Consumption Of Raw Fish Research Articles

First detection of Eustrongylides excisus (Nematoda: Dioctophymatidae) in big-scale sand smelt (Atherina boyeri) from the lake Massaciuccoli (Northwest Tuscany, Italy): implications for public health and seafood quality

Eustrongylides spp. are cosmopolitan parasitic nematodes with several freshwater fish species as intermediate or paratenic hosts, rarely reported as zoonotic agents. This work aims to report, for the first time, the occurrence of this parasite in specimens of big-scale sand smelt (Atherina boyeri) caught in the lake Massaciuccoli (Northwest Tuscany, Italy). Totally 3317 specimens of A. boyeri were collected in three different samplings (August–October 2019). Fish were visually examined and then submitted to artificial digestion. Visible parasites were collected and counted after both procedures, then they were identified to genus level by microscopic examination and to species level by molecular analysis of the ITS gene region. Overall, 75 nematodes identified as larval stages of Eustrongylides excisus were found (P: 2.3% 95% CI 1.8–2.8; MA: 0.02; MI: 1), in the viscera and in the muscle. A. boyeri is a highly appreciated fish species in several Italian areas as well as in various Mediterranean countries. Beside an epidemiological interest due to its role in the parasite cycle, the report of E. excisus in the study area arises possible quality and public health issues. Therefore, also considering the method of preparation of A. boyeri and that lately the increasing consumption of raw fish has also targeted freshwater fish species, it is essential to communicate the presence of this hazard and the need of applying appropriate sanitary measures to all FBOs along the supply chain and to consumers.

High prevalence of Clonorchis sinensis infections and coinfection with hepatitis virus in riverside villages in northeast China

In China, the prevalence of Clonorchis sinensis (C. sinensis) infections is only evaluated at the provincial level by national sampling surveys, and data from villages and counties are still lacking. In this study, we conducted a cross-sectional survey in 10 villages located along the Lalin River in northeast China. Clonorchiasis was diagnosed using a modified Kato–Katz method that detects the C. sinensis egg in stools. A total of 3,068 persons were screened and 2,911 were recruited for the study. Overall, the prevalence of C. sinensis infection was 29.3%. Among 175 participants who were cured after antiparasitic treatment, 54 (30.86%) were re-infected in this survey. After calibration of potential confounders, male gender, occupation as a farmer, smoking, and occasionally or frequently eating raw fish were independent risk factors for C. sinensis infection. The results of laboratory examinations in the C. sinensis/hepatitis B or C virus co-infection group were similar to those in the hepatitis B or C virus mono-infection groups. In conclusion, C. sinensis is highly endemic in villages along the Lalin River, and the primary route of infection is the consumption of raw freshwater fish. Co-infection with C. sinensis did't aggravate the clinical manifestations of viral hepatitis in this cross-sectional study.

First Occurrence of Eustrongylides spp. (Nematoda: Dioctophymatidae) in a Subalpine Lake in Northwest Italy: New Data on Distribution and Host Range.

The genus Eustrongylides includes nematodes that infect fish species and fish-eating birds inhabiting freshwater ecosystems. Nematodes belonging to the genus Eustrongylides are potentially pathogenic for humans; infection occurs after the consumption of raw or undercooked fish. In the two-year period 2019–2020, a total of 292 fish belonging to eight species were examined for the occurrence of Eustrongylides spp. from Lake San Michele, a small subalpine lake in northwest Italy. The prevalence of infestation was 18.3% in Lepomis gibbosus, 16.7% in Micropterus salmoides, and 10% in Perca fluviatilis. The other five fish species (Ameiurus melas, Ictalurus punctatus, Squalius cephalus, Carassius carassius, and Scardinius erythrophthalmus) were all negative for parasite presence. There were no significant differences in prevalence between the three fish species (Fisher’s exact test; p = 0.744). The mean intensity of infestation ranged from 1 (M. salmoides and P. fluviatilis) to 1.15 (L. gibbosus), and the mean abundance ranged from 0.1 (P. fluviatilis) to 0.28 (L. gibbosus). There were significant differences in the infestation site between the four muscle quadrants (anterior ventral, anterior dorsal, posterior ventral, and posterior dorsal) and the visceral cavity (Kruskal–Wallis test; p = 0.0008). The study findings advance our knowledge about the distribution and host range of this parasite in Italy.

