Expression and functionality of allergenic genes regulated by simulated gastric juice in Anisakis pegreffii.

To better understand the molecular mechanisms underlying allergens and parasite immunity and discover the stage-enriched gene expression of fish-borne zoonotic nematodes in the stomach, we used RNA-seq to study the transcriptome profiles of Anisakis pegreffii (Nematoda: Anisakidae, AP) in simulated gastric juice. Mobile L3 larvae were incubated in simulated medium at 37 °C in 5% CO2 (AP-GJ) and the control group larvae were collected in PBS under the same conditions (AP-PBS). We found that the sequences of A. pegreffii were highly similar to Toxocara canis sequences. Among the transcripts, there would be 138 up-regulated putative genes and 251 down-regulated putative genes in AP-GJ group. Several lipid binging-related genes were more highly expressed in AP-GJ larvae. Moreover, 17 allergen genes were up-regulated and 29 were down-regulated in AP-GJ larvae. Eleven allergen genes belonged to one or more of the following three categories: biological process, cellular component, and molecular function. According to KEGG analysis, the main pathways that were represented included protein processing in transcription, immune system, cancer, and infectious disease. In particular, the most significant changes in the expression of parasite-derived allergen products occurred in AP-GJ larvae. This study helps us to extend our understanding of the biology of the fish-borne zoonotic parasite A. pegreffii and could be helpful for more precise risk assessment and providing guidelines for allergic consumers.

El ciclo evolutivo de parásitos de la familia anisakidae. Hacia una prospectiva de medidas sanitarias de control / The evolutionary cycle of parasites of the anisakidae family. towards a prospective of sanitary control measures

Las larvas de nematodos en los peces, generalmente corresponde a especies de la familia Anisakidae, son gusanos redondos, sin segmentación; con hospedadores intermediarios y definitivos y un huésped accidental que es el humano, en quién va producir una enfermedad parasitaria del tacto digestivo, mundialmente conocida como anisakiasis, asociada a reacciones de hipersensibilidad debido a los alérgenos del parásito. La presencia de estos parásitos en los productos de la pesca, deberá ser controlada con medidas preventivas establecidas en la legislación sanitaria de países; estableciendo profilaxis, medidas higiénicas como consumir el pescado cocido, o sometido previamente a congelación a -20°C por 48 a 72 horas, para prevenir la enfermedad. Cuando enfocamos hacia una prospectiva de medidas sanitarias de control preventivo, se plantea el establecimiento de un plan de requerimientos de alimentos seguros, basado en el análisis de riesgos y control de puntos críticos (HACCP), constituido por un paquete de documentos escritos basados en los principios de seguridad de alimentos; que contendrá: el análisis de riesgos; controles preventivos; programas en la cadena de suministros; delineamiento de los procedimientos para ser seguidos por monitoreo, acciones correctivas y verificación. Estará basado en las obligaciones que se puedan establecer bajo jurisdicción regulatoria para el pescado, en cuanto a la pesca o captura, manipulación a bordo o en la orilla y mecanismos de conservación hasta el expendio; que dé lugar a un manual de buenas prácticas de manufactura, análisis de riesgo y controles preventivos de riesgos para la regulación de alimentos de origen marino para consumo humano

The larvae of nematodes in fish generally correspond to species of the Anisakidae family, they are round worms, without segmentation; with intermediate and definitive hosts and an accidental host that is human, in whom it will produce a parasitic disease of the digestive tract, worldwide known as anisakiasis, associated with hypersensitivity reactions due to parasite allergens. The presence of these Parasites in fishery products should be controlled with preventive measures established in the sanitary legislation of countries; establishing prophylaxis, hygienic measures such as consuming the cooked fish, or previously subjected to freezing at -20 ° C for 48 to 72 hours to prevent the disease. When we focus on a prospective of preventive control sanitary measures, the establishment of a plan for safe food requirements based on risk analysis and control of critical points (HACCP), constituted by a package of written documents based on the principles, is considered food safety; which will contain: risk analysis; preventive controls; programs in the supply chain; delineation of the procedures to be followed by monitoring, corrective actions and verification. It will be based on the obligations that can be established under the regulatory jurisdiction for fish, in terms of fishing or capture, handling on board or on the shore and conservation mechanisms up to the sale; that results in a manual of good manufacturing practices, risk analysis and preventive risk controls for the regulation of food of marine origin for human consumption

A Case Report of Adhesional Small Bowel Obstruction Caused by Extraintestinal Anisakiasis.

