anisakiasis

Gastrointestinal infection caused by accidental ingestion of uncooked saltwater fish containing nematodes of the family Anisakidae. Etiology: 1) Anisakis simplex 2) Pseudoterranova decipiens Epidemiology: 1) most cases in Japan, Netherlands & Chile 2) sushi, pickled green herring & ceviche respectively, implicated 3) larvae killed by cooking to 60 degrees C or freezing at -20 degrees C for 3 days 4) larvae not killed by smoking, marinating, or salting Pathology: 1) larvae may pentrate mucosa of stomach 2) larvae may enter small bowel & penerate mucosa eliciting eosinophilic granulomatous response Clinical manifestations: 1) violent upper abdominal pain may occur within hours of ingestion a) nausea & occasionally vomiting b) may mimick acute abdomen 2) symptoms may appear 1-2 weeks after ingestion a) intermittent abdominal pain b) diarrhea c) nausea d) fever e) may resemble Crohn's disease Laboratory: 1) direct visualization with upper endoscopy 2) outlining of worms by radiocontrast studies 3) histopathology of biopsied material 4) eggs not found in stool since larvae do not mature in humans 5) Anisakis IgE in serum Differential diagnosis: - Crohn's disease

References

Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 919