Socioeconomic and Behavior Influenced Raw Fish Consumption, 2nd Intermediate Hosts of Opisthorchis viverrini, in Northeastern Thailand

Socioeconomic and Behavior Influenced Raw Fish Consumption, 2nd Intermediate Hosts of Opisthorchis viverrini, in Northeastern Thailand

Anisakis and Hysterothylacium species in Mediterranean and North-East Atlantic fishes commonly consumed in Spain: Epidemiological, molecular and morphometric discriminant analysis

The consumption of raw fish parasitized with larval ascaridoid nematodes of the family Anisakidae can cause anisakiasis, provoking gastrointestinal and/or allergic symptomatology. The main causative agents in the Anisakis genus are the sibling species Anisakis simplex sensu stricto (s.s.) and A. pegreffii of the A. simplex sensu lato (s.l.) complex. Larvae of A. simplex (s.l.) are frequently detected in fish commonly consumed in Spain, as are larvae of the genus Hysterothylacium of the family Raphidascarididae, associated with allergic reactions but not considered pathogenic. Reported here are the results of an epidemiological survey of ascaridoid larvae in three commonly consumed fish species in Spain, horse mackerel (Trachurus trachurus) (n = 52), blue whiting (Micromesistius poutassou) (n = 93) and anchovy (Engraulis encrasicolus) (n = 69), caught in the North-Eastern Atlantic, West Mediterranean and Adriatic Sea. The larvae found in the dissected fish were identified in the following order of abundance: A. simplex (s.l.) (n = 2003), Hysterothylacium aduncum (n = 422), H. fabri (n = 180) and A. physeteris (n = 15). Binomial regression analysis showed a correlation between A. simplex (s.l.) and Hysterothylacium larvae abundance and the host geographical location, the North-Eastern Atlantic being the area with the highest parasitation. Fish length and weight and Fulton's condition factor were correlated with A. simplex (s.l.) abundance only in horse mackerel. There was a significant presence of A. simplex (s.l.) and H. aduncum larvae in the musculature of North-Eastern Atlantic blue whiting, the most parasitized part being the anteroventral region, followed equally by the anterodorsal and central sections. The ITS rDNA of larvae of the sibling species A. simplex (s.s.) and A. pegreffii was identified by PCR-RFLP, and a binary logistic regression model was developed to study their morphometric differentiation. Anisakis simplex (s.s.) was detected in the North-Eastern Atlantic and A. pegreffii in all the areas studied. The morphometric analysis discriminated between the two species at the third and fourth larval stages (L3 and L4), the latter obtained by in vitro culture in RPMI-1640 medium. Two discriminant functions were obtained for the L3 and L4 larvae, the ventricle being a key parameter for specific differentiation in both stages, providing taxonomical criteria that could be used besides molecular identification. The present study reveals differences in the parasitation of the studied fish, including the distribution of larvae in the musculature, related to the host species and its geographical origin.

Current status of Opisthorchis viverrini, minute intestinal fluke and Taenia spp. infections among inhabitants in the Kenethao district of northern Lao PDR

This study reports the prevalence of Ov/minute intestinal fluke (MIF) and Taenia infections among inhabitants of the Kenethao district, northern Lao PDR. Fecal samples from 580 inhabitants were examined using the formalin-ethyl acetate concentration technique. The prevalence of Ov/MIF, Taenia spp. and coinfection was 45.3, 11.9 and 6.1%, respectively. There was no significant difference between males and females for Ov/MIF (p=0.813) and Taenia infection (p=0.759). The prevalence of Ov/MIF was significantly associated with age (p=0.005), but not for Taenia infection (p=0.836). Consumption of raw fish (p=0.001) and raw meat (p=0.046) was significantly associated with parasitic infections. The results suggest that Ov/MIF and Taenia spp. are highly endemic in this area and there is a need for projects to eliminate these parasites.