BACKGROUND: Small bowel obstruction (SBO) is a common diagnosis made in the emergency department (ED). We present a case with an unusual underlying cause of SBO: extraintestinal infection with an Anisakis roundworm. CASE REPORT: A healthy young woman with no prior abdominal surgery presented with epigastric abdominal pain, nausea, and anorexia 1 day after eating a raw oyster. Laboratory studies were significant for 14% eosinophilia. Initial abdominal computed tomography (CT) showed small bowel inflammation and small-volume ascites. After discharge home, she returned on day 14 of illness with a closed-loop SBO, to which she was predisposed by an adhesion formed in association with an eosinophilic abscess containing an Anisakis roundworm. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Anisakiasis is an uncommon cause of common symptoms with which patients may present to EDs. The diagnosis should be considered in patients presenting with abdominal pain and recent ingestion of raw seafood, with suspicion raised further by the presence of focal gastric or small bowel inflammation and ascites on abdominal CT. Extraintestinal anisakiasis can cause inflammation leading to intraabdominal adhesions, a sequela of which is small bowel obstruction. If suspicion for gastric or intestinal anisakiasis is high, treatment with endoscopic removal or albendazole may be initiated.

Gastro-allergic anisakiasis: The first case reported in Colombia and a literature review / Anisakiasis gastro-alérgica, primera descripción de un caso en Colombia y revisión bibliográfica

Anisakiasis is a zoonotic parasitic disease caused by consumption of raw or undercooked fish or seafood infected with nematodes of the Anisakis, Pseudoterranova or Contracaecum genera. Here, we describe the first case of anisakiasis in Colombia and summarize the available literature. A 52-year-old female with a history of abrupt-onset sharp epigastric pain, nausea, vomit, diarrhea, and urticaria following fish consumption consulted the health service. The physical examination revealed moderate tenderness of the epigastric region; the laboratory evaluation showed leukocytosis and a simple X-ray and ECG showed no abnormalities. The diagnosis was made by endoscopic examination, which revealed a thickened gastric wall and a moving larval worm. An Anisakis larva was found and extracted endoscopically, which relieved the pain of the patient. Clinically, anisakiasis may present as a gastric, intestinal, extragastrointestinal or allergic disease. Diagnosis and treatment of anisakiasis are made by a dietary history, direct visualization and endoscopic extraction of possible larvae, which is the only effective therapy.

La anisakiasis es una enfermedad parasitaria zoonótica causada por el consumo de pescados o mariscos crudos o poco cocidos infectados con nematodos de los géneros Anisakis, Pseudoterranova y Contracaecum. Se describe el primer caso de anisakiasis en Colombia y se resume la literatura médica disponible. Una mujer de 52 años de edad consultó por dolor epigástrico agudo de inicio abrupto, náuseas, vómitos, diarrea y urticaria después de consumir pescado. El examen físico reveló sensibilidad moderada en el epigastrio. El examen de laboratorio evidenció leucocitosis, en tanto que la radiografía simple y el electrocardiograma no reflejaron ninguna anormalidad. El diagnóstico se hizo mediante una endoscopia de vías digestivas altas, la cual reveló engrosamiento de la pared gástrica y un parásito en movimiento. Se encontró una larva de Anisakis y se la extrajo por endoscopia, lo que alivió el dolor de la paciente. Clínicamente, la anisakiasis puede presentarse como una enfermedad gástrica, intestinal, en otros sistemas o alérgica. El diagnóstico se hace con base en la elaboración del historial alimentario del paciente y la visualización directa de las larvas; el único tratamiento efectivo consiste en su extracción endoscópica.

