Anisakis, just think about it in an emergency!

Abstract

A few years ago, Anisakis infection was almost unknown. Since the first observation in the Netherlands in 1960, several cases of gastrointestinal infections due to a zoonosis sustained by this nematode have been described in countries in which the consumption of raw or uncooked fish (e.g., marinated or salted) is common. Japan alone accounts for 90% of all cases of anisakiasis described in the literature because of the widespread use of raw fish in traditional Japanese cuisine, with sushi and sashimi. Nonetheless, other cases have been reported in Europe, North and South America, and Asia. In Italy, this zoonosis is rare and mostly transmitted by the ingestion of marinated anchovies in coastal areas, or fashion foods (sushi, sashimi, etc.) in inland areas. Once eaten, this parasite can cause an acute form of disease characterized by severe abdominal pain, and for this reason many patients receive the final diagnosis only on obtaining the surgical specimen. Since conservative medical treatment for acute anisakiasis relies on endoscopic removal of the nematode from the gastrointestinal wall if performed within 12h from the ingestion of contaminated fish, it should be compulsory to consider this parasitosis in the accident and emergency department. Here we describe two cases of infection by Anisakis simplex due to ingestion of marinated anchovies in a coastal area of the Tyrrhenian Sea and discuss the types and varieties of Anisakis infection in humans.

Anisakiasis presenting to the ED: clinical manifestations, time course, hematologic tests, computed tomographic findings, and treatment

“…The larvae can penetrate the gastrointestinal tract and cause gastric or small intestinal anisakiasis. Every year, approximately 20 000 cases of anisakiasis are reported worldwide, with more than 90% from Japan and most of the other cases from Spain, the Netherlands, and Germany, depending on the habits of fish consumption; however, anisakiasis remains a rare disease [1][2][3]. Although the prevalence of anisakiasis is rare in the United States and European Union, particularly in inland areas, compared with that in Japan [2,3], the incidence is expected to increase, given the growing popularity of Japanese cuisine, such as sushi or sashimi.…”

Anisakiasis Causing Acute Dysentery in Malaysia

“…Serological studies have been used to detect Anisakis-induced IgE. 4,6,16,17 This antibody, however, lacks specificity as a result of cross-reactivity with other nematode antigens. The serological test is not generally available and it is of limited benefit in early diagnosis.…”

“…Humans acquire the infection by eating raw or undercooked infected marine fish, squid, clams, or eels. [3][4][5] After ingestion of the L3 larvae, humans can exhibit gastric, intestinal, extraintestinal, or allergic symptoms. 3,4,[6][7][8] Patients may present with epigastric pain, nausea, vomiting, symptoms of bowel obstruction, acute abdomen, or symptoms of allergic reaction such as urticaria, and angioedema.…”

“…[3][4][5] After ingestion of the L3 larvae, humans can exhibit gastric, intestinal, extraintestinal, or allergic symptoms. 3,4,[6][7][8] Patients may present with epigastric pain, nausea, vomiting, symptoms of bowel obstruction, acute abdomen, or symptoms of allergic reaction such as urticaria, and angioedema. 3,4,9 These manifestations are predominantly caused by the attachment, embedment, or penetration of the L3 larvae into the gastric and intestinal mucosa.…”

“…3,4,[6][7][8] Patients may present with epigastric pain, nausea, vomiting, symptoms of bowel obstruction, acute abdomen, or symptoms of allergic reaction such as urticaria, and angioedema. 3,4,9 These manifestations are predominantly caused by the attachment, embedment, or penetration of the L3 larvae into the gastric and intestinal mucosa. 10 The time to the onset of symptoms after ingestion of raw or undercooked infected marine animals vary from a few hours to several weeks.…”