Usefulness of Ultrasound in the Diagnosis of Intestinal Anisakiasis.

To evaluate the ultrasound (US) findings of gastrointestinal anisakiasis and the utility of US in its early diagnosis. We retrospectively assessed the imaging findings and clinical data of 21 patients with gastrointestinal anisakiasis. Diagnosis was confirmed by a positive antigen (n = 16), endoscopy (n = 2), or a compatible clinical presentation, physical examination, and history of raw fish consumption (n = 3). Ultrasound findings reviewed included segmental circumferential bowel wall thickening, segmental edema of the valvulae conniventes, dilated small bowel loops with hyperperistalsis or hypoperistalsis, free fluid, and color Doppler hyperemia. Segmental circumferential bowel wall thickening was present in all 21 patients, whereas segmental edema of the valvulae conniventes was visualized in 13 patients, moderately dilated small-bowel loops proximal to the affected segment with increased peristalsis in 14 patients, small-to-moderate ascites in 18 patients, and color Doppler hyperemia in 7 patients. The US evaluation ruled out a surgical pathologic examination in all patients, and the diagnosis of anisakiasis was suggested by the radiologist on the basis of US findings in 12 patients. Familiarity with the suggestive US presentation of intestinal anisakiasis may allow the radiologist to propose the diagnosis of this overlooked cause of abdominal pain and may also prompt an investigation of recent raw or lightly cooked seafood ingestion. Ultrasound findings of bowel wall thickening, especially segmental edema of the valvulae conniventes, hyperperistalsis, and dilatation of small-bowel loops proximal to the affected segment, ascites, and color Doppler hyperemia, along with a history of raw fish ingestion should aid the radiologist in the diagnosis of anisakiasis.

First Report of Clinostomum complanatum (Trematoda: Digenea) in European Perch (Perca fluviatilis) from an Italian Subalpine Lake: A Risk for Public Health?

Clinostomum complanatum, a digenean trematode of the Clinostomidae family, is a fish-borne zoonotic parasite responsible for Halzoun syndrome in humans and is transmitted through the consumption of raw or undercooked freshwater fish. Of the total of 112 specimens of European perch (Perca fluviatilis) sampled from a subalpine lake (Lake Endine) in North Italy in 2019, 21 (18.75%) tested positive for encysted metacercariae in the fillet. This study reports the first isolation of C. complanatum in P. fluviatilis and highlights the possible zoonotic risk for consumers, since P. fluviatilis is a food fish used in the traditional local cuisine.

Pathoecology of the town of Yeniseisk in Western Siberia from the 17th and 18th centuries

This article examines the prevalence and range of parasitic diseases based on soil sediment samples found in the town of Yeniseisk located in western Siberia.These soil samples were taken from the sacral surface of 14 individuals buried at the cemetery of the Epiphany Cathedral dating back to the 17th century, and 15 samples of toilet contents taken from an 18th century mansion. It was found that Diphyllobothrium sp. eggs prevailed in the samples taken from the sacral surface. They were found in 64.3% of cases. At the same time, the prevalence of diphyllobothriasis does not depend on gender. Ascaris lumbricoides eggs were found in 1 individual, or 7.14% of the entire sample. However, Ascaris lumbricoides eggs prevailed in the toilet content of samples collected from the Yeniseisk manision. They were found in 14 of 15 samples (93.3%), while Taenia sp. eggs were found in 1 sample (6.7%).Having examined the results within a historical context, we conclude that the high prevalence of Diphyllobothriasis in the Yeniseisk population, responsible for establishing this burial ground, was caused by consumption of raw fish or poorly cooked fish and persisted, owing to a relative stability of dietary habits dating back to the Pomors, who were the first Russian settlers in the region in the 17th century, as well as a tradition of eating fish adopted from the indigenous population of the Siberian North. Both traditions were probably adapted to Northern conditions and were considered, in particular, as antiscorbutic. Taenia sp. cestode eggs detected in the content of one toilet sample is indicative of having consumed contaminated, insufficiently boiled or roasted, raw beef and/or pork. The diet of the Russians who settled in Yeniseisk during the 18th century was probably more diverse and included a sufficient amount of beef and/or pork. The minimal prevalence of ascariasis in Yeniseisk in the 17th century, as identified by the present study, might reflect relatively satisfactory sanitary conditions based on the small initial population. However, as the population and its density grew during the 18th century, it is likely that the sanitary conditions deteriorated, possibly aggravated by frequent floods.

