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Endoscopic image of the patient's brother. An Anisakis larva was seen in the stomach, and the adjacent mucosa was swollen.
Source publication
The clinical characteristic of gastrointestinal anisakiasis is severe abdominal pain after eating raw fish. Intestinal anisakiasis is more uncommon than gastric anisakiasis. Most patients with intestinal anisakiasis need hospitalization because anisakiasis can cause intestinal obstruction, ileus, peritonitis or intestinal perforation. We report a c...
Citations
... As stated above, the endoscopically removal of larvae in GA and the surgical intervention of granulomas in IA represent a remedy to the disease and its symptoms in humans. However, despite the fact that there is not a large clinical evidence for a significant success of the use of chemical treatment in the clinical manifestation, it should be mentioned that the use of Albendazole, Prednisolone and Olopatadine hydrochloride have found to improve symptoms in cases of IA (Toyoda and Tanaka, 2016). Furthermore, treatment with corticosteroid and an anti-allergic agent could be an option for patients with IA and GA (Toyoda and Tanaka, 2016). ...
... However, despite the fact that there is not a large clinical evidence for a significant success of the use of chemical treatment in the clinical manifestation, it should be mentioned that the use of Albendazole, Prednisolone and Olopatadine hydrochloride have found to improve symptoms in cases of IA (Toyoda and Tanaka, 2016). Furthermore, treatment with corticosteroid and an anti-allergic agent could be an option for patients with IA and GA (Toyoda and Tanaka, 2016). ...
... As stated above, the endoscopically removal of larvae in GA and the surgical intervention of granulomas in IA represent a remedy to the disease and its symptoms in humans. However, despite the fact that there is not a large clinical evidence for a significant success of the use of chemical treatment in the clinical manifestation, it should be mentioned that the use of Albendazole, Prednisolone and Olopatadine hydrochloride have found to improve symptoms in cases of IA (Toyoda and Tanaka, 2016). Furthermore, treatment with corticosteroid and an anti-allergic agent could be an option for patients with IA and GA (Toyoda and Tanaka, 2016). ...
... However, despite the fact that there is not a large clinical evidence for a significant success of the use of chemical treatment in the clinical manifestation, it should be mentioned that the use of Albendazole, Prednisolone and Olopatadine hydrochloride have found to improve symptoms in cases of IA (Toyoda and Tanaka, 2016). Furthermore, treatment with corticosteroid and an anti-allergic agent could be an option for patients with IA and GA (Toyoda and Tanaka, 2016). ...
An overview around the systematics, biology and ecology of the species so far included in the genus Anisakis is here reported. Immunopathological features related to the clinic forms of human anisakiasis due to the zoonotic species (i.e., A. simplex (s.s.) and A. pegreffii) as well its diagnosis, are summarized. The epidemiology of anisakiasis, whose incidence is particularly high in those countries having raw fish consumption habits, is reviewed.
... Gastrointestinal anisakiasis has become common worldwide with the spread of raw fish consumption [1][2][3]. Approximately 20,000 cases of anisakiasis are found around the world annually, of which 90% involve the stomach, and only 4-5% involve the small intestine [4,5]. The low incidence of anisakiasis in the small intestine is because Anisakis are easily found in the stomach endoscopically, thus preventing Anisakis migration into the small intestine [6]. ...
... In the patients with anisakiasis, the parasites can be retained in the intestinal lumen and remain alive for up to 1 week at most, so conservative treatment is possible [4]. However, the small intestine has a weaker wall than the stomach, and perforation can occur in patients with intestinal anisakiasis. ...
Background
Anisakiasis is a parasitic infection caused by Anisakis worms found in raw fish. Most cases of anisakiasis occur in the stomach and rarely occur in the intestine. It is extremely rare for live larvae to break through the intestine into the mesentery and cause severe intestinal ischemia. Anisakiasis can be treated conservatively, because the larvae will die in approximately 1 week, but, sometimes, a serious condition can arise, as in this case. We report the first case of extraluminal anisakiasis in which a live Anisakis worm caused severe intestinal ischemia.
Case presentation
The patient was a 26-year-old woman who ate squid a week prior. She had abdominal pain and was admitted to our emergency department. On physical examination, abdominal guarding and rebound tenderness were present in her lower abdomen. Contrast-enhanced computed tomography showed ascites, the whirl sign, localized submucosal edema of the intestinal wall, and a dilated small bowel segment with edema. We suspected the strangulated small bowel obstruction based on the CT-scan findings. To rule out the strangulated small bowel obstruction, laparoscopic exploration was performed. Bloody ascites in the pouch of Douglas and severe inflammation in 20 cm of the ileum were observed. An Anisakis larva had perforated the intestinal wall and was found alive in the mesentery. The ileum had developed a high degree of ischemia, so the affected section was resected. Histopathological examination revealed that the Anisakis worm body was in the inflamed mesentery and caused a high degree of ischemia in the intestinal tract. The patient was discharged 9 days after surgery.
