Anisakiasis Infection: Description, Causes and Risk Factors:ICD-9-CM: 127.1.Family of large nematode worms found in the stomach and intestines of fish-eating birds and marine mammals, infection being acquired from marine fish; human cases of anisakiasis have been reported from Japan.Alternative Name: Anisakis.Infection of the intestinal wall by larvae of Anisakis marina and other genera of anisakid nematodes (Contracaecum, Phocanema), characterized by intestinal eosinophilic granuloma and symptoms like those of peptic ulcer or tumor.Alternative Name: Herring-worm disease.Anisakiasis is a zoonotic disease. Anisakiasis is the disease caused by infection with Anisakis worms. It is frequently reported in areas of the world where fish is consumed raw, lightly pickled or salted. The disease is caused by the ingestion of larval nematodes in raw seafood dishes such as sushi, sashimi, ceviche, and pickled herring. They are infective to humans and cause Anisakiasis, and fish which have been infected with Anisakis spp. can produce an anaphylactic reaction in people who have become sensitized to Immunoglobulin E. Anisakis spp. have a complex life cycle which passes through a number of hosts through the course of its life. Aniskiasis is contracted when inadequately cooked fish containing these nematode larvae are eaten. Infection is diagnosed after surgical intervention for intestinal obstruction or peritonitis, which is caused by necrotizing, eosinophilic, granulomatous inflammation.Adult stages of Anisakis simplex or Pseudoterranova decipiens reside in the stomach of marine mammals, where they are embedded in the mucosa, in clusters. Unembryonated eggs produced by adult females are passed in the feces of marine mammals. The eggs become embryonated in water, and first-stage larvae are formed in the eggs. The larvae molt, becoming second-stage larvae, and after the larvae hatch from the eggs, they become free-swimming.Larvae released from the eggs are ingested by crustaceans.The ingested larvae develop into third-stage larvae that are infective to fish and squid.The larvae migrate from the intestine to the tissues in the peritoneal cavity and grow up to 3 cm in length. Upon the host's death, larvae migrate to the muscle tissues, and through predation, the larvae are transferred from fish to fish. Fish and squid maintain third-stage larvae that are infective to humans and marine mammals.When fish or squid containing third-stage larvae are ingested by marine mammals, the larvae molt twice and develop into adult worms. The adult females produce eggs that are shed by marine mammals.Humans become infected by eating raw or undercooked infected marine fish.Symptoms:After ingestion, the anisakid larvae penetrate the gastric and intestinal mucosa, causing the symptoms of anisakiasis. Within hours after ingestion of infected larvae, violent abdominal pain, nausea, and vomiting may occur. Occasionally the larvae are coughed up. If the larvae pass into the bowel, a severe eosinophilic granulomatous response may also occur 1 to 2 weeks following infection, causing symptoms mimicking Crohn's disease.Diagnosis:Diagnosis can be made by gastroscopic examination during which the 2 cm larvae are visualized and removed, or by histopathologic examination of tissue removed at biopsy or during surgery.Treatment Option:The treatment of choice is surgical or endoscopic removal.Medical Treatment Include: Treatment with albendazole 400 mg po as a single dose may be effective. Cooking to > 50° C (> 122° F) or freezing for > 24 h destroys larvae; they may resist pickling, salting, and smoking.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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