Prevalence and antibiotic susceptibility pattern of Escherichia coli O157:H7 isolated from harvested fish at Lake Hayq and Tekeze dam, Northern Ethiopia

Fisheries play a significant role in food security, livelihood, and source of income in developing countries. Although fish are a healthy source of protein, they can also spread diseases caused by pathogenic micro-organisms they may harbor. Epidemiology of foodborne pathogens is not well studied in Ethiopia. To address this issue to some extent, a cross-sectional study with a simple random sampling approach was conducted from October 2017 to May 2018 with the objectives of to isolate and estimate the prevalence of Escherichia coli O157: H7 in fish, and to evaluate the antimicrobial susceptibility pattern of the isolates in selected Lakes of Northern Ethiopia. All the microbial identification and isolation procedures were conducted based on ISO 6887-3:2017 recommendations. Antimicrobial susceptibility test was also performed following the standard procedure of Kirby-Bauer disk diffusion protocol. From the total 410 fish samples examined, six (1.46%) of them were found contaminated with Shiga toxin-producing Escherichia coli O157: H7 strain. The organism was isolated from landing sites (5/293) and local retail markets (1/75). Besides, Escherichia coli O157: H7 was isolated from filleted fish (5/214) and whole fish (1/125); however, it was not isolated from samples of ready to eat fish and working environments of restaurants. The antibiotic susceptibility test revealed that the isolates were resistant to Ampicillin and Streptomycin disks. However, Ciprofloxacin, Gentamicin and Nalidixic acid were found effective in inhibiting the growth of all of the isolates. Since pathogenic Escherichia coli strain was detected from fish, raw and undercooked fish consumption in Ethiopia may result in contracting infections. The occurrence of such pathogenic organisms in fish indicates the need for intervention by stakeholders. Supports like freezers, generators, the establishment of fish processing plants and on job training about proper fish handling practices may play a tremendous role in decreasing the level of contamination of fish in Ethiopia.

The control of clonorchiasis in Guangdong province, southern China

Oriental liver fluke disease (clonorchiasis), caused by Clonorchis sinensis, is endemic in 81 counties in Guangdong province, China. This study was conducted following increasing lack of clonorchiasis awareness and increased consumption of raw freshwater fish and raw fish porridge at home and restaurants, which has been attributed to improved living standards in China, and is considered to have led to a higher C. sinensis infection rate in the country. A total of 61,517 individuals were investigated from 123 sites during a provincial survey in 1988, with average C. sinensis infection rate of 1.82% that increased to 4.08% (335/8217) in 1997. Higher infection rate was observed in adult men than women, with heavy infection rate in fishermen and businessmen because they have access and means to get raw fishes for consumption. Thus, clonorchiasis has become a serious public health problem in Guangdong province. Efforts targeting clonorchiasis prevention and control in Guangdong province started in the 1990s. These included carrying out large-scale surveys and chemotherapy in epidemic regions, research on promotion of environmental sanitation and methods for freshwater aquaculture. Establishment and promotion of clonorchiosis demonstration plots for comprehensive control measures, as well as the development of clonorchiasis-prevention community-out-patient clinics were initiated and their effectiveness was evaluated. However, there seem to be no obvious decline in the prevalence of C. sinensis with 4.90% (608/12,401) in 2015, at Guangdong province due to the people's habit of eating raw fishes in endemic areas. This has led to increasing calls to improve environmental sanitation in the aquaculture industry. It is, however, believed that control efforts on clonorchiosis in the province are at an early stage and require strengthening through the cooperation of different departments to work out effective strategies for sustainable field application of control mechanisms.

