Ingestion Of Raw Fish Research Articles

Intestinal anisakiasis: CT imaging findings-a 10-year descriptive study in a single center.

The aim of this study was to retrospectively review cases of intestinal anisakiasis diagnosed by CT over a 10-year period and to evaluate imaging findings associated with the disease. This retrospective study included 71 patients with clinical suspicion of intestinal anisakiasis in whom an abdominopelvic computed tomography (CT) was performed at a single institution between June 2011 and December 2021. To identify the cases, we used medical term search engines and the hospital's radiology case database. Clinical information was gathered from the medical records. A radiologist with five years of experience reviewed and analyzed the CT images to determine the characteristic findings of intestinal anisakiasis. The study included 47 confirmed cases of intestinal anisakiasis. The mean age of the patients was 52 years (range 18-87 years), being more frequent in men than women (26:21). All patients reported ingestion of raw fish, most commonly anchovies in vinegar (30/47, 63,8%). Abdominal pain was the predominant symptom, accompanied by nausea, vomiting, and occasionally fever. The most common clinical suspicions were intestinal obstruction (14/47, 29,8%) and appendicitis (10/47, 21,3%), whereas intestinal anisakiasis was suspected in only 2 cases prior to imaging. CT showed thickening of the bowel wall with submucosal edema in all patients, predominantly involving the ileum (43/47, 91,5%), usually in a relatively long segment (mean of 17,5 cm, range 10-30 cm). Simultaneous involvement of multiple bowel segments was observed in 16 cases (34%). Intestinal obstruction with dilatation of proximal loops (33/47, 70,2%), ascites (45/47, 95,7%), and mesenteric fat striation (32/47, 68,1%) were also common findings. This study demonstrates the value of computed tomography in suggesting the diagnosis of intestinal anisakiasis, which often presents with nonspecific clinical manifestations. The characteristic CT findings that provide diagnostic clues are bowel wall thickening with submucosal edema, typically involving a long segment of the ileum, with signs of intestinal obstruction, ascites, and mesenteric fat striation. Simultaneous involvement of several intestinal segments (typically the gastric antrum and right colon) is an additional finding to be considered and may provide a diagnostic clue.

The autochthonous cases of acute opisthorchiasis in the Moscow region

Acute stages of parasitic diseases are rare diagnosed and therefore, clinicians have limited knowledge of their clinical features. We describe five autochtnonous acute cases of opisthorchiasis in Moscow region acquired from eating raw ides (L. idus). The most frequent clinical symptoms were febrile, eosinophilic syndrome with cholestasis. The patients were positive for IgG antibodies to Opisthorchis felineus. Eggs of O. felineus were found in one patient. As egg production O. felineus starts 1 month after exposure and opisthorchiasis cases in Moscow region have low numbers of worms, the sensitivity of microscopy is low. Therefore we consider opisthorchiasis in all patients of unexplained acute fever, pain in upper right abdominal quadrant, and eosinophilia with cholestasis, when patients confirm the ingestion of raw fish. We recommend one day of praziquantel 25 mg/kg TID to patients infected with O. felineus. In previous publications describing the autochtnonous cases of opisthorchiasis in Moscow region the authors supposed that cases of local infection will be found again in Moscow region and this is just a matter of time. The cases reported here confirm that this infection is endemic in Moscow region. The local people living close to rivers especially those who eat raw fish are at risk of infection O. felineus. There is a clear need to undertake special studies pertaining to the ways of promoting people living in Moscow region become aware of opisthorchiasis and to be motivated in preventive measures and treatment.

Anisakis Allergy: Is Aquacultured Fish a Safe and Alternative Food to Wild-Capture Fisheries for Anisakis simplex-Sensitized Patients?

Simple SummaryThe diagnosis of Anisakiasis is documented by the occasional finding of L3 larvae in the infected gastro-intestinal tract. Currently, about 14 allergens have been described, among which Ani s1 and Ani s4, both highly heat-resistant, appear central in Anisakiasis anaphylaxis and necessary to cause allergic reactions. Food has to be considered Anisakis-free only when heat-resistant Anisakis allergens are not present. Background: Anisakis simplex (A. simplex) infection, in humans, causes a series of clinical manifestations affecting the gastro-intestinal tract known as Anisakiasis/Anisakidosis. Patients may also present allergic manifestations such as hives and/or angioedema and even anaphylactic shock. The aim of this study was to investigate whether aquacultured fish could be considered A. simplex-free food and constitute a safe, alternative, wild-capture fish food for Gastro-Allergic Anisakiasis (GAA)-sensitized subjects. Methods: Protein extracts from A. simplex larvae in the third stage (L3) and from edible part of heavily infected horse mackerel (Trachurus trachurus) and aquacultured sea bream, have been tested for A. simplex allergens presence by immunological analysis. Western blot analysis using, as source of specific Anisakis allergens antibodies, serum samples from subjects referring allergic symptoms after raw fish ingestion, was performed. These subjects showed high levels of specific IgE anti A. simplex allergens determined by clinical laboratory tests (ISAC test). Results: Our data demonstrate the presence of Ani s4 allergen in both infected and aquacultured fish extracts, providing a possible interpretation for the allergic manifestations reported by subjects, already sensitized to A. simplex, who ate frozen or well-cooked or, even, aquacultured fish. Conclusions: The present data stimulate more accurate prophylaxis suggestions for Anisakis allergy and more specific controls of fishmeal used in aquaculture.

