liver fluke、[[]]、Opisthorchis

関: オピストルキス、オピストルキス属、肝蛭属、肝蛭、ネコ肝吸虫、肥大吸虫属、タイ肝吸虫、Opisthorchis属、肝吸虫属、肝蛭科

モロコ、コイなどから感染。肝臓内短観に寄生。短観拡張、肝硬変などの肝病変をきたす

同: clonorchiasis

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/31 00:52:59」(JST)

wiki en

Clonorchis sinensis, the Chinese liver fluke, is a human liver fluke in the class Trematoda, phylum Platyhelminthes. This parasite lives in the liver of humans, and is found mainly in the common bile duct and gall bladder, feeding on bile. These animals, which are believed to be the third most prevalent worm parasite in the world, are endemic to Japan, China, Taiwan, and Southeast Asia, currently infecting an estimated 30,000,000 humans.^[1] 85% of cases are found in China.

It is the most prevalent human trematode in Asia, and still actively transmitted in Korea, China, Vietnam and also Russia, with 200 million people at constant risk. Recent studies have proved that it is capable of causing cancer of liver and bile duct, and in fact the International Agency for Research on Cancer has classed it as a group 1 biological carcinogen in 2009.^[2]^[3]^[4]

Life cycle

An adult Clonorchis sinensis has these main body parts: oral sucker, pharynx, caecum, ventral sucker, vitellaria, uterus, ovary, Mehlis' gland, testes, excretory bladder.

Life cycle of Clonorchis sinensis

The eggs of a C. sinensis, which contain the miracidium that develops into the adult form, float in fresh water until eaten by a snail.

First intermediate host

Freshwater snail Parafossarulus manchouricus - synonym: Parafossarulus striatulus, often serves as a first intermediate host for C. sinensis in China, Japan, Korea and Russia.^[5]^[6]

Other snail hosts include:

Bithynia longicornis - synonym: Alocinma longicornis - in China^[6]
Bithynia fuchsiana - in China^[6]
Bithynia misella - in China^[6]
Parafossarulus anomalosiralis - in China^[6]
Melanoides tuberculata - in China^[6]
Semisulcospira libertina - in China^[6]
Assiminea lutea - in China^[6]
Tarebia granifera - in Taiwan, China^[6]

Once inside of the snail body, the miracidium hatches from the egg, and parasitically grows inside of the snail. The miracidium develops into a sporocyst, which in turn house the asexual reproduction of redia, the next stage. The redia themselves house the asexual reproduction of free-swimming cercaria. This system of asexual reproduction allows for an exponential multiplication of cercaria individuals from one miracidium. This aids the Clonorchis in reproduction, because it enables the miracidium to capitalize on one chance occasion of passively being eaten by a snail before the egg dies.

Once the redia mature, having grown inside the snail body until this point, they actively bore out of the snail body into the freshwater environment.

Second intermediate host

There, instead of waiting to be consumed by a host (as is the case in their egg stage), they seek out a fish. Boring their way into the fish's body, they again become parasites of their new hosts.

Once inside of the fish muscle, the cercaria create a protective metacercarial cyst with which to encapsulate their bodies. This protective cyst proves useful when the fish muscle is consumed by a human.

Definitive host

The acid-resistant cyst enables the metacercaria to avoid being digested by the human gastric acids, and allows the metacercaria to reach the small intestine unharmed. Reaching the small intestines, the metacercaria navigate toward the human liver, which becomes its final habitat. Clonorchis feed on human bile created by the liver. In the human liver, the mature Clonorchis reaches its stage of asexual reproduction which they produce eggs every 1–30 seconds.

Effects on human health

Dwelling in the bile ducts, Clonorchis induces an inflammatory reaction, epithelial hyperplasia and sometimes even cholangiocarcinoma, the incidence of which is raised in fluke-infested areas.^[7]

One adverse effect of Clonorchis is the possibility for the adult metacercaria to consume all bile created in the liver, which would inhibit the host human from digesting, especially fats. Another possibility is obstruction of the bile duct by the parasite or its eggs, leading to biliary obstruction and cholangitis (specifically oriental cholangitis).