2699 An Uncommon Cause of Vomiting and Abdominal Pain in Pregnancy

INTRODUCTION: Anisakis is a zoonotic parasitic disease that infects marine mammals. Gastrointestinal anisakiasis is caused by consumption of undercooked or raw seafood infected by nematodes of the Anisakis species. While it is common in Asia it is an uncommon infection in North America with only a few reported cases. Here we present a case of gastric anisakiasis in a pregnant woman complicating the diagnosis and management. CASE DESCRIPTION/METHODS: A 32 year old newly pregnant female presented to the infectious disease clinic with acute onset abdominal pain and emesis. She reported finding two mobile “worms” in raw salmon, after ingesting six ounces of the fish, a day before. A specimen was sent to the microbiology laboratory with the preliminary read concerning for roundworm. Given the concern for anisakiasis, pregnancy status and risk of perforation, she was directly admitted for upper endoscopy. This revealed a thin, translucent, 20 mm × 1 mm worm burrowed into the greater curvature of the proximal antrum. The worm was removed in entirety with cold biopsy forceps and sent to microbiology. Biopsies were taken from the site of burrow. Pathology was consistent with mild gastritis with focally increased eosinophils and no remnant of the parasite. The worm was identified as anisakis species. The patient’s symptoms resolved spontaneously. Her pregnancy limited evaluation of the remainder of her G.I tract for evidence of infection. Since she had no symptoms of obstruction, she was discharged with instructions to complete a bowel purge upon returning home. DISCUSSION: Gastric anisakiasis is uncommon in the U.S. In addition, this case was complicated by the patient’s pregnancy, precluding the use of imaging techniques such as CT scans to help narrow the diagnosis in suspected anisakiasis and exonerate complications. Obstruction is a commonly reported complication for which there has been reported success with Albendazole therapy, undesirable in this case, being pregnancy category C. Another reported and somber complication includes perforation from the burrowing of untreated parasites. To minimize adverse outcomes with imaging and antiparasitic therapy, our patient underwent curative endoscopic therapy followed by a bowel purge to empirically purge remaining parasites from the distal G.I tract. With globalization of cuisine and increasing consumption of raw fish in the west, physicians should have a heightened suspicion of parasitic infections such as anisakis given the significant sequalae of untreated infection.

Anisakis spp. IN TRAHIRAS (Hoplias lacerdae) FROM TELES PIRES RIVER AFFLUENT, MATO GROSSO STATE, BRAZIL

Anisakiasis is a parasitic disease caused by the consumption of raw or undercooked fish containing the third larval stage of anisakid nematodes. Safety in fish consumption from extractive fisheries is a challenge for public health authorities. This study presents the hematological analysis, necroscopic and histopathological examination of three Hoplias lacerdae parasitized by Anisakis spp. captured in an affluent of the Teles Pires River, in the municipality of Sinop, State of Mato Grosso, Brazil. At necropsy, intense parasitism was observed, characterized by free and adherent anisakid larvae in organs and mesentery. In the histopathological study, there were nephrotic alterations and hepatopathies, as well as the first report of the presence of Anisakis cyst adhered in the myocardium of Hoplias lacerdae. There was a correlation between the increase in the number of parasites and the circulating leukocytes, influenced by the number of neutrophils and eosinophils. However, other studies should be designed to elucidate the pathophysiological and epidemiological changes in Hoplias lacerdae by the parasitism of Anisakis spp., due to its socioeconomic importance, as well as the potential risk to public health.

