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Anisakiasis

Anisakis is a genus of parasitic nematodes, which have life cycles


involving fish and marine mammals. They are infective to humans and
cause anisakiasis. People who produce immunoglobulin E in response to
this parasite may subsequently have an allergic reaction, including
anaphylaxis, after eating fish that have been infected with Anisakis species.
Etymology
The genus Anisakis was created in 1845 by Flix Dujardin as a subgenus
of the genus Ascaris Linnaeus, 1758. Dujardin did not explicit the
etymology but stated that the subgenus included the species in which the
males have unequal spicules ("mles ayant des spicules ingaux"); thus
the name Anisakis is based on anis- (Greek prefix for different) and akis
(Greek for spine or spicule). Two species were included in the new
subgenus, Ascaris (Anisakis) distans Rudolphi, 1809 and Ascaris (Anisakis)
simplex Rudolphi, 1809.
Life cycle
Anisakis species have complex life cycles which pass through a
number of hosts through the course of their lives. Eggs hatch in seawater,
and larvae are eaten by crustaceans, usually euphausids. The infected
crustacean is subsequently eaten by a fish or squid, and the nematode
burrows into the wall of the gut and encysts in a protective coat, usually on
the outside of the visceral organs, but occasionally in the muscle or
beneath the skin. The life cycle is completed when an infected fish is eaten
by a marine mammal, such as a whale, seal, or dolphin. The nematode
excysts in the intestine, feeds, grows, mates and releases eggs into the
seawater in the host's feces. As the gut of a marine mammal is functionally
very similar to that of a human, Anisakis species are able to infect humans
who eat raw or undercooked fish.
The known diversity of the genus has increased greatly over the past
20 years, with the advent of modern genetic techniques in species
identification. Each final host species was discovered to have its own
biochemically and genetically identifiable "sibling species" of Anisakis,
which is reproductively isolated. This finding has allowed the proportion of

different sibling species in a fish to be used as an indicator of population


identity in fish stocks.
Morphology
Anisakids share the common features of all nematodes; the
vermiform body plan, round in cross section and a lack of segmentation.
The body cavity is reduced to a narrow pseudocoel. The mouth is located
anteriorly, and surrounded by projections used in feeding and sensation,
with the anus slightly offset from the posterior. The squamous epithelium
secretes a layered cuticle to protect the body from digestive juices.
As with all parasites with a complex life cycle involving a number of
hosts, details of the morphology vary depending on the host and life cycle
stage. In the stage which infects fish, Anisakis species are found in a
distinctive "watch-spring coil" shape. They are roughly 2 cm long when
uncoiled. When in the final host, anisakids are longer, thicker and more
sturdy, to deal with the hazardous environment of a mammalian gut.
Health implications
Anisakids pose a risk to human health through intestinal infection with
worms from the eating of underprocessed fish, and through allergic
reactions to chemicals left by the worms in fish flesh.
Anisakiasis
Anisakiasis is a human parasitic infection of the gastrointestinal tract
caused by the consumption of raw or undercooked seafood containing
larvae of the nematode Anisakis simplex. The first case of human infection
by a member of the family Anisakidae was reported in the Netherlands by
Van Thiel, who described the presence of a marine nematode in a patient
suffering from acute abdominal pain. It is frequently reported in areas of the
world where fish is consumed raw, lightly pickled or salted. The areas of
highest prevalence are Scandinavia (from cod livers), Japan (after eating
sushi and sashimi), the Netherlands (by eating infected fermented herrings
(maatjes)), and along the Pacific coast of South America (from eating
ceviche). Fewer than ten cases occur annually in the United States.
Development of better diagnostic tools and greater awareness has led to
more frequent reporting of anisakiasis.

Within a few hours of ingestion, the parasitic worm tries to burrow


though the intestinal wall, but since it cannot penetrate it, it gets stuck and
dies. The presence of the parasite triggers an immune response; immune
cells surround the worms, forming a ball-like structure that can block the
digestive system, causing severe abdominal pain, malnutrition and
vomiting. Occasionally, the larvae are regurgitated. If the larvae pass into
the bowel or large intestine, a severe eosinophilic granulomatous response
may also occur one to two weeks following infection, causing symptoms
mimicking Crohn's disease.
Diagnosis can be made by gastroscopic examination, during which the 2cm larvae are visually observed and removed, or by histopathologic
examination of tissue removed at biopsy or during surgery.
Raising consumer and producer awareness about the existence of anisakid
worms in fish is a critical and effective prevention strategy. Anisakiasis can
be easily prevented by adequate cooking at temperatures greater than
60C or freezing. The FDA recommends all shellfish and fish intended for
raw consumption be blast frozen to -35C or below for 15 hours or be
regularly frozen to -20C or below for seven days. Salting and marinating
will not necessarily kill the parasites. Humans are thought to be more at risk
of anisakiasis from eating wild fish than farmed fish. Many countries require
all types of fish with potential risk intended for raw consumption to be
previously frozen to kill parasites. The mandate to freeze herring in the
Netherlands has virtually eliminated human anisakiasis.
Allergic reactions
Even when thoroughly cooked, Anisakis larvae pose a health risk to
humans. Anisakids (and related species such as the sealworm,
Pseudoterranova species, and the codworm Hysterothylacium aduncum)
release a number of biochemicals into the surrounding tissues when they
infect a fish. They are also often consumed whole, accidentally, inside a
fillet of fish.
Anisakid larvae in the body cavity of a herring (Clupea harengus)
Acute allergic manifestations, such as urticaria and anaphylaxis, may
occur with or without accompanying gastrointestinal symptoms. The
frequency of allergic symptoms in connection with fish ingestion has led to
the concept of gastroallergic anisakiasis, an acute IgE-mediated

generalized reaction. Occupational allergy, including asthma, conjunctivitis,


and contact dermatitis, has been observed in fish processing workers.
Sensitivization and allergy are determined by skin-prick test and detection
of specific antibodies against Anisakis. Hypersensitivity is indicated by a
rapid rise in levels of IgE in the first several days following consumption of
infected fish.
Treatment
For the worm, humans are a dead-end host. Anisakis and
Pseudoterranova larvae cannot survive in humans, and will eventually die.
In some cases, the infection will resolve with only symptomatic treatment.
In other cases, however, infection can lead to small bowel obstruction,
which may require surgery, although treatment with albendazole alone
(avoiding surgery) has been reported to be successful. Intestinal
perforation (an emergency) is also possible.

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