Central Serous Retinopathy (CSR) a report of 80 cases by Dr. John Chiao-nan Chang, M.D. and Dr. Yin-Ping Wang, M.D. Hong Kong on page 125 of their report observed that 19% of the cases of CSR in their sample tested positive for Clonorchis sinensis.^[8]

Symptoms

While normally asymptomatic most pathological manifestations result from inflammation and intermittent obstruction of the biliary ducts. The acute phase consists of abdominal pain with associated nausea and diarrhea. Long standing infections consist of fatigue, abdominal discomfort, anorexia, weight loss, diarrhea, and jaundice. The pathology of long standing infections consist of bile stasis, obstruction, bacterial infections, inflammation, periductal fibrosis, and hyperplasia. Development of cholangiocarcinoma is progressive.^[9]

Diagnosis and treatment

Infection is detected mainly on identification of eggs by microscopic demonstration in faeces or in duodenal aspirate. But other sophisticated methods have been developed such as ELISA which has become the most important clinical technique. Diagnosis by detecting DNAs from eggs in faeces are also developed using PCR, real-time PCR, and LAMP, which are highly sensitive and specific. Imaging diagnosis has been studied in depth and is now widely used.^[2]^[10] Drugs used to treat infestation include triclabendazole, praziquantel, bithionol, albendazole, levamisole and mebendazole.However, benzimidazoles are very weak as vermicide. As with other trematodes, praziquantel is the drug of choice. Lately, tribendimidine has been acknowledged as an effective and safe drug.^[2]^[11]

References

^ Wu W, Qian X, Huang Y, Hong Q (2012). "A review of the control of Clonorchiasis sinensis and Taenia solium taeniasis/cysticercosis in China". Parasitology Research 111 (5): 1879–1884. doi:10.1007/s00436-012-3152-y. PMID 23052782.
^ ^a ^b ^c Hong ST, Fang Y (2012). "Clonorchis sinensis and clonorchiasis, an update". Parasitology International 61 (1): 17–24. doi:10.1016/j.parint.2011.06.007. PMID 21704726.
^ Sripa B, Brindley PJ, Mulvenna J, Laha T, Smout MJ, Mairiang E, Bethony JM, Loukas A (2012). "The tumorigenic liver fluke Opisthorchis viverrini--multiple pathways to cancer". Trends in Parasitology 28 (10): 395–407. doi:10.1016/j.pt.2012.07.006. PMC 3682777. PMID 22947297.
^ American Cancer Society (2013). "Known and Probable Human Carcinogens". cancer.org. American Cancer Society, Inc. Retrieved 2013-06-02.
^ Clonorchis sinensis. Web Atlas of Medical Pathology, accessed 1 April 2009
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ World Health Organization (1995). Control of Foodborne Trematode Infection. WHO Technical Report Series. 849. PDF part 1, PDF part 2. page 125-126.
^ Kumar et al.: Robbins & Cotran Pathologic Basis of Disease 7E
^ Report Text
^ Dr. Kuo, O. Sinensis Lecture, ATSU School of Osteopathic Medicine Arizona, June 2012
^ Huang SY, Zhao GH, Fu BQ, Xu MJ, Wang CR, Wu SM, Zou FC, Zhu XQ (2012). "Genomics and molecular genetics of Clonorchis sinensis: current status and perspectives". Parasitology International 61 (1): 71–76. doi:10.1016/j.parint.2011.06.008. PMID 21741496.
^ Xu LL, Xue J, Zhang YN, Qiang HQ, Xiao SH (2011). "In vitro effect of seven anthelmintic agents against adult Clonorchis sinensis". Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 29 (1): 10–15. PMID 21823316.

External links

Wikimedia Commons has media related to Clonorchis sinensis.

