Clonorchiasis in bone marrow transplant recipients

Area of Science:

• Hepatology
• Infectious Diseases
• Transplantation Medicine

Background:

• Clonorchiasis, a parasitic liver fluke infection caused by Clonorchis sinensis, can pose risks in immunocompromised patients.
• Bone marrow transplantation (BMT) involves significant immunosuppression, increasing susceptibility to opportunistic infections.

Purpose of the Study:

• To investigate the prevalence of Clonorchis sinensis infection in bone marrow transplant recipients.
• To evaluate the safety and efficacy of treating clonorchiasis prior to BMT.
• To determine if clonorchiasis contraindicates BMT.

Main Methods:

• Retrospective analysis of 380 bone marrow transplant recipients between 1991 and 1996.
• Stool examinations for Clonorchis sinensis ova and Salmonella species.
• Ultrasonography for hepatobiliary abnormalities.
• Treatment with praziquantel for positive cases.
• Monitoring for post-transplant complications and survival rates.

Main Results:

• Five cases (1.3%) of clonorchiasis were identified during pre-BMT screening.
• No patients exhibited symptoms of clonorchiasis; ultrasonography revealed no significant hepatobiliary pathology.
• All five patients received praziquantel successfully, with negative stool examinations post-treatment.
• Two patients developed mild veno-occlusive disease (VOD) of the liver, while two others had transient hyperbilirubinemia related to conditioning toxicity.
• All patients survived beyond 300 days post-transplantation.

Conclusions:

• Clonorchis sinensis infection is treatable with praziquantel prior to bone marrow transplantation.
• Clonorchiasis, when effectively treated, does not appear to be a contraindication for BMT.
• Pre-transplant screening for parasitic infections is crucial in endemic areas for BMT candidates.