Complex insight on microanatomy of larval \u201chuman broad tapeworm\u201d Dibothriocephalus latus (Cestoda: Diphyllobothriidea)

BackgroundIn Europe, the tapeworm Dibothriocephalus latus (syn. Diphyllobothrium latum) is a well-known etiological agent of human diphyllobothriosis, which spreads by the consumption of raw fish flesh infected by plerocercoids (tapeworm’s larval stage). However, the process of parasite establishment in both intermediate and definitive hosts is poorly understood. This study was targeted mainly on the scolex (anterior part) of the plerocercoid of this species, which facilitates penetration of the parasite in intermediate paratenic fish hosts, and subsequently its attachment to the intestine of the definitive host.MethodsPlerocercoids were isolated from the musculature of European perch (Perca fluviatilis) caught in Italian alpine lakes. Parasites were examined using confocal microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Immunofluorescence tagging was held on whole mount larvae.ResultsThe organisation of the central and peripheral nervous system was captured in D. latus plerocercoids, including the ultrastructure of the nerve cells possessing large dense neurosecretory granules. Two types of nerve fibres run from the body surface toward the nerve plexus located in the parenchyma on each side of bothria. One type of these fibres was found to be serotoninergic and possessed large subtegumental nerve cell bodies. A well-developed gland apparatus, found throughout the plerocercoid parenchyma, produced heterogeneous granules with lucent core packed in a dense layer. Three different types of microtriches occurred on the scolex and body surface of plerocercoids of D. latus: (i) uncinate spinitriches; (ii) coniform spinitriches; and (iii) capilliform filitriches. Non-ciliated sensory receptors were observed between the distal cytoplasm of the tegument and the underlying musculature.ConclusionsConfocal laser scanning microscopy and electron microscopy (SEM and TEM) showed the detailed microanatomy of the nervous system in the scolex of plerocercoids, and also several differences in the larval stages compared with adult D. latus. These features, i.e. well-developed glandular system and massive hook-shaped uncinate spinitriches, are thus probably required for plerocercoids inhabiting fish hosts and also for their post-infection attachment in the human intestine.

Prevalence, Species Distribution, and Related Factors of Fish-Borne Trematode Infection in Ninh Binh Province, Vietnam.

Background. Clonorchis sinensis/Opisthorchis viverrini and minute intestinal flukes (MIF) such as Haplorchis pumilio and H. taichui are fish-borne trematodes (FBT) that may coexist in regions where local people have a habit of eating raw fish like Vietnam. Responses to FBT should be verified according to the data on the distribution of these flukes. This study aims to explore the prevalence of different species of FBT and related factors among local people in a northern province of Vietnam. Methods. A cross-sectional study was conducted in Kim Son and Yen Khanh districts, Ninh Binh province, between March 2016 and March 2017. Four hundred people aged 15 years or older were interviewed and gave stool samples. The FBT eggs in faecal samples were enumerated by modified formalin-ether technique and identified by sequencing of the second internal transcribed spacer (ITS2) region. Result. Among the 400 persons, 19.5% were infected with FBT. On univariate analysis, eating raw fish was the main risk factor (odds ratios (OR)) of 6.769 (95% confidence interval (CI) of 2.655–17.259) followed by being of male gender (3.994 (CI95% 2.117–7.536)) and drinking alcohol (2.680 (CI95% 1.440–4.986)), respectively. There was no risk of increased infection among those living at home without hygienic latrines, those living close to rivers or having ponds, or those raising cats or dogs. By multivariate analysis, FBT infection was only related to the consumption of raw fish and gender. Seventy stool samples with a sufficient amount of faecal matter were subjected to DNA extraction, 42.85% of them yielded DNA production, and all were of Clonorchis sinensis. Conclusion. Results of the study showed the high prevalence of infection of fish-borne trematode, mostly C. sinensis among humans in Ninh Binh province. The prevention of FBT should be strengthened with programs detailed according to the distribution of FBT in different endemic areas.