WHO
Animal Diversity Web
Centers for Disease Control and Prevention
Encyclopedia of Life
Discovery of Clonorchis Sinensis
Centre for Food Safety
Video of Clonorchis sinensis infestation in the Images in Clinical Medicine section of the New England Journal of Medicine, April 17, 2008 [1]

UpToDate Contents

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1. 肝吸虫：肝吸虫症およびオピストルキス症 liver flukes clonorchiasis and opisthorchiasis
2. 胆道寄生虫症の内視鏡診断およびマネージメント endoscopic diagnosis and management of biliary parasitosis
3. 再発性化膿性胆管炎 recurrent pyogenic cholangitis
4. 東南アジアへの旅行によって感染する可能性のある疾患 diseases potentially acquired by travel to southeast asia
5. 胆管癌の疫学、病因、および分類 epidemiology pathogenesis and classification of cholangiocarcinoma

English Journal

Proteomic analysis of different period excretory secretory products from Clonorchis sinensis adult worms: molecular characterization, immunolocalization, and serological reactivity of two excretory secretory antigens-methionine aminopeptidase 2 and acid phosphatase.

Zheng M, Hu K, Liu W, Li H, Chen J, Yu X.SourceDepartment of Clinical Laboratory, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510120, People's Republic of China.
Parasitology research.Parasitol Res.2013 Mar;112(3):1287-97. doi: 10.1007/s00436-012-3264-4. Epub 2012 Dec 30.
The excretory secretory products (ESP) of Clonorchis sinensis are the causative agents of clonorchiasis and biliary diseases. The parasites' ESP play important roles in host-parasite interactions. The protein compositions of ESP at different secretory times are different and have not been systemical
PMID 23274491

Identification and biochemical characterization of adenylate kinase 1 from Clonorchis sinensis.

Liang P, Zhang F, Chen W, Hu X, Huang Y, Li S, Ren M, He L, Li R, Li X, Xu J, Wu Z, Lu G, Yu X.SourceDepartment of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.
Parasitology research.Parasitol Res.2013 Feb 28. [Epub ahead of print]
Adenylate kinase 1 is responsible for the conversion of AMP into ADP involved in purine metabolism. In the present study, adenylate kinase 1 gene (CsADK1) was isolated from an adult cDNA library of Clonorchis sinensis, and the recombinant protein was expressed in Escherichia coli. Bioinformatics ana
PMID 23455935

Molecular identification, immunolocalization, and characterization of Clonorchis sinensis calmodulin.

Zhou J, Sun J, Huang Y, Zhou C, Liang P, Zheng M, Liang C, Xu J, Li X, Yu X.SourceDepartment of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, No 74, The Second Zhongshan RD, Guangzhou, Guangdong, 510080, China.
Parasitology research.Parasitol Res.2013 Feb 17. [Epub ahead of print]
One cDNA clone (Cs18h09) encoding Clonorchis sinensis calmodulin (CsCaM) was isolated from our adult cDNA plasmid library. The open reading frame of CsCaM contains 450 bp which encodes 149 amino acids. CsCaM protein comprises four calcium-binding EF-hand motifs. The amino acid sequence of CsCaM sha
PMID 23417096

Japanese Journal

社会・経済損失をもたらす肝吸虫Clonorchis sinensis の感染とその一次・二次予防の対策に関する基盤研究

牧純
松山大学論集 24(4-3), 309-339, 2012-10-01
NAID 110009632053

社会・経済損失をもたらす肝吸虫Clonorchis sinensisの感染とその一次・二次予防の対策に関する基盤研究 (岩林彪教授記念号)

牧純,関谷洋志,田邊知孝 [他]
松山大学論集 24(4-3), 251-273, 2012-10
NAID 40019571431

Effect of artemether, artesunate, OZ78, praziquantel, and tribendimidine alone or in combination chemotherapy on the tegument of Clonorchis sinensis

KEISER Jennifer,VARGAS Mireille
Parasitology international : official journal of the Japanese Society of Parasitology 59(3), 472-476, 2010-09-01
NAID 10029825749

The complete mitochondrial genomes of the liver flukes Opisthorchis felineus and Clonorchis sinensis (Trematoda)

SHEKHOVTSOV Sergei V.,KATOKHIN Alexei V.,KOLCHANOV Nikolai A.,MORDVINOV Viatcheslav A.
Parasitology international : official journal of the Japanese Society of Parasitology 59(1), 100-103, 2010-03-01
NAID 10029823470