Anisakiasis gastro-alérgica, primera descripción de un caso en Colombia y revisión bibliográfica / Gastro-allergic anisakiasis: The first case reported in Colombia and a literature review

Resumen La anisakiasis es una enfermedad parasitaria zoonótica causada por el consumo de pescados o mariscos crudos o poco cocidos infectados con nematodos de los géneros Anisakis, Pseudoterranova y Contracaecum. Se describe el primer caso de anisakiasis en Colombia y se resume la literatura médica disponible. Una mujer de 52 años de edad consultó por dolor epigástrico agudo de inicio abrupto, náuseas, vómitos, diarrea y urticaria después de consumir pescado. El examen físico reveló sensibilidad moderada en el epigastrio. El examen de laboratorio evidenció leucocitosis, en tanto que la radiografía simple y el electrocardiograma no reflejaron ninguna anormalidad. El diagnóstico se hizo mediante una endoscopia de vías digestivas altas, la cual reveló engrosamiento de la pared gástrica y un parásito en movimiento. Se encontró una larva de Anisakis y se la extrajo por endoscopia, lo que alivió el dolor de la paciente. Clínicamente, la anisakiasis puede presentarse como una enfermedad gástrica, intestinal, en otros sistemas o alérgica. El diagnóstico se hace con base en la elaboración del historial alimentario del paciente y la visualización directa de las larvas; el único tratamiento efectivo consiste en su extracción endoscópica.

Abstract Anisakiasis is a zoonotic parasitic disease caused by consumption of raw or undercooked fish or seafood infected with nematodes of the Anisakis, Pseudoterranova or Contracaecum genera. Here, we describe the first case of anisakiasis in Colombia and summarize the available literature. A 52-year-old female with a history of abrupt-onset sharp epigastric pain, nausea, vomit, diarrhea, and urticaria following fish consumption consulted the health service. The physical examination revealed moderate tenderness of the epigastric region; the laboratory evaluation showed leukocytosis and a simple X-ray and ECG showed no abnormalities. The diagnosis was made by endoscopic examination, which revealed a thickened gastric wall and a moving larval worm. An Anisakis larva was found and extracted endoscopically, which relieved the pain of the patient. Clinically, anisakiasis may present as a gastric, intestinal, extragastrointestinal or allergic disease. Diagnosis and treatment of anisakiasis are made by a dietary history, direct visualization and endoscopic extraction of possible larvae, which is the only effective therapy.

Effectiveness of five flavored Tunisian olive oils on Anisakis larvae type 1: application of cinnamon and rosemary oil in industrial anchovy marinating process.

BACKGROUND: Anisakidosis is caused by the ingestion of raw or undercooked fish or cephalopods containing viable Anisakis larvae. Several natural extracts, oils, essential oils, and their compounds have been tested against Anisakis. In this study the effectiveness of Tunisian olive oil with different spices or plants (cardamom, cinnamon, ginger, laurel, and rosemary) was tested against Anisakis larvae type 1. RESULTS: For the in vitro test, larvae were submerged separately in the oils mentioned above and observed to check viability. Cinnamon oil was the most effective against parasites with lethal time (LT) scores being LT50 = 1.5 days and LT100 = 3 days, followed by rosemary. Laurel, cardamom, and ginger oils were less effective. For the ex vivo experiment, cinnamon, and rosemary oils were tested in anchovy fillets, previously artificially parasitized. Cinnamon was the most effective against parasites (dead after 4 days) as compared to rosemary (7 days). CONCLUSION: The use of cinnamon and rosemary-flavored olive oil in the industrial marinating process can be considered as an efficient alternative to the freezing process required by European Regulation EC No 853/2004 to devitalize Anisakis. © 2019 Society of Chemical Industry.

Activity of tea tree (Melaleuca alternifolia) essential oil against L3 larvae of Anisakis simplex.

