Parasitic and infectious diseases of the biliary tract in migrants and international travelers

ABSTRACT

Introduction: In recent years, global and regional crises have led to extraordinary worldwide migration, accompanied by an increase in long-distance travel from Western countries. Both are linked to a rising incidence of rare parasitic and infectious diseases in first world countries, including in the biliary tract.

Areas covered: A selective literature research in PubMed was performed to review the most important parasitic and infectious biliary diseases, which are caused by a wide variety of pathogens and may be latent over long periods, with chronic courses leading to cholangitis, hepatic failure or development of cholangiocarcinoma. Parasites such as Ascaris, Fasciola and Clonorchis/Opisthorchis are particularly important and may trigger biliary diseases or predisposition for bacterial superinfections. Viral or protozoal cholangitis is mainly a problem of impaired immunity.

Expert commentary: Currently, these entities are still rare in migrants and long-distance travelers. However, a significant increase in Western countries has to be expected. Incidences are most likely underestimated because of protracted clinical latency. Diagnosis depends on the relevant pathogens, the host’s immune status and the extent or distribution of biliary obstruction. Modern tomographic methods, ERCP and specific microbiological/parasitological/virological tests are of crucial diagnostic importance. Antimicrobial/antiparasitic/antiviral therapy along with ERCP and interventional sonography/radiology provide effective treatment options.

KEYWORDS:

• Biliary infections
• parasitic diseases
• trematodes
• cholangitis
• imaging
• anthelminthic therapy
• traveler
• migrant medicine

Acknowledgments

The authors would like to thank Johannes Wiegand (Leipzig University Hospital, Germany) for his helpful assistance. Native language support was provided by Rodney Yeates. Excerpts of this manuscript were published in German in the journal ‘Der Gastroenterologe’ (Parasitäre und infektiöse Gallenwegserkrankungen. Relevante Aspekte nach Fernreise bzw. Migration) Volume 11, Issue 4, 2016, Pages 303-316 (DOI: 10.1007/s11377-016-0084-6), Copyright Springer [8].

Declaration of interest

C. Lübbert received financial support for consulting, lecturing fees and travel expenses from Astellas, InfectoPharm, MSD, Novartis, Pfizer and the Falk Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.