Related Pictures

★リンクテーブル★

リンク元	「蠕虫」「寄生虫症」「Opisthorchis」「liver fluke」「Opisthorchis viverrini」

「蠕虫」

Clonorchis sinensis
	Clonorchis sinensis under a light microscope. Notice the ovaries. This species is monoecious
Scientific classification
Kingdom:	Animalia
Phylum:	Platyhelminthes
Class:	Trematoda
Order:	Opisthorchiida
Family:	Opisthorchiidae
Genus:	Clonorchis
Species:	C. sinensis
Binomial name
	Clonorchis sinensis; Looss, 1907

　　[★]

英: helminth, worms
ラ: helminthen
関: 微生物学、蠕虫症、家畜伝染病予防法

蠕虫類

吸虫類 trematoda
条虫類 cestoda
線虫類 nematoda
鉤頭虫類 acanthocephala

蠕虫類と感染症

蠕虫類	病原体名		病名	感染経路	寄生部位	症状	診断	治療
線虫類	Ancylostoma duodenale	ズビニ鉤虫	鈎虫症/十二指腸虫症	F型幼虫経口感染、経皮	空腸上部	皮膚炎、若菜病、貧血	飽和食塩水浮遊法、遠心沈降法	pyrantel pamoate、鉄剤
	Necator americanus	アメリカ鉤虫	鈎虫症/十二指腸虫症	F型幼虫経口感染、経皮	空腸上部	皮膚炎、若菜病、貧血	飽和食塩水浮遊法、遠心沈降法	pyrantel pamoate、鉄剤
	Strongyloides stercoralis	糞線虫	糞線虫症	F型幼虫経皮感染	小腸上部	Loffler症候群	糞便塗沫、普通寒天平板培養による R型、F型幼虫の検出	thiabendazole, ivermectin
	Enterobius vermicularis	蟯虫	蟯虫症	虫卵経口感染	盲腸～大腸	夜間の掻痒、不眠、情緒不安定	肛囲検査法「柿の種」	pyrantel pamoate
	Ascaris lumbricoides	回虫	回虫症	虫卵経口感染	小腸孵化→門脈→ 肺発育→食道嚥下→小腸	Loffler症候群。急性腹痛	糞便虫の虫卵の証明	pyrantel pamoate
	Toxocara canis	イヌ回虫	幼虫移行症	生後1-2ヶ月の感染犬の糞から経口感染	なし	幼虫移行症→失明	免疫診断	治療法無し？
	Wuchereria bancrofti	バンクロフト糸状虫	フィラリア症/糸状虫症	アカイエカ	リンパ系	急性期：リンパ肝炎、リンパ腺炎を伴う熱発作(filarial fever) 慢性期：乳糜尿、リンパ管瘤、陰嚢水腫、象皮病	急性期：夜間のmicrofilariaの検出慢性期：特有の症状を考慮	diethylcarbamazine & ivermectin
	Brugia malayi	マレー糸状虫	フィラリア症/糸状虫症	アカイエカ	リンパ系		急性期：夜間のmicrofilariaの検出慢性期：特有の症状を考慮	diethylcarbamazine & ivermectin
	Dirofilaria immitis	イヌ糸状虫		アカイエカ	なし	幼虫移行症→肺血管閉塞→胸部X線画像銭形陰影
	Gnathostoma spinigerum	有棘顎口虫	顎口虫症	ドジョウ、雷魚、ヘビの生食		消化管壁貫通→皮下移動による腫瘤や線状皮膚炎	移動性腫瘤、皮膚爬行疹雷魚やドジョウの生殖の問診免疫血清診断	なし
	Gnathostoma hispidum	剛棘顎口虫
	Gnathostoma doloresi	ドロレス顎口虫
	Gnathostoma nipponicum	日本顎口虫
	Anisakis simplex, larva	アニキサス幼虫	アニサキス症 (1)胃アニサキス症、 (2)腸アニサキス症、 (3)異所性アニサキス症	経口感染終宿主：クジラ、イルカ。中間宿主：オキアミ。待機宿主：サバ、ニシン、アジ、タラなど	胃や腸	(1)急激な上腹部痛"胃けいれん" (2)腹痛、急性虫垂炎、イレウス様。劇症型と緩和型がある (3)腹腔内の炎症性肉芽腫	胃内視鏡検査	内視鏡による虫体摘出
