BILIARY PARASITES

Parasitic diseases of the biliary tract occur frequently in tropical a nd subtropical areas and cause high morbidity and mortality. In genera l, neither the clinical presentation nor the general laboratory findin gs are sufficiently unique to raise the possibility of a parasitic bil iary infestation in the mind of the surgeon. Once considered, however, the presence of a parasitic biliary infestation is easily confirmed. Most commonly this is accomplished by the identification of the parasi te in stools or duodenal contents. Ultrasonography, CT and MRI are not only important in the diagnosis of parasitic biliary diseases but als o in the follow-up and surveillance. ERCP is an excellent diagnostic t ool for demonstrating the presence of parasites in the biliary tree. F urthermore, ERCP is also used in the therapy of biliary parasitic infe stations and carries less morbidity and mortality than the surgical ap proach. Surgery is only indicated in complicated cases. Mechanisms tha t may be effective against parasites include: antibodies; cytotoxic T cells; T-cell-induced activated macrophages; natural killer cells, and a variety of cells that mediate antibody-dependent cell-mediated cyto toxicity and modulators of the immune system such as cytokines. Future research has to focus on the importance of these mechanisms for the i mmune evasion by parasites.