Conclusions
A living Anisakis larva punctured the mesentery of the small intestine, resulting in severe intestinal ischemia. As seen in this case, intestinal anisakiasis may cause serious symptoms, and a low threshold for performing diagnostic laparoscopy for the early diagnosis of bowel ischemia secondary to anisakiasis can be useful in determining the definite diagnosis and indications for resection.
... (3). Patients are mainly infected with Anisakis simplex(2).Pseudoterranova decipiens, A. physeteris, A. pregreffi and Contracaecum species are other anisakids known to cause man infection. ...
Anisakiasis is human zoonotic parasitic infection caused by a nematode parasite called Anisakis. This infection is usually reported in Asian countries where consumption of raw seafood is common. Very few cases have been reported in North America. We present the case of a female Canadian patient with an Anisakis larvae in an incarcerated ventral hernia. Cases of Anisakis infections are exceedingly rare in western countries, with very few previous reports describing extra-gastrointestinal cases. Diagnosis is often difficult since the symptoms of anisakiasis are not pathognomonic. As the larvae cannot survive in the body, conservative treatment might be effective in intestinal anisakiasis and surgery is usually performed when complications are encountered. Preventive measures are crucial and include educating the public about the risks of raw fish consumption and the importance of visually inspecting consumed fish and freezing it before ingestion to kill the larvae and prevent the infection. Keywords: Anisakis, Anisakiasis, Incarcerated hernia
... Infection was associated with abdominal pain, nausea and diarrhea with very high eosinophilia and the formation of granulomata in gastrointestinal tract if the larvae were not removed Morsy et al., (2017). Freezing for few days and prompt cooking of fish is enough to kill the larvae and prevent infection Toyoda and Tanaka (2016). ...
... The disease is characterized by the acute onset of epigastric pain 1.4 ± 1.1 days after ingesting the contaminated food [1]. Anisakis larvae are reportedly killed by exposure to some medications such as peppermint, creosote, and albendazole in vitro in some animal models [5][6][7]. Although the clinical effectiveness of these medications after oral administration remains unclear, the endoscopic removal of the live larva from the gastric mucosa has been shown to cure the disease [1]. ...
... Gastric anisakiasis is a well-known parasitic disease resulting from the consumption of raw marine food infected with third-stage larvae of the nematode A. simplex, which causes severe epigastric pain and allergic reactions [5]. Although most patients with gastric anisakiasis are reportedly from Japan, due to the traditional Japanese habit of eating raw seafood (sashimi and sushi), the popularization of the food to other world regions has increased the number of patients of gastric anisakiasis globally [1]. ...
Anisakiasis is a parasitic disease caused by the ingestion of raw or uncooked seafood infected with third-stage larvae of the anisakid nematodes. A 45-year-old Japanese man presented with epigastric pain and itchy skin with rash on his arm, chest, and back after eating vinegar-marinated raw mackerel sushi. He underwent an emergent endoscopic examination using narrow-band imaging (NBI) that revealed two anisakidlarvae. NBI showed the larvae more clearly than white light imaging on the cardiac region of the stomach. We sprayed L-menthol on the larvae for stopping their movement and then easily removed them using biopsy forceps. The macroscopic examination and genotype analysis of the specimens revealed the two larvae as belonging to A. simplex sensu stricto. Our case demonstrates the usefulness of endoscopic examination with NBI and of the L-menthol spray in visualizing and immobilizing the larvae for removal.
... Infection with type II 3 rd stage Anisakis larvae was associated with abdominal pain, nausea and diarrhea with very high eosinophilia and the formation of granulomata in gastrointestinal tract if the larvae were not removed (Morsy et al, 2017). Freezing for few days and prompt cooking of fish is enough to kill the larvae and prevent infection (Toyoda and Tanaka, 2016). ...
Study of the prevalence and identification of the juveniles of Anisaxis spp. in the marine fishes is of great value for biologists and medical parasitologists. In this study, Red Sea fishes at Hurghada, Egypt were examined for adult and larval helminthes. Among others, Anisakis simplex third stage larvae; type I & type II were identified from three fish hosts; Caranx sexfasciatus, Cephalopholis miniata and Variola louti. The prevalence of larvae was reported and their light and SEM morphological characters were illustrated. The encountered larvae were compared with previously described ones from Red Sea fishes from Egypt, Yemen and Arabia Saudi, and their zoonotic pathogenesis was discussed.