Detection of Antibiotic Resistance in Escherichia coli Strains: Can Fish Commonly Used in Raw Preparations such as Sushi and Sashimi Constitute a Public Health Problem?

Forty-five E. coli isolates were recovered from fresh fish. Three of the E. coli isolates produced ESBL. ESBL-producing E. coli isolates harbored the blaCTX-M-1 and blaTEM genes. The presence of ESBL-producing E. coli may represent a serious public health problem.

Repeated praziquantel treatment and Opisthorchis viverrini infection: a population-based cross-sectional study in northeast Thailand

BackgroundOpisthorchis viverrini infection is highly prevalent in northeast Thailand. This liver fluke is classified as a carcinogen due to its causal links with cholangiocarcinoma (CCA) development. Although treatment with praziquantel (PZQ) effectively cures O. viverrini infection, the prevalence remains high due to the traditional consumption of raw fish. Therefore, re-infection is common in the endemic community, leading to severe hepato-biliary morbidities including the fatal CCA. In this study, we evaluate the association between the frequency of previous PZQ treatment and current O. viverrini infections among Thai adults living in the endemic area of northeast Thailand.MethodsThis study includes all participants who were screened for O. viverrini infection in the Cholangiocarcinoma Screening and Care Program (CASCAP), northeast Thailand. History of PZQ treatment was recorded using a health questionnaire. O. viverrini infections were diagnosed using urine antigen detection. Associations between PZQ and O. viverrini were determined by adjusted odds ratio (aOR) and 95% confidence interval (CI) using multiple logistic regression.ResultsAmong participants, 27.7% had previously been treated once with PZQ, 8.2% twice, 2.8% three times, and 3.5% more than three times. Current O. viverrini prevalence was 17% (n = 524). Compared with participants who never used PZQ, the aOR for infection among those who used the drug once was 1.09 (95% CI: 0.88–1.37), twice was 1.19 (95% CI: 0.85–1.68), three times was 1.28 (95% CI: 0.74–2.21), and more than three times was 1.86 (95% CI: 1.18–2.93; P = 0.007).ConclusionsThe population with a frequent history of PZQ use and still continued raw fish consumption showed high levels of repeated reinfection with O. viverrini. They were infected, treated and re-infected repeatedly. These findings suggest that certain participants continue raw fish consumption even after previous infection. This is a particular problem in highly endemic areas for O. viverrini and increases the risk of CCA.

Anisakiasis in Italy: Analysis of hospital discharge records in the years 2005-2015.

BackgroundAnisakiasis is a fish-borne zoonosis caused by the ingestion of marine food infected with Anisakis third-stage larvae, widespread marine parasitic nematodes. Gastrointestinal and/or allergic clinical signs and symptoms are not specific. While frequently reported in countries with large raw fish consumption as Japan, the global prevalence of anisakiasis may be severely underestimated due to limitations of available diagnostic tools and to diverse clinical manifestations. Recently, infective larvae were found in the same localization with gastrointestinal tumors. The occurrence of allergic exacerbation upon secondary exposure and the possible occupational exposure, highlight the need to increase scientific evidences on anisakiasis.MethodsWe performed a retrospective descriptive study using analysis of Hospital Discharge Records (HDRs) from 2005 to 2015 in Italy, with particular attention to allergic manifestations. Descriptive statistics and multivariate analyses were performed using backward step-wise logistic regression models to assess spatial distribution and temporal trend as well as the variables independently associated with the allergic clinical signs and symptoms in Italian cases of anisakiasis.ResultsHDRs reporting the ICD-9 code for anisakiasis were retrieved (370), with a higher number of cases reported from central and southern regions, with particular regard to populations inhabiting the coastal territories. Around 40% of patients presented allergic manifestations and half of them showed serious allergic reactions. The multivariate analyses showed an independent association between allergic manifestations and features as living in southern regions and female gender, while anaphylactic episodes was independently associated only with female gender.ConclusionThe present study is the first attempt to a better understanding of the epidemiological picture of anisakiasis in Italy, mining official data. A common strategy on data collection, monitoring and reporting would favor a more accurate epidemiological scenario in Italy, since the report of the diseases is not mandatory.

