39. Parasitic Diseases

  1. Eugene R. Schiff MD, MACP, FRCP2,
  2. Willis C. Maddrey MD, MACP, FRCP3 and
  3. Michael F. Sorrell MD, FACP4
  1. Michael A. Dunn MD

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch39

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

Dunn, M. A. (2011) Parasitic Diseases, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch39

Editor Information

  1. 2

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 3

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 4

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. University of Pittsburgh, Pittsburgh, PA, USA

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509



  • Parasitic;
  • malaria;
  • ascariasis;
  • schistosomiasis;
  • fascioliasis;
  • clonorchiasis;
  • opisthorchiasis;
  • hydatid;
  • echinococcosis;
  • cholangiohepatitis


The liver is a host organ for parasites that span a broad range in terms of size (intracellular to centimeters), reproductive capacity within the liver (none to multiple generations per day), and potential for injury to the host (minimal to lethal). Parasites include single-celled protozoa that live within hepatocytes (malaria), within reticuloendothelial cells (Leishmania), or are extracellulary (Entamoeba). Multicellular complex organisms inhabit or transit the portal vessels (schistosomes), the bile ducts (Clonorchis, Opisthorchis, Ascaris, and mature Fasciola), and the liver parenchyma (Echinococcus and immature Fasciola). Well-adapted parasites are unlikely to cause severe or even noticeably acute symptoms in a well-nourished and immunologically normal human host. However, the adverse long-term consequences of chronic and minimally symptomatic parasitic liver diseases are becoming better understood, for example nutritional deficits and diminished work productivity in chronic schistosomiasis and the risk of cholangiocarcinoma after years of bile duct fluke infection. Parasite adaptation may fail because the host is immunocompromised from human immunodeficiency virus infection or immunosuppressed after transplantation, resulting in lethal manifestations such as severe visceral leishmaniasis. If a parasite adapted to nonhuman hosts accidentally infects a human, organ destruction and severe effects are common, for example in cystic and alveolar hydatid disease. Successful recognition and management of parasitic liver diseases has always required an appropriate level of suspicion and diagnostic testing for patients who have lived or traveled in endemic areas. As therapeutic immunosuppression of chronic inflammatory diseases becomes more widespread, clinicians will need to expand their capacity to recognize and treat parasitic infections in new situations.