... 7,8 Although there have been few reports on the efficacy of steroid therapy, this anti-inflammatory treatment could potentially resolve intestinal anisakiasis symptoms and reduce the length of hospital stay. [9][10][11] Anisakiasis should be considered in patients with abdominal pain after raw fish ingestion. However, there are differences in the presentation, diagnostic methods, and management between gastric anisakiasis and intestinal anisakiasis. ...
A 50-year-old man presented with epigastric pain after eating raw mackerel. Abdominal computed tomography revealed submucosal edema of the gastric antrum and pelvic ileum. Gastroscopy revealed an Anisakis simplex in the gastric antrum. His epigastric pain resolved after endoscopic removal of the Anisakis; however, he developed right lower quadrant pain the following day. Abdominal computed tomography showed submucosal edema of the terminal ileum involving different ileal loops, which was not present on admission. The patient developed delayed intestinal anisakiasis. A serving of raw fish may contain more than one Anisakis. After gastric anisakiasis, a second Anisakis may cause intestinal anisakiasis.
... Intestinal anisakiasis can elicit severe symptoms of bowel obstruction that are also present in acute abdominal diseases, and it is therefore mostly treated surgically (12), whereas colonic anisakiasis is usually asymptomatic and a collateral finding during colonoscopy (12). In young or middle-aged patients without severe concomitant diseases, the intestinal form may be successfully treated by conservative methods, including antibiotics, analgesics, and corticosteroids in combination with an antiallergic agent (10,13,14). In chronic cases of intestinal anisakiasis, a standard approach of treatment with albendazole has been widely employed, although it has resulted in conflicting conclusions. ...
Anisakiasis is among the most significant emerging food-borne parasitoses contracted through consumption of thermally unprocessed seafood harbouring infective Anisakis spp. larvae. The efficacy of the currently applied anthelminthic therapy in humans and in model organisms has not proven sufficient, so alternative solutions employing natural compounds combined with chemical inhibitors should be explored. By testing toxicity of the natural monoterpenes nerolidol and farnesol, and conventional anthelminthics abamectin and levamisole, in the presence/absence of MK-571 and Valspodar that inhibit the ABC transporter proteins Multidrug Resistance Protein (MRP-like) and P-glycoprotein (P-gp), we determined the preliminary traits of Anisakis detoxifying mechanisms. We found that Anisakis P-gp and MRP-like transporters have a role in the efflux of the tested compounds, which could be useful in the design of novel anthelminthic strategies. Expectedly, transporter activation and efflux fluctuated over time; they were synchronously active very early post-exposure, while the activity of one transporter dominated over the other in a time-dependent manner. MRP-like transporters dominated in the efflux of farnesol and P-gp dominated in efflux of nerolidol, while both were active in effluxing levamisole. The highest toxicity was exerted by abamectin, a P-gp inhibitor per se , also eliciting the highest oxidative stress in treated Anisakis larvae. We suggest that ß-tubulin, observed for the first time as a core element in Anisakis cuticle, might represent an important target for the tested compounds.
... Diagnosis of anisakidosis initially relies on a detailed history of recent seafood consumption and may be confirmed by direct visualization and examination of the larvae. Removal of the worm by endoscopy/colonoscopy [96] or surgery [97] allows concurrent diagnosis and treatment of gastric/intestinal form of the disease, but non-invasive methods such as sonography and X-ray have also been proven as valuable diagnostic tools [98][99][100]. Haematological evaluations may show leukocytosis, e.g. ...
... It has also been shown that administration of corticosteroids like 6-methylprednisolone (1 mg/kg/24 h for 5 days) may be a useful option to treat the acute intestinal anisakiasis as an alternative to surgical resection [130]. Moreover, prednisolone (5 mg/day for 10 days) and olopatadine hydrochloride (10 mg/day for 6 weeks) have demonstrated promising results to resolve intestinal anisakiasis symptoms [100]. ...
Parasites from the family Anisakidae are widely distributed in marine fish populations worldwide and mainly nematodes of the three genera Anisakis, Pseudoterranova and Contracaecum have attracted attention due to their pathogenicity in humans. Their life cycles include invertebrates and fish as intermediate or transport hosts and mammals or birds as final hosts. Human consumption of raw or underprocessed seafood containing third stage larvae of anisakid parasites may elicit a gastrointestinal disease (anisakidosis) and allergic responses. Excretory and secretory (ES) compounds produced by the parasites are assumed to be key players in clinical manifestation of the disease in humans, but the molecules are likely to play a general biological role in invertebrates and lower vertebrates as well. ES products have several functions during infection, e.g. penetration of host tissues and evasion of host immune responses, but are at the same time known to elicit immune responses (including antibody production) both in fish and mammals. ES proteins from anisakid nematodes, in particular Anisakis simplex, are currently applied for diagnostic purposes but recent evidence suggests that they also may have a therapeutic potential in immune-related diseases.