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.

Foreign body in the ileum after eating shabu-shabu

An asymptomatic 73-year-old man underwent a follow-up colonoscopy after a right hemicolectomy for advanced cancer. A larva was incidentally observed, the head of which was inserted into the ileal mucosa...

Emerging infections: mimickers of common patterns seen in dermatopathology.

The following discussion deals with three emerging infection diseases that any dermatopathologist working in the northern hemisphere can come across. The first subject to be dealt with is gnathostomiasis. This parasitic disease is produced by the third larvarial stage of the parasite that in most patients is associated with the ingestion of raw fish. Epidemiologically, it is most commonly seen in South East Asia, Japan, China, and the American continent, mainly in Mexico, Ecuador, and Peru. Nowadays, the disease is also seen in travelers living in the developed countries who recently came back from visiting endemic countries. The disease produces a pattern of migratory panniculitis or dermatitis with infiltration of eosinophils in tissue. The requirements for making the diagnosis are provided, including clinical forms, common histological findings on skin biopsy as well as the use of ancillary testing. Buruli ulcer, a prevalent mycobacterial infection in Africa, is described from the clinical and histopathological point of view. The disease has been described occasionally in Central and South America as well as in developed countries such as Australia and Japan; Buruli ulcer has also been described in travelers returning from endemic areas. Clinically, the disease is characterized by large, painless ulcerations with undermined borders. Systemic symptoms are usually absent. Classical histological findings include a particular type of fat necrosis and the presence of abundant acid fast bacilli in tissue. Such findings should raise the possibility of this disease, with the purpose of early therapeutically intervention. Lastly, the infection by free living ameba Balamuthia mandrillaris, an emerging condition seen in the US and Peru, is extensively discussed. Special attention is given to clinical and histological characteristics, as well as to the clues for early diagnosis and the tools available for confirmation.

Clinical and Endoscopic Features of Colonic Anisakiasis in Korea.

To analyze the clinical and endoscopic features of colonic anisakiasis. A retrospective chart review of 20 patients with colonic anisakiasis, who were diagnosed by colonoscopy at 8 hospitals between January 2002 and December 2011, was performed. Patients’ mean age was 53.6±10.74 years. Seventy percent patients were men. Acute abdominal pain was a common symptom that mostly developed within 48 hr after the ingestion of raw fish, and which lasted for 1–28 days. Sixty percent patients had ingested raw fish before the diagnosis of colonic anisakiasis and 40% patients were incidentally found to have colonic anisakiasis during the screening colonoscopies. Leukocytosis and eosinophilia were each found in 20% of the patients. In all patients who underwent colonoscopy, the worms were removed with biopsy forceps, except in 1 case, and a definite diagnosis of anisakiasis was made. In some cases of colonic anisakiasis, colonoscopy may be helpful in the diagnosis and treatment to avoid surgical intervention.

АCUTE INFECTION OF OPISTHORCHIS FELINEUS IN MOSCOW: CASES FROM DELIVERED FISH AND CASES IN TOURISTS TRAVELLED TO ENDEMIC REGIONS IN RUSSIA

We describe the human acute opisthorchiasis outbreaks in Moscow region acquired from eating raw Leuciscus idus, Abramis brama and Aspius aspius in 10 patiens: 5 delivered fish from Tyumen and Sverdlovsk regions and 5 – from fish during their travelling to Tomsk and Astrakhan regions. Although, 18 people had identical history of consumption raw fish 10 had clinical symptoms of which the most frequent one was febrile eosinophilic syndrome. Other 8 people had no clinical symptoms. Eggs of O.felineus were found in 10 patients. Due to risk of cholangiocarcinoma in patients infected with O.felineus we recommend one day of praziquantel 25 mg/kg TID. Although opisthorchiasis is not frequently reported in Moscow region, it should be considered in cases of unexplained acute febrile eosinophilic syndrome with cholestasis, especially when patients confirm the ingestion of raw fish.