Nematicidal activity of Melaleuca alternifolia essential oil, commonly known as tea tree oil (TTO), was assayed in vitro against L3 larvae of Anisakis simplex. The results showed a mortality of 100% for concentrations between 7 and 10 µL/mL after 48 h of incubation, obtaining an LD50 value of 4.53 µL/mL after 24 hours and 4.27 µL/mL after 48 hours. Concentration-dependent inhibition of acetylcholinesterase was observed for tea tree essential oil showing inhibition values of 100% at 100 µL/mL. This fact suggests that TTO may act as an AChE inhibitor. Terpinen-4-ol was discarded as main larvicide compound as it did not show larvicidal or anticholinesterase activity. The data obtained suggest that the essential oil of Melaleuca alternifolia may have a great therapeutic potential for the treatment of human anisakiasis.

Multiple acute parasitization by Anisakis simplex.

Hypersensitivity to Anisakis is an increasingly prominent medical problem throughout the world, due to a better understanding of diseases induced by parasites and to modern culinary habits of eating raw or undercooked fish. We describe the case of a patient who presented epigastric pain, wheals, erythema, and pruritus 3 hours after the ingestion of fish. More than 200 larvae were obtained by endoscopy. However, the patient only developed an immune response with specific immunoglobulin E and eosinophilia peaking at day 18 and decreasing during the 17-month follow-up. Only eosinophilia reached normal limits.

Nematoides anisaquídeos e cestoides Trypanorhyncha de importância em saúde pública em Aluterus monoceros (Linnaeus, 1758) no Estado do Rio de Janeiro, Brasil / Larvae of Anisakidae nematodes and Trypanorhyncha cestodes of public health importance in Aluterus monoceros (Linnaeus, 1758) in Rio de Janeiro State, Brazil

Entre maio e agosto de 2006, foram adquiridos 100 espécimes de peixe-porco, Aluterus monoceros em estabelecimentos de pescado nos municípios de Niterói e Rio de Janeiro. Os peixes foram medidos, necropsiados, filetados e seus órgãos analisados. Foram encontrados 16 peixes parasitados por larvas de nematoides anisaquídeos pertencentes às espécies Anisakis sp. e Contracaecum sp., com prevalência de 1 e 16 por cento, intensidade média de 2 e 3,31 e abundância média de 0,02 e 0,53, respectivamente. Duas larvas de Anisakis sp. foram encontradas no mesentério de um peixe; e de Contracaecum sp. no fígado e mesentério, com amplitude de variação da intensidade de infecção de 1 a 9. Cinquenta e um peixes mostravam-se parasitados no fígado e mesentério por cestoides da ordem Trypanorhyncha. As espécies colhidas foram Floriceps saccatus e a Callitetrarhynchus speciosus, com a prevalência de 45 e 6 por cento, intensidade média de 3,17 e 2,83, variando de 1 a 20 e 1 a 5, e abundância média de 1,43 e 0,06, respectivamente. Larvas de Anisakis sp. e essas duas espécies de Trypanorhyncha foram registradas pela primeira vez parasitando A. monoceros.

One hundred specimens of unicorn leatherjacket, Aluterus monoceros purchased from markets of municipalities of Niterói and Rio de Janeiro from May to August 2006. The fishes were measured, necropsied, fileted and analysed their organs. Sixteen fishes were parasitized by nematode Anisakidae: Anisakis spp. and Contracaecum sp. with respectively, 1 and 16 percent of prevalence, 2 and 3.31 of mean intensity, and 0.02 and 0.53 of mean abundance. Two larvae of Anisakis sp. were found in mesentery of one fish and Contracaecum sp. was found in liver and mesentery with 1 to 9 specimens of range of infection. Fifty-one fishes were parasitized on the liver and mesentery by metacestodes of Trypanorhyncha. The collected species were Floriceps saccatus and Callitetrarhynchus speciosus with respectively, 45 and 6 percent of prevalence, 3.17 and 2.83 of mean intensity, and 1.43 and 0.06 of mean abundance, the range of infection by F. saccatus was 1 to 20 and by C. speciosus was 1 to 5. Anisakis sp. and these two species of Trypanothyncha were reported in A. monoceros for the first time.