	Pseudoterranova decipiens	アニキサス幼虫	アニサキス症 (1)胃アニサキス症、 (2)腸アニサキス症、 (3)異所性アニサキス症	経口感染終宿主：クジラ、イルカ。中間宿主：オキアミ。待機宿主：サバ、ニシン、アジ、タラなど	胃や腸		胃内視鏡検査	内視鏡による虫体摘出
	Trichinella spiralis	旋毛虫	旋毛虫症	経口感染豚肉、クマ肉の生食		(1)成虫侵襲期：下痢、腹痛 (2)幼虫筋肉移行期：顔面浮腫、心筋障害など (3)幼虫被嚢期：全身浮腫、衰弱		急性期：ステロイド殺虫：mebendazole
			鞭虫症		盲腸	慢性下痢、腹痛、異食症、貧血	セロファン重層塗沫法、ホルマリンエーテル法	mebendazole
	Spirurin nematode larva	旋尾線虫	旋尾線虫幼虫	ホタルイカの生食	なし	皮膚爬行疹、イレウス様症状	予防：-30℃24時間。生食には-30℃4日間以上	摘出
吸虫類	Shistosoma japonicum	日本住血吸虫	日本住血吸虫症	糞便虫の虫卵→ミラシジウム→ ミヤイリガイ体内でセルカリア→ 人畜の皮膚より浸入→循環系→ 門脈に寄生	門脈	(1)潜伏期：侵入部の掻痒性皮膚炎。肺移行期：咳、発熱 (2)急性期：虫卵の門脈系寄生、産卵。住血吸虫性赤痢。 (3)慢性期：虫卵の肝、脳などの塞栓。肝硬変。脾腫、腹水	糞便虫の虫卵の検出。直腸粘膜層掻爬法、肝穿刺による組織内虫卵の検出。補助診断として免疫血清学的検査。	praziquantel
	Paragonimus westermani	ウェステルマン肺吸虫	肺吸虫症/肺ジストマ症	経口感染淡水産のカニ、イノシシ肉の生食	肺	痰、咳、胸痛、時に喀血	痰や便の虫卵検査、胸部写真、断層写真で明らかな虫嚢。免疫学血清検査
	Paragonimus miyazakii	宮崎肺吸虫	肺吸虫症/肺ジストマ症	経口感染淡水産のカニ、イノシシ肉の生食	肺	気胸、胸水貯留、膿胸、好酸球増加		praziquantel
	Clonorchis sinensis	肝吸虫	肝吸虫症/肝ジストマ症	経口感染虫卵→(マメタニシ:セルカリア)→ セルカリア→(魚:メタセルカリア)→ 摂取→(ヒト:成虫)→虫卵	胆管	胆汁流出障害による肝障害→肝硬変	糞便、胆汁(十二指腸ゾンデ法)。肝吸虫卵の検出。CT像。エコー検査。	praziquantel
			横川吸虫症	淡水魚(アユ、フナ、ウグイ、シラウオ)の生食	小腸粘膜	下痢、腹痛	糞便虫の虫卵	praziquantel
条虫類	Taeniarhynchus saginatus	無鉤条虫	腸管条虫症	経口感染。中間宿主：ウシ	小腸	無症状。下痢。広節裂頭条虫感染では悪性貧血。	糞便虫の虫卵と体節により診断	praziquantel。有鉤条虫の場合はガストログラフィン。有鉤条虫の駆虫の際、虫体を破壊しない →虫体の融解による嚢虫症
	Taenia solium	有鉤条虫		経口感染。中間宿主：ブタ
	Diphyllobothrium latum	広節裂頭条虫		経口感染。中間宿主：サケ、マス
		日本海裂頭条虫		経口感染。中間宿主：サケ
			腸管外条虫症
			有鉤嚢虫症	有鉤条虫の虫卵の経口摂取	皮下、筋肉内脳、脊髄、眼球	皮下、筋肉内：小指頭大の無症状腫瘤脳、脊髄、眼球：Jacksonてんかん。痙性麻痺など	皮下の虫嚢	外科的摘出。成虫寄生がなければ、praziquantel, albendazole + ステロイド
	Echinococcus granulosus	単包虫	包虫症/ エキノコックス症 (単包虫症)	終宿主：イヌ、キツネなど。中間宿主：ヒト、ブタ、野ネズミなど。終宿主の糞便虫の虫卵を中間宿主が接種して発症	肝、肺、まれに脳、腎、筋肉	肝寄生：肝部疼痛、満腹、時に黄疸、下肢浮腫肺寄生：胸部圧迫感、胸痛、咳、血痰、時に喀血	肝や肺の嚢胞形成から疑う。早期に診断に皮内反応→ CT、エコー→ 生検。免疫血清学的診断法	外科的切除。 albendazoleの長期投与
	Echinococcus multilocularis	多包虫	包虫症/ エキノコックス症 (多包虫症)	終宿主：イヌ、キツネなど。中間宿主：ヒト、ブタ、野ネズミなど。終宿主の糞便虫の虫卵を中間宿主が接種して発症	肝、肺、まれに脳、腎、筋肉	肝寄生：肝部疼痛、満腹、時に黄疸、下肢浮腫肺寄生：胸部圧迫感、胸痛、咳、血痰、時に喀血	肝や肺の嚢胞形成から疑う。早期に診断に皮内反応→ CT、エコー→ 生検。免疫血清学的診断法	外科的切除。 albendazoleの長期投与

