Increasing global migration due to crises combined with increasing international travel is associated with a rising incidence of rare parasitic and infectious diseases in the Western world, including numerous biliary disorders. These encompass a wide spectrum of infectious agents affecting the biliary tree. Some entities (e.g., acute cholangitis) manifest as a medical emergency with high mortality if not properly managed in a timely manner, and others implicate chronic or latent processes that may predispose a patient to liver failure or cholangiocarcinoma. The clinical, microbiological, parasitological and imaging features as well as the subsequent therapy depend on the pathogens involved, the immune status of the host, and the degree and distribution of biliary obstruction. Bacterial agents such as Enterobacteriaceae, enterococci, streptococci, and anaerobes cause most cases of infectious cholangitis in Western countries. In other parts of the world, parasites like Ascaris lumbricoides,Fasciola hepatica, and Opisthorchis spp. play an important role. This should be considered especially in migrants with diseases of the biliary tract. Viral or protozoal cholangitis primarily affect immunocompromised patients. Sectional imaging, especially the gastroenterological ultrasound examination, together with endoscopic retrograde cholangiopancreatography (ERCP), and adequate microbiological, parasitological and virological tests play a pivotal role in the diagnosis of biliary infections and help to identify predisposing causes. ERC and interventional sonography/radiology along with antimicrobial and antiparasitic therapy provide effective treatment options for acute life-threatening biliary infections, chronic entities, and complications. © 2016, Springer-Verlag Berlin Heidelberg.

Therapy Parasitic diseases Cholangitis Biliary infections Diagnostic imaging

Fasciola hepatica immunocompromised patient antiparasitic agent travel Opisthorchis rapid response team Ascaris lumbricoides migrant Enterobacteriaceae antimicrobial therapy parasitic liver disease Enterococcus endoscopic retrograde cholangiopancreatography cholestasis bile duct carcinoma parasite examination Streptococcus biliary tract disease anaerobic bacterium cholangitis liver failure virus examination echography Incidence Article microbiological examination migration antiinfective agent