Anisakiasis, un atentado culinario prevenible contra el tracto gastrointestinal / Anisakiasis, a preventable culinary attempt for the gastrointestinal tract

Nuevos hábitos culinarios se han esparcido, desde las culturas originales, para convertirse en costumbres universales. El riesgo que esta globalización puede aparejar probablemente sea subestimado, a no ser que los gastroenterólogos estén conscientes de nuevas enfermedades relacionadas, por ejemplo, con la presencia de agentes infecciosos. Anisakiasis es una de tales enfermedades, relacionadas con la ingestión de pescado crudo o poco cocido, que se presenta en la cultura japonesa, (“el sushi”, “sashimi”), áreas en Sudamérica (“ceviche”), España (“anchoas de vinagre”) y Países Bajos (el pescado crudo). La prevención, está relacionada con la manipulación apropiada, la cocción adecuada y el almacenamiento en frío del pescado. Anisakiasis podría convertirse en un problema clínico serio, debido al compromiso gástrico con ulceraciones, dolor y raras veces pseudotumores en la pared digestiva. El compromiso del intestino delgado es también considerable, secundario a una reacción inflamatoria local severa con edema y estenosis intestinal que simula una obstrucción intestinal. El tratamiento esteroidal generalmente resuelve la crisis, de lo contrario la cirugía es requerida. La reacción alérgica a la presencia del parásito puede llegar a ser un grave problema. La presente revisión trata de aspectos clínicos patológicos, así como del ciclo del parásito, instrumentos diagnósticos y manejo terapéutico.

New culinary habits have been spread, from their original cultures, to become universally known today. They are probably not or insufficiently considered as risky, unless the gastroenterologists become aware of new diseases related for instance with the presence of infective agents. Anisakiasis is one of such diseases, related with the ingestion of raw or undercooked fish, with occurrence in the Japanese culture, (“Sushi”, “sashimi”), areas in South America (“Ceviche”), Spain (“vinegar anchovies”) and The Netherlands (Raw fish). Prevention is related with proper manipulation, cooking and fish frozen storage. Anisakiasis could become a severe clinical problem, because of gastric involvement with ulcerations, pain and rarely intramural pseudotumors. Small intestine involvement is also considerable due to severe inflammatory local reaction, with edema and intense narrowing of the intestinal lumen that mimics intestinal obstruction. Steroidal treatment often solves the crisis. Allergic and general reaction to the occurrence of the parasite is also sometimes a big problem. The present review deals with clinical pathological aspects, as well as parasite cycle, diagnostic tools and treatment.

Pathological and ultrastructural studies on anisakis simplex rudolphi-1809 infecting Carangoides bajad with special reference to intestinal maturation in puppies.

Thirty five (70%) of 51 Carangoides bajad were naturally infected with Anisakis simplex during the period from September 2007 to January 2008. The fish were collected from eastern south coast of the Red Sea at Hurgada. The morphological and ultrastructures of Anisakis larvae and adults, and the induced lesions in the fish (intermediate host), five puppies (final host) were orally given infected fish. The body of the larvae is gradually tapering towards the anterior part. It is covered by striated ornamentation longitudinally and horizontally, except the anterior region which is smooth. The morphological and ultrastrutural examinations of the anterior body end of larvae showed a prominent boring tooth, 3 pairs of lips inconspicuous and an excretory ventral pore between the rudimentary subventral lips. The anal end showed a distinct mucron and a slit-shaped anus. The pathological studies revealed encapsulated larvae with concentrical fibrous connective tissue infiltrated, with macrophages and lymphocytes on the surface of liver, spleen and peritoneum of the infected fish. The macrophages aggregated together to form the denser part of the capsule, and invaded the adjacent parenchymal tissue. The hepatocytes, under the affected capsule were necrotic and invaded by melanomacrophages.

Anisakis pegreffi etiological agent of gastric infections in two Italian women.

