Epidemiological Studios on Clonorchis sinensis Infection along the Nam-river in Gyeongnam Province, Korea

남강유역 간흡충감염의 역학적 조사연구

An epidemiological study on Clonorchis sinensis infection along the Nam-river (total length ; 186km) flowing in Gyeongsang-nam-do, southern part of Korea, was carried out. Formalin-ether concentration technique and Stoll's egg counting method were employed to figure out the prevalence of C. sinensis infection. For the detection of cercariae from Parafossarulus sp., the snail host of C. sinensis, each snail was placed in aerated tap water, and examined for expelled cercariae. For observing the metacercariae the fresh water fish favorably eaten in raw conditions wore prepared by means of pressing the muscles between two slide glasses and/or by digesting them with artificial gastric juice. The fresh water fish were fed to the rabbits to get the worms and to identify the morphology of adult C. sinensis. The results are summarized as follows: 1. Overall Prevalence of C. sinensis infection was 38.75 from 5,291 examinees; 44.15 (1,408 out of 3,196) in male and 30.4% (637 out of 2,095) in female. 2. The prevalence rates were 42.0% at the upper stream, 41.2% around the vicinity of Jinyanglake, 34.2% at Jinju city, 34.2% at middle stream and 40.3% at down stream regions, respectively. 3. By age, the highest positive rate (53.4∼54.3%) was observed in 30 to 59 years of age. In this age group, the rate in males was 59.7∼62.2%, and in females 42.2∼44.4%, In the age group of less than 19 years it was 7.5∼20.9%. 4. By social strata, the positive rate was 16.5% in the primary school children, 22.6% in school students, 46.2% in teachers and local officers and 49.6% in the general inhabitants. 5. The quantitative examinations with the stool collected from clonorchiasis cases revealed that the light infection (less than 4,000/EPG) was 53.6%, moderate infection (4,001∼10,000 /EPG) 30.3% and heavy infection (more than 10,001/EPG) 16.1%, respectively. More than half of total cases examined were light infection, and 73.2% of female examinees were lightly infected with this cuke. 6. The average value of EPG was 4,963 (male, 6,057; female, 2,557 and the highest value was obtained from the age group of 30 to 59 years (5,240∼6,454). 7. The prevalence of Metagonimus yokogawai infection in humans was 5.5%, and 89.8% of metagonimiasis cases wore double-infected arith C. sinensis. The highest prevalence rate was observed in Jinju city (11.2%). 8. Total of 5,005 Parafossarulus sp., the snail intermediate host of C. sinensis, were examined for the detection of cercariae. The cercarial expulsion rate was 0.34%, and the snails collected in Jin-yang-lake side and in the down stream expelled mainly the cercariae of C, sinensis. 9. About 788 cercariaejday (range: 127∼1,503) were expelled daily from a snail naturally infected with C. sinensis. The snails which released more than 1,000 cercariae/day were 30.8% out of total collected. A snail uniquely released 5,840 cercariae/day in this study. 10. The other trematode cercariae besides C. sinensis were also detected, and the rates out of total snails were the cercariae of Losogenes liberum 6.71%, Cyathocotyle orientalis 0.26%, Notocotylus attenuatus 2.52% and Mucobucaris 0.54%, 11. Ten out of 18 species of fresh water fish caught along the river harbored the metacercariae of C, sinensis. The highest rate of metacercarial infection in fish was detected in Pseudorasbora larva (85.9%). The fish mainly eaten by the inhabitants along the Nam-river, and the metacercarial infection rates were: Zacco platypus 8.0%, Hemibarbus sp. 18.2∼26.7%, Gnathepcgcn sp. 37.5%, Ischikauia steenackeri 42.9% and Pseudogobio esocinus 16.7%. 12. Out of 36 P. larva, the number of metacercariae were about 109 (ranEe; 18∼446) per fish and 27 per gram of flesh. The fish caught in spring harbored the highest number of metacercariae. As indicated above, the prevalence of C. sinensis infection in the inhabitants residing around the Nam-river was relatively high. The farther toward the upper stream areas, the higher was the positive rate of C. sinensis infection, and most of clonorchiasis cases were lightly infected. The snail hosts of C. sinensis distributed all around the Nam-river. Several species of freshwater fish were infected with the metacercariae of C. sinensis and the infection rates were relatively high. To prevent C. sinensis infection in the endemic areas, the effective health education system is suggested as a control measure, although mass treatment is also expected to be useful, using chemotherapeutic agents such as "praziquantel", a recently developed anthelminthic for C. sinensis inftraction.