「寄生虫症」

　　[★]

英: parasitosis, parasitic disease
関: 寄生虫感染症、寄生虫疾患、寄生虫

肝障害をきたす寄生虫症

「Opisthorchis」

　　[★]

肝吸虫、オピストルキス、肝吸虫属、オピストルキス属、Opisthorchis属

関: Clonorchis sinensis、liver fluke、Opisthorchis felineus、Opisthorchis viverrini

「liver fluke」

　　[★]

肝吸虫

関: Clonorchis sinensis、Fasciola、Fasciola hepatica、Fasciolidae、Fasciolopsis、Opisthorchis

「Opisthorchis viverrini」

　　[★] タイ肝吸虫

((学名))イ肝吸虫

関: Clonorchis sinensis、Opisthorchis、Opisthorchis felineus

[1] Wu W, Qian X, Huang Y, Hong Q (2012). "A review of the control of Clonorchiasis sinensis and Taenia solium taeniasis/cysticercosis in China". Parasitology Research 111 (5): 1879–1884. doi:10.1007/s00436-012-3152-y. PMID 23052782.

[hong-2] Hong ST, Fang Y (2012). "Clonorchis sinensis and clonorchiasis, an update". Parasitology International 61 (1): 17–24. doi:10.1016/j.parint.2011.06.007. PMID 21704726.

[3] Sripa B, Brindley PJ, Mulvenna J, Laha T, Smout MJ, Mairiang E, Bethony JM, Loukas A (2012). "The tumorigenic liver fluke Opisthorchis viverrini--multiple pathways to cancer". Trends in Parasitology 28 (10): 395–407. doi:10.1016/j.pt.2012.07.006. PMC 3682777. PMID 22947297.

[4] American Cancer Society (2013). "Known and Probable Human Carcinogens". cancer.org. American Cancer Society, Inc. Retrieved 2013-06-02.

[5] Clonorchis sinensis. Web Atlas of Medical Pathology, accessed 1 April 2009

[WHO_1995-6] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ World Health Organization (1995). Control of Foodborne Trematode Infection. WHO Technical Report Series. 849. PDF part 1, PDF part 2. page 125-126.

[7] Kumar et al.: Robbins & Cotran Pathologic Basis of Disease 7E

[8] Report Text

[9] Dr. Kuo, O. Sinensis Lecture, ATSU School of Osteopathic Medicine Arizona, June 2012

[10] Huang SY, Zhao GH, Fu BQ, Xu MJ, Wang CR, Wu SM, Zou FC, Zhu XQ (2012). "Genomics and molecular genetics of Clonorchis sinensis: current status and perspectives". Parasitology International 61 (1): 71–76. doi:10.1016/j.parint.2011.06.008. PMID 21741496.

[11] Xu LL, Xue J, Zhang YN, Qiang HQ, Xiao SH (2011). "In vitro effect of seven anthelmintic agents against adult Clonorchis sinensis". Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 29 (1): 10–15. PMID 21823316.

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Clonorchis sinensis