Two cases of gastric anisakiasis have been documented in two Italian women who had consumed raw anchovies (Engraulis encrasicolus). The first patient was a 49-year-old woman presenting with epigastric pain and bloody vomiting after ingestion of marinated (vinegar) raw anchovies. During the esophagogastroduodenoscopy (EGDS) a white color worm was detected and extracted from cardia by means of biopsy forceps. The second patient was a 59-year-old woman with irritable bowel syndrome and gastritis, who underwent to periodical EGDSs. In the course of the last EGDS, a white color round worm on antrum and a small polyp on the fundus of the stomach were observed. The two nematodes have been identified as L3 larvae of the genus Anisakis by a light microscope, and as Anisakis pegreffi by polymerase chain reaction-restriction fragment length polymorphism. The molecular identification of the etiological agent at the species level allows to identify what Anisakidae species play a zoonotic role and which are the fish host species.

Anisakidae parasitos de congro-rosa, Genypterus brasiliensis Regan, 1903 comercializados no estado do Rio de Janeiro, Brasil de interesse na saúde pública / Anisakidae parasites of cusk-eel, Genypterus brasiliensis Regan, 1903 purchased in the Rio de Janeiro state, Brazil and of interest in public health

The aim of this study was to identify the species Anisakidae, of interest to public health, parasitizing the cusk-eel, Genypterus brasiliensis Regan, 1903 purchased in markets ofNiteroi and Rio de Janeiro counties, Brazil, emphasizing their parasite indexes, sites of infection and higienic-sanitary importance. Seventy-four specimens ofG brasiliensis were necropsiedfrom October 2002 to September 2003. Twenty fish specimens (27 percent>) were parasitized by live larvae of Anisakidae. The collected species were represented by Anisakis physeteris, Anisakis simplex, Anisakis sp., Pseudoterranova decipiens, Pseudoterranova sp., Hysterothylacium sp., Raphidascaris sp., Contracaecum sp. and Terranova sp. The species Anisakis sp. and A. simplex presented the higher prevalences, both with 13,5 percent whereas A. physeteris presented the lower prevalence 1,35 percent. The other species, Pseudoterranova sp., P. decipiens, Hysterothylacium sp., Raphidascaris sp., Contracaecum sp. and Terranova sp. presented prevalences of 10,8 percent, 5,4 percent, 2,7 percent, 4,1 percent, 1,4 percent and 1,4 percent, respectively. The sites of infection were, the mesentery, stomach and intestinal seroses, intestine, ovary and musculature.

O objetivo deste estudo foi determinar as especies de Anisakidae parasitando congro-rosa, Genypterus brasiliensis Regan, 1903 comercializados nos mercados dos municipios de Niterói e Rio de Janeiro, Brasil, de interesse em saúde pública, enfatizando seus índices parasitarios, sitios de infecção e importância higiénico-sanitária. Setenta e quatro espécimes de G. brasiliensis foram necropsiados de outubro de 2002 a setembro de 2003. Vinte peixes (27 por cento) estavam parasitados por larvas vivas de nematóides Anisakidae: Anisakis physeteris, Anisakis simplex, Anisakis sp., Pseudoterranova decipiens, Pseudoterranova sp., Hysterothylacium sp., Raphidascaris sp., Contracaecum sp. e Terranova sp. As especies Anisakis sp. e A. simplex foram as especies que apresentaram maior prevalência, ambos com 13,5 por cento e A. physeteris a menor prevalência 1,35 por cento. As demais especies, Pseudoterranova sp., P decipiens, Hysterothylacium sp., Raphidascaris sp., Contracaecum sp. e Terranova sp. apresentaram as seguintes prevalências 10,8 por cento, 5,4 por cento, 2,7 por cento, 4,1 por cento, 1,4 por cento e 1,4 por cento, respectivamente. Os sitios de infecção foram o mesentério, serosa do estómago e intestinal, instestino, ovario e musculatura.

[Gastrointestinal anisakiasis. Study of a series of 25 patients]. / Anisakiasis gastrointestinal. Estudio de una serie de 25 pacientes.

