Parasitologia · Published 2026-07-09 · DOI 10.3390/parasitologia6040040
Jamal Tarrabain, Keshini Abeyewardene, Gregory D. Hawley, Andrea K. Boggild
Clonorchiasis is a parasitic infection caused by the trematode <i>Clonorchis sinensis</i>, which is endemic to East Asia but increasingly observed in non-endemic regions due to global migration. Chronic infection can lead to recurrent pyogenic cholangitis (RPC) and other hepatobiliary complications including cholangiocarcinoma. We herein review clonorchiasis and opisthorchiasis as potential contributory drivers of RPC in migrants from Southeast Asia through framing with a case of a Filipino woman residing in Canada who presented with a two-year history of intermittent right upper quadrant pain, liver enzyme derangement, and imaging features consistent with RPC. Despite negative stool ova and parasite (O&P) testing, empirical treatment with praziquantel (1800 mg three times daily for two days) led to clinical and biochemical improvement. Hepatobiliary trematodiasis, including clonorchiasis and opisthorchiasis, can be challenging to diagnose, and clonorchiasis and opisthorchiasis cannot be distinguished on clinical or radiographic grounds alone. Clonorchiasis can be challenging to diagnose in non-endemic areas due to low parasitologic test sensitivity and non-specific clinical features. Imaging findings and epidemiologic context are critical for raising clinical suspicion and guiding management. Healthcare providers in non-endemic regions should include clonorchiasis and opisthorchiasis in the differential diagnosis of unexplained cholestasis, particularly in migrants from areas endemic for clonorchiasis and opisthorchiasis. Negative stool tests do not exclude infection, and early empirical treatment may prevent irreversible hepatobiliary damage and reduce long-term malignancy risk.
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Tarrabain, J., Abeyewardene, K., Hawley, G., et al. (2026). Recurrent Pyogenic Cholangitis with Probable Intercurrent Latent Clonorchiasis in a Filipino Migrant to Canada: A Review of Implications for Diagnosis and Management. Parasitologia. https://doi.org/10.3390/parasitologia6040040