Low Anisakis-specific IgE prevalence in dyspeptic patients in Italy – a retrospective study

Abstract The aims of this case-control study were to determine the prevalence of Anisakis -specific IgE in patients reporting chronic or acute gastrointestinal (GI) symptoms and to investigate the correlation with raw fish ingestion habits. A group of patients undergoing gastric endoscopy and a control group of healty subjects answered a self-administered questionnaire on their food habits, presence of symptoms (both allergic and not allergic), and general life style. The presence of anti-Anisakis IgE has been evaluated using a serum immunoCAP assay. Our data show a low prevalence of IgE directed against Anisakis allergens in Italy in dyspeptic patients, despite the high consumption of poorly cooked fish. These findings does not correlate with the results of studies from other Mediterranean countries, such as Spain, for example. The general prevalence of Anisakis allergens sensitization in Italy could be further investigated through screenings in the allergic population, especially on those patients who claim to have developed a fish allergy and with history of raw fish consumption. Moreover, the attention should be moved on recent allergic reactions associated with fishing ingestion. This could in fact indicate a recent encounter with the parasite. Finally, we must underline that the evaluation of Anisakis-specific IgG would have probably shown a difference in terms of exposure between the two groups; thus, it might be useful to detect also this antibody class in future population-based studies.

CT findings of gastric and intestinal anisakiasis

PurposeTo illustrate the CT findings of gastrointestinal anisakiasis.Subjects and methodsThe Institutional Review Board approving this retrospective study waived the requirement for informed consent. Review of our emergency department’s clinical records from September 2008 to January 2012 identified 41 consecutive patients who were diagnosed with gastrointestinal anisakiasis. 20 patients were diagnosed with gastric anisakiasis with endoscopically proven Anisakis larvae, and 21 patients were diagnosed with intestinal anisakiasis with positive test results for anti-anisakidae antibody and the presence of intestinal lesions on CT. Two radiologists retrospectively assessed the CT findings.ResultsThe mean time delay from raw fish ingestion to symptom onset was 5.2 h (range 0.5–24 h) in gastric anisakiasis and 39 h (range 12–120 h) in intestinal anisakiasis. Gastric anisakiasis showed marked submucosal edema of the gastric wall (20/20 patients, 100%), increased attenuation of adjacent fat (19/20, 95%), and ascites (14/20, 70%) on CT. Intestinal anisakiasis showed marked submucosal edema of the intestine (21/21 patients, 100%) without showing complete intraluminal occlusion, ascites (21/21, 100%), increased attenuation of adjacent fat (19/21, 90%), and fluid collection in the distal segment of the constricted small intestine (13/21, 62%) on CT.ConclusionSevere submucosal edema with ascites is a characteristic finding of gastrointestinal anisakiasis when compared with other forms of gastroenteritis. When CT shows the typical findings of gastrointestinal anisakiasis, radiologists may suggest the possibility of clinically undiagnosed anisakiasis, especially in intestinal anisakiasis as the diagnosis is sometimes difficult due to the long interval between food intake and symptom onset.

Unusual cause of small intestine obstruction in a child

Anisakiasis is caused by human infection by the anisakis larvae, a marine nematode found in undercooked or raw fish. Infection with the parasite Anisakis simplex is common in Japan and northern European countries. With the increased popularity of eating sushi and raw fish infection with anisakis is expected to rise. We present the case of a 14-year-old boy who had eaten sushi 3 days before the onset of symptoms and had small bowel obstruction caused by enteric anisakiasis. To the best of our knowledge this is the first reported case of intestinal anisakiasis presenting as a bowel obstruction in a child. Enteric anisakiasis is very rare, and its diagnosis is usually made after laparotomy. Nevertheless, when signs of acute abdomen develop after the ingestion of raw fish, such as sushi or sashimi, the possibility of enteric anisakiasis should be considered.

魚介類の生食による寄生虫症

魚介類の生食による寄生虫症

Gastrointestinal Manifestations and Management of Anisakiasis

Anisakiasis is a parasitic disease of the gastrointestinal tract acquired by ingestion of raw fish containing stage 3 larvae. In the present report, we describe a patient who frequently ate raw fish who presented with acute onset of epigastric abdominal pain and a peripheral blood eosinophilia. His symptoms resolved with endoscopic removal of the nematode. Given the increasing consumption of raw fish in Western cultures, anisakiasis should be considered in patients with abdominal pain and a history of raw fish consumption.