INTRODUCTION: Infection with the parasite Anisakis simplex is common in Japan and northern European countries. The number of reported cases in Spain has increased since the first description in 1991. The aim of the present study was to evaluate the incidence, clinical patterns, histopathological lesions, treatment, and outcome of Anisakis simplex infection in our environment. MATERIAL AND METHOD: Cases of gastrointestinal anisakiasis diagnosed in our center from December 1999 to January 2002 were studied. Only patients with detection of the parasite in oral endoscopy or the surgical specimen and those with elevated levels of specific IgE to Anisakis simplex, a clinical picture compatible with anisakiasis, or a history of raw fish intake were included. Epidemiological, clinical and laboratory data, as well as diagnostic, histopathologic and therapeutic features, and outcome in these patients were recorded. RESULTS: Twenty-five cases of gastrointestinal anisakiasis were diagnosed during the study period, representing an incidence of 3.87 cases per 100 000 inhabitants/year. All the patients had ingested raw anchovies. Two groups were observed. The first group was composed of 10 patients with a gastric form of the infection, in which the main symptom was epigastralgia (90%). Oral endoscopy was performed in all patients and the parasite was detected in five (50%). The second group was composed of 15 patients with intestinal involvement in which the main manifestations were symptoms mimicking appendicitis (80%). The most frequent finding of laparotomy and/or imaging tests (abdominal ultrasonography, intestinal transit, abdominal CAT) was terminal ileitis (80%). Seven patients underwent surgery: intestinal resection was performed in four with detection of Anisakis simplex in three. Eosinophilic infiltration was found in all surgical specimens. Treatment was symptomatic in most of the patients and outcome was favorable in all. CONCLUSIONS: Infection with Anisakis simplex should be investigated in patients with abdominal pain after intake of raw fish, ileitis of unclear origin, or eosinophilic gastroenteritis.

A case of acute gastric anisakiasis provoking severe clinical problems by multiple infection.

Acute gastric anisakiasis with multiple anisakid larvae infection is reported. A 68-year-old woman residing in Busan, Korea, had epigastric pain with severe vomiting about 5 hours after eating raw anchovies. Four nematode larvae penetrating the gastric mucosae in the great curvature of the middle body and fundus were found and removed during gastro-endoscopic examination. Another one thread-like moving larva was found in the great curvature of upper body on the following day. On the basis of their morphology, the worms were identified as the 3rd stage larvae of Anisakis simplex. This case is acute gastric anisakiasis provoking severe clinical problems by the multiple infection and the greatest number of anisakid larvae found in a patient in Korea.

[Anisakiasis: a borderline disorder]. / Anisakiasi: una patologia di confine.

Anisakis simplex is a nematode which can parasitize many different kinds of fish or cephalopods (codfish, salmon, tuna, mackerel, hake, etc). Anisakis simplex can cause different diseases in humans. The human being acquires the larvae by eating raw or undercooked seafood. Acute anisakiasis is probably caused by an inflammatory and/or allergic response in the digestive tract mucosa with abdominal pain. It can also induce IgE-mediated reactions with several clinical manifestations ranging from urticaria/angioedema to anaphylaxis. Chronic anisakiasis results from abscesses or eosinophilic granulomas caused by parasite invasion. This later form can mimic appendicitis, duodenal ulcer, inflammatory bowel diseases and intestinal obstruction. An early gastroduodenoscopy can confirm the diagnosis and prevent the complications. Serodiagnosis of anisakiasis is difficult since many Anisakis antigens show cross-reativity complications. In fact many people have high IgE titles in the absence of obvious allergic reactions to seafoods. As preventive measures heating for 10 min over 65 degrees C or freezing (minus 20 degrees for 24 h) destroys the infectivity of the larval stage but not always prevent allergic reactions.

[1st case of extra-gastrointestinal anisakiasis in a human diagnosed in Italy]. / Primo caso di anisakiosi extragastrointestinale nell'uomo diagnosticato in Italia.

A case of extra-gastrointestinal infection by Anisakis in a woman living in Catania (Sicily, Southern Italy) is described. The patient complained of severe pain in the ileocecal region, and a diagnosis of acute appendicitis led to an appendectomy. During the intervention, a laparoscopic exploration showed a nodule on the large omentum that was surgically removed. Parasitological diagnosis was achieved on the basis of morphological observations carried out on the histological sections of the nodule.