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Peer-reviewedCC BY 4.0Infection

Paucisymptomatic opisthorchiasis in a non-endemic country: a neglected differential diagnosis?

  • S. Dirik1
  • C. Boesecke2,3
  • S. Breitschwerdt2,3
  • S. M. Fünger2,3
  • A. Hoerauf4,3
  • M. P. Hübner4,3
  • G. J. Rieke2,3
  • J. K. Rockstroh2,3
  • J. C. Wasmuth2,3
  • H. Wobser2
  • D. Benke2,3
4 affiliations
  1. 1Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey
  2. 2Department of Medicine I, University of Bonn, University Hospital Bonn, Bonn, Germany
  3. 3German Center for Infection Research (DZIF), Partner Site Bonn-Köln, Bonn, Germany
  4. 4Institute for Medical Microbiology, Immunology and Parasitology, University of Bonn, University Hospital Bonn, Bonn, Germany
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Abstract

Case presentation: We report a case of opisthorchiasis in a 71-year-old woman with intermittent upper abdominal pain, whose cause had remained unclear for a long time. She grew up in Kazakhstan and moved to Germany more than 30 years ago. After positive serological testing for Opisthorchis during a recent visit to her home country, she presented at our clinic for further evaluation. Stool examination confirmed the presence of Opisthorchis eggs. The symptoms quickly resolved after treatment with praziquantel. Abdominal sonography revealed adenomyomatosis of the gallbladder fundus and multiple gallbladder polyps, most likely a consequence of chronic inflammation caused by the parasite. Sonographic surveillance was recommended with regard to a potentially increased risk of cholangiocarcinoma.

Discussion and conclusions: No certified serological test for opisthorchiasis is available in Germany and molecular or antigen-based tests for this infection are also largely unavailable. Diagnosis therefore has to rely on stool microscopy which requires the examination of multiple samples to ensure adequate sensitivity. Diagnosis is further complicated as symptoms are often nonspecific and liver flukes are usually not among the initial differential diagnoses. Missing the diagnosis, however, carries the risk of serious complications. Global travel and migration as well as recent autochthonous cases in the European Union underscore the need for increased vigilance for opisthorchiasis even in non-endemic areas.

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Cite

BibTeXRIS
BibTeX
@article{dirik2026paucisymptomatic,
  title = {{Paucisymptomatic opisthorchiasis in a non-endemic country: a neglected differential diagnosis?}},
  author = {S. Dirik and C. Boesecke and S. Breitschwerdt and S. M. Fünger and A. Hoerauf and M. P. Hübner and G. J. Rieke and J. K. Rockstroh and J. C. Wasmuth and H. Wobser and D. Benke},
  journal = {Infection},
  year = {2026},
  month = jun,
  doi = {10.1007/s15010-026-02853-4},
  url = {https://doi.org/10.1007/s15010-026-02853-4},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Paucisymptomatic opisthorchiasis in a non-endemic country: a neglected differential diagnosis?
AU  - S. Dirik
AU  - C. Boesecke
AU  - S. Breitschwerdt
AU  - S. M. Fünger
AU  - A. Hoerauf
AU  - M. P. Hübner
AU  - G. J. Rieke
AU  - J. K. Rockstroh
AU  - J. C. Wasmuth
AU  - H. Wobser
AU  - D. Benke
PY  - 2026
DA  - 2026/06/01
JO  - Infection
DO  - 10.1007/s15010-026-02853-4
UR  - https://doi.org/10.1007/s15010-026-02853-4
AB  - Case presentation: We report a case of opisthorchiasis in a 71-year-old woman with intermittent upper abdominal pain, whose cause had remained unclear for a long time. She grew up in Kazakhstan and moved to Germany more than 30 years ago. After positive serological testing for Opisthorchis during a recent visit to her home country, she presented at our clinic for further evaluation. Stool examination confirmed the presence of Opisthorchis eggs. The symptoms quickly resolved after treatment with praziquantel. Abdominal sonography revealed adenomyomatosis of the gallbladder fundus and multiple gallbladder polyps, most likely a consequence of chronic inflammation caused by the parasite. Sonographic surveillance was recommended with regard to a potentially increased risk of cholangiocarcinoma.  Discussion and conclusions: No certified serological test for opisthorchiasis is available in Germany and molecular or antigen-based tests for this infection are also largely unavailable. Diagnosis therefore has to rely on stool microscopy which requires the examination of multiple samples to ensure adequate sensitivity. Diagnosis is further complicated as symptoms are often nonspecific and liver flukes are usually not among the initial differential diagnoses. Missing the diagnosis, however, carries the risk of serious complications. Global travel and migration as well as recent autochthonous cases in the European Union underscore the need for increased vigilance for opisthorchiasis even in non-endemic areas.
SN  - 0300-8126
SN  - 1439-0973
ER  -