A Case of Anisakiasis Invading the Stomach and the Colon at the Same Time after Eating Anchovies

Anisakiasis of the gastrointestinal tract is caused by the ingestion of raw fish or uncooked food infested with Anisakis larvae. A large number of cases of gastric anisakiasis have been reported in countries where the eating of raw fish is customary. However, there have been few reports of anisakiasis of the colon confirmed by colonoscopy and also very few reports of endoscopic ultrasonographic findings of anisakiasis. A 47-year-old man had epigastric pain with nausea after eating raw anchovies. Endoscopy found a living tubular structure penetrating into the lesser curvature of the stomach and the midtranseverse colon area. It was withdrawn with biopsy forceps. We report a case of anisakiasis simultaneously invading the stomach and the colon confirmed by endosopic utrasonographic findings and biopsy findings.

Detection of Kudoa septempunctata 18S Ribosomal DNA in Patient Fecal Samples from Novel Food-Borne Outbreaks Caused by Consumption of Raw Olive Flounder (Paralichthys olivaceus)

Kudoa septempunctata is a newly identified myxosporean parasite of olive flounder (Paralichthys olivaceus) and a suspected causative agent of several food-borne gastroenteritis outbreaks in Japan. Here, we report the detection of K. septempunctata 18S ribosomal DNA in fecal samples of outbreak patients using an efficient method based on real-time PCR. We first performed a spiking experiment to assess whether our previously developed real-time PCR assay was applicable to detect K. septempunctata in feces. Simultaneously, we compared the relative extraction efficacy of K. septempunctata DNA using three commercial kits. Finally, our detection method was validated by testing 45 clinical samples obtained from 13 food-borne outbreaks associated with the consumption of raw flounder and 41 fecal samples from diarrhea patients epidemiologically unrelated to the ingestion of raw fish. We found that the FastDNA Spin Kit for Soil (MP Biomedicals) was the most efficient method for extracting K. septempunctata DNA from fecal samples. Using this kit, the detection limit of our real-time PCR assay was 1.6 × 10(1) spores per g of feces, and positive results were obtained for 21 fecal and 2 vomitus samples obtained from the food-borne outbreaks. To our knowledge, this is the first report to describe the detection of K. septempunctata DNA in patient fecal samples. We anticipate that our detection method will be useful for confirming food-borne diseases caused by K. septempunctata in laboratory investigations.

生食用魚類の喫食によると推定された集団下痢症の疫学調査成績

生食用魚類の喫食によると推定された集団下痢症の疫学調査成績

Clinical Characteristics of Seven Patients with Aeromonas Septicemia in a Japanese Hospital

The genus Aeromonas comprises flagellated gram-negative rods widely distributed in freshwater, estuarine and marine environments. Aeromonas species may cause a variety of illnesses in humans, such as enterocolitis and septicemia, especially in warmer tropical or subtropical environments. To recognize the characteristics of Aeromonas septicemia in Japan, we reviewed laboratory data and medical records in our hospital. During 11 years (from 2000 to 2010), Aeromonas septicemia was observed in seven patients involving six female subjects. Six patients were observed in summer or fall. The incidence of Aeromonas septicemia was about 0.07 per 1000 admissions, and two out of the seven patients died. All patients had underlying diseases such as malignancy (six patients) and choledocholithiasis (one patient). Two patients developed septicemia within two days after ingesting raw seafood. Five patients developed Aeromonas septicemia > 48 h after admission. Fever was present in all patients, and four out of the seven patients developed septic shock. All patients developed monomicrobial septicemia. A. hydrophila was isolated from five patients, and A. caviae and A. veronii biovar sobria were isolated from one patient each. Most antimicrobial agents had high activity against the isolated strains. However, a carbapenem-resistant strain appeared in one patient during treatment and led to death. Aeromonas septicemia is uncommon in temperate areas but can occur particularly in warm seasons. Immunocompromised conditions and recent ingestion of raw fish or shellfish are important characteristics of developing Aeromonas septicemia.

Narrow band imaging enhancement could improve gastric anisakis detection

Gastrointestinal anisakiasis is a parasitic disease acquired by humans after ingestion of raw fish infected with third stage larvae of the nematode Anisakis simplex. Even if considered a rare disease in Western countries, it is underestimated in many Italian regions with large fishing-based activities and widespread consumption of raw sea food.

