapy of helminth infection. Expert Opin Pharmacother 10: 435–451. doi: 10.1517/14656560902722463
[14]
Cioli D, Pica-Mattoccia L (2003) Praziquantel. 90. Parasitol Res. pp. 3–9.
[15]
Shen C, Choi MH, Bae YM, Yu G, Wang S, et al. (2007) A case of anaphylactic reaction to praziquantel treatment. Am J Trop Med Hyg 76: 603–605.
[16]
Greenberg RM (2005) Ca2+ signalling, voltage-gated Ca2+ channels and praziquantel in flatworm neuromusculature. 131. Parasitology. pp. 97–108.
[17]
Choi MH, Chang BC, Lee SJ, Jang IJ, Shin SG, et al. (2006) Therapeutic evaluation of sustained-releasing praziquantel (SRP) for clonorchiasis: phase 1 and 2 clinical studies. Korean J Parasitol 44: 361–366. doi: 10.3347/kjp.2006.44.4.361
[18]
Chai JY, Park JH, Han ET, Guk SM, Shin EH, et al. (2005) Mixed infections with Opisthorchis viverrini and intestinal flukes in residents of Vientiane municipality and Saravane Province in Laos. J Helminthol 79: 283–289. doi: 10.1079/JOH2005302
[19]
Rim HJ, Park HY, Kim SJ, Lee SH (1980) Morphological observations on Clonorchis sinensis obtained from rats treated with praziquantel. Korean J Parasitol 21: 192–198. doi: 10.3347/kjp.1980.18.2.192
[20]
Mehlhorn H, Kojima S, Rim HJ, Ruenwongsa P, Andrews P, et al. (1983) Ultrastructural investigations on the effects of praziquantel on human trematodes from Asia: Clonorchis sinensis, Metagonimus yokogawai, Opisthorchis viverrini, Paragonimus westermani and Schistosoma japonicum. Arzneimittelforschung 33: 91–98.
[21]
Cho SY, Song KY, Rah BJ (1983) Lipofuscin pigment in adult Clonorchis sinensis. Korean J Parasitol 21: 32–39. doi: 10.3347/kjp.1983.21.1.32
[22]
Sithithaworn P, Tesana S, Pipitgool V, Kaewkes S, Pairojkul C, et al. (1991) Relationship between faecal egg count and worm burden of Opisthorchis viverrini in human autopsy cases. Parasitology 102: 277–281. doi: 10.1017/S0031182000062594
[23]
Komiya Y, Suzuki N (1964) Progress of medical parasitology in japan. Tokyo: Meguro Parasitological Museum. 1: 553–600.
[24]
Seo BS, Lee SH, Chai JY, Hong ST (1983) Praziquantel (Distocide?) in treatment of Clonorchis sinensis infection. Korean J Parasitol 21: 241–245. doi: 10.3347/kjp.1983.21.2.241