Modeling the Transmission Dynamics of Clonorchiasis in Foshan, China

Clonorchiasis, known as the Chinese liver fluke disease, is caused by Clonorchis sinensis infection with food-borne liver fluke, which is transmitted via snails to freshwater fish and then to human beings or other piscivorous mammals. Clonorchis sinensis infection is mainly related to liver and biliary disorders, especially cholangiocarcinoma, and has an increased human-health impact due to the greater consumption of raw freshwater fish. In this article, we propose a deterministic model to describe the spread of clonorchiasis among human-snail-fish populations and use the model to simulate the data on the numbers of inspected and infected individuals of Foshan City, located in Guangdong Province in the southeast of P.R China, from 1980–2010. Mathematical and numerical analyses of the model are carried out to understand the transmission dynamics of clonorchiasis and explore effective control measures for the local outbreaks of the disease. We find that (i) the transmission of clonorchiasis from cercariae to fish plays a more important role than that from eggs to snails and from fish to humans; (ii) As the cycle of infection-treatment-reinfection continues, it is unlikely that treatment with drugs alone can control and eventually eradicate clonorchiasis. These strongly suggest that a more comprehensive approach needs to include environmental modification in order to break the cercariae-fish transmission cycle, to enhance awareness about the disease, and to improve prevention measures.

Radiographic Diagnosis of Diphyllobothriasis: Hiding in Plain Sight

2482 Figure 1. Axial, coronal, and sagittal CT images depicting a curvilinear filling defect in the small bowel concerning for intestinal tapewormDiphyllobothriasis is diagnosed by identification of proglottids in the stool or by direct endoscopic visualization of a worm. We describe a case in which an intestinal tapeworm is stumbled upon via abdominal imaging. An 80 year smoker with idiopathic pulmonary fibrosis presented to a VA gastroenterology clinic for dyspepsia unresponsive to H2 blockers and proton pump inhibitors. He reported 3 months of progressive abdominal fullness, bloating, intermittent loose stools, and anorexia leading to 20-25 pounds of weight loss. Physical exam showed conjunctival pallor and mild abdominal distension. A CBC demonstrated macrocytic anemia. Vitamin B12 level was 90pg/ml (nl 213-816 pg/ml). Serum anti-parietal cell and antiintrinsic factor antibodies were negative, and serum gastrin and folate levels were normal. He refused endoscopy. Contrasted CT of the abdomen and pelvis demonstrated a curvilinear filling defect from the proximal jejunum through most of the visualized small bowel. Three stool ova and parasite (O&P) samples were collected; two demonstrated proglottids characteristic of Diphyllobothrium. His symptoms resolved after a dose of praziquantel (10mg/kg), and repeat stool O&P after one month proved eradication. The frequency of parasite detection via stool O&P has been reported at ˜20% when examining a single sample, compared to ˜50% when two or more are examined. Likewise, examining two or more specimens increases the sensitivity from 75% to 92%. Uniquely, the initial hint of a parasite in our patient was found via imaging. Radiographic findings of intestinal tapeworms are rare, and CT in the presence of known infection does not always demonstrate a parasite. The first two cases of tapeworm visualization via capsule endoscopy were recently reported. The focused differential for this elderly smoker with dyspepsia and weight loss included peptic ulcer disease and gastrointestinal malignancy. Screening labs for gastrinoma and pernicious anemia were negative. This patient did not report typical risk factors for diphyllobothriasis, including travel to endemic regions and raw fish consumption. After the patient refused endoscopy, CT revealed distinctive findings concerning for intestinal tapeworm, confirmed by observation of proglottids in the stool. Macrocytic anemia in the setting of weight loss and dyspepsia requires a workup for malabsorption, malignancy, and, though rare, parasitic infection.