Detection of new Anaplasmataceae in the digestive tract of fish from southeast Asia

The bacteria of the genus Neorickettsia are strict intracellular bacteria of the Anaplasmataceae family. They are transmitted to their definitive host (humans and animals) by ingestion of raw fish, snails or aquatic insects that are parasitised by infected trematodes. Among them, three species (N. sennetsu, N. helminthoeca and N. risticii) are known to cause diseases in mammals (humans and animals) [1] but two have not yet been associated with the disease (SF agent, and Ehrlichia species trout isolate). About 50 million people in the world are infested by food-borne trematodes, predominantly in southeast Asia. Uncooked fish and shellfish consumption is the principal mode of transmission. Fish-borne trematodes in humans are increasing in endemic areas, and are emerging in Europe and America [2]. Globalisation, international travels and new cooking fashions such as eating raw fish ‘Sushi’ and ‘Sashimi’ are likely to lead to new emerging infections caused by Neorickettsia. We studied here the presence of Neorickettsia in fish and fish-based ingredients that are usually consumed uncooked in southeast Asia. A total of 126 fish and 19 ingredients made from uncooked fish were studied. Between January and February 2007, 57 frozen fish and seven ingredients imported from Thailand and Vietnam were bought in the Asian market in Marseille. In March 2007, 69 other fish preserved in 70% ethanol and 12 supplementary ingredients were collected in Cambodia. After dissection of defrosted fish, stomach and intestine were collected for direct examination for parasite by binocular microscope, and then processed for PCR analysis, culture and histology. Found worms were kept in the 70% ethanol for morphological and molecular identification of the 18S gene by using primers P6.F and 18sr2R [3]. Following DNA extraction of the fish digestive tract, DNA of Anaplasmataceae was detected by rrS PCR using primers: Ehr16SD and Ehr16SR [1]. We completed rrS sequences found by using specific primers (Ncs-614F: 5¢-TTG-GTG-TAG-GGG-TGAAAT-CC, Ncs-606R: 5¢-CCC-CTA-CAC-CAA-AAATTC-CA) and non-specific primers (NcsMA-14F: 5¢-GGC-AGA-CGG-GTG-CGT-AAC, Ncs-1321R: 5¢-GAC-GGG-CAG-TGT-GTA-CAA-GA) newly designed respectively by alignment of rrS sequences of three new Anaplasmataceae with Neorickettsia sequences available in GenBank and by alignment of rrS sequence of all Anaplasmataceae available in GenBank. DNA fragment of the citrate synthase gene (gltA) of Anaplasmataceae was identified by using F1 and R1b as previously described [1]. Negative controls consisted of DNA extracted from human colon, uninfected fish and sterile water. DNA of A. phagocytophilum was used as positive control of rrS PCR and N. sennetsu for gltA PCR. We designed new primers CG-442F (5¢-GGC-CCATAC-CCC-ARN-AAT-G) and CG-877R (5¢-GCDAGT-TTT-TGT-CAR-GTN-GA) to confirm the species of positive fishes. The sequence diversity of the rrS gene was used to define a new species when it was at least 3% between bacterial species. The new genus was definite when rrs gene sequence similarities were lower than 97% [4]. We identified 35 worms in six Channa striata imported into Marseille from Thailand. Sequence analysis of the 18S gene showed that all worms were belonging to Neoechinorhynchus pseudemydis species. Three new Anaplasmataceae were detected in three fish by rrS PCR by using Ehr16SD and Ehr16SR primers (Table 1). After completion of the rrS sequences, the Anaplasmataceae from the stomach of Channa striata fish imported from Thailand was identified as a new genus with a Corresponding author and reprint requests: P. Brouqui, URMITE CNRS ⁄ IRD UMR 6236, IFR 48, Universite de la Mediterranee, Faculte de Medecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France E-mail: philippe.brouqui@univmed.fr

Acute Intestinal Obstruction Due to Intestinal Anisakiasis Resolved with Conservative Therapy

Intestinal anisakiasis is rarely diagnosed because it is thought to be uncommon and is poorly recognized. It produces severe abdominal pain and an inflammatory reaction often resulting in reactive intestinal obstruction, which is sometimes treated with an unnecessary laparotomy as acute abdomen or intestinal obstruction. We reported a 58-year-old female with acute intestinal obstruction caused by intestinal anisakiasis, which resulted in a self-limiting clinical course. The diagnosis was based on a history of recent ingestion of raw fish and abdominal computed tomographic findings of partial thickening of the intestinal wall accompanied by focal luminal narrowing with ascites. In spite of the severity of the abdominal pain, the bowel obstruction induced by inflammation and edema was resolved with conservative treatment after three weeks. Accordingly, intestinal anisakiasis was considered in the differential diagnosis of intestinal obstruction, which can be treated with conservative therapy.