Ascites Caused by Intestinal Anisakiasis: A Case Report and Literature Review.

Anisakiasis is a parasitic infection affecting the human gastrointestinal tract. It is caused by the consumption of contaminated, raw or inadequately cooked fish or squid, which is typically used for making sushi and sashimi. Most cases involve gastric anisakiasis, whereas intestinal anisakiasis is rare. This report describes the case of a 63-year-old Japanese woman with a history of raw fish consumption who presented with acute-onset abdominal pain and vomiting. Abdominal computed tomography (CT) demonstrated thickened small bowel loops and ascites on the liver surface. The patient was admitted for supportive care. On the second day of hospitalization, contrast-enhanced abdominal CT revealed that the ascites had moved from the liver surface to the pouch of Douglas. On the fifth day of hospitalization, the patient was discharged with a substantial improvement in abdominal pain. Five days after the discharge, her eosinophil count was elevated, and parasitic disease was therefore suspected. Anti-Anisakis IgG/A and IgE (RAST) antibody levels were elevated, confirming the diagnosis of intestinal anisakiasis. A review of 51 reported cases of intestinal anisakiasis suggests that the presence of ascites and measurement of anti-Anisakis antibody titers are helpful for diagnosis in cases presenting with nonspecific abdominal symptoms after consumption of raw or undercooked fish.

Bactericidal effect of water-washing methods on Vibrio vulnificus contaminated in a raw fish Konosirus punctatus: water type, temperature, and pH.

This study aimed to evaluate a method for effectively reducing Vibrio vulnificus contamination in fish based on the type of washing water and method. Texture profiles and sensory evaluations were performed to determine the effect of the developed method on the quality and preference of the samples. The selected fish sample was Konosirus punctatus, which is mainly consumed in Asian countries. Various factors that could affect the survival rate of V. vulnificus were reviewed, including water type, temperature, exposure time, organic acids, pH, and washing methods. As a result, immersion and washing with filtered water with pH adjusted to 4.0 using acetic acid showed a high bactericidal effect of 2.5 log MPN/100 g. Furthermore, this method showed no statistically significant effect on the texture and sensory characteristics of fish. The results of the present study suggest a simple and effective method for preventing V. vulnificus infection in raw fish.

Double balloon enteroscopy in the detection and removal of jejunal anisakiasis: Case report.

A 53-year-old Japanese man presented to the emergency department with epigastric pain and bloating. Computed tomography revealed a thickening of the jejunal wall and proximal dilation. Double-balloon enteroscopy was performed to investigate the jejunal thickening, which revealed an anisakis larva in the jejunum with an associated ulcer. The larva was removed using endoscopic forceps, after which there was immediate improvement of symptoms. Further patient interview determined that he had consumed marinated mackerel the day before the onset of symptoms. After diagnosis of small intestinal anisakiasis, he was successfully treated using double-balloon enteroscopy. Its use for small intestinal anisakiasis is rare, and this case may be the first instance in the jejunum. Removal of the anisakis larva led to a clear diagnosis and a quick resolution of symptoms. A history of raw fish consumption a few days before the onset of abdominal symptoms and abnormal findings on computed tomography scans are key to the diagnosis of small intestinal anisakiasis. Double-balloon enteroscopy was thought to be a safe means of making accurate diagnoses and appropriate treatment of our patients.

Fulminant necrotizing fasciitis by Edwardsiella tarda in a patient with alcoholic liver cirrhosis: A case report.

We herein present a unique and extremely rare fulminant case of Edwardsiella tarda infection-related necrotizing fasciitis. The patient had alcoholic cirrhosis and preferred to consume raw fish. He experienced painful swelling of the right forearm one day after he got a minor injury when falling from the ladder, and visited our hospital. His accompanied symptoms were diarrhea and general fatigue. His consciousness got deteriorated after the admission. The lesion of the right forearm had spread and the color had deteriorated with epidermolysis in a few hours. Necrotizing soft-tissue infection was suspected, and emergency debridement of the swollen forearm was performed 4 hours after the admission. However, unfortunately, he died of sepsis approximately 5 hours later. Histological examination of the biopsy specimen revealed features consistent with those of necrotizing fasciitis. The bacterial cultures of blood and the wound identified E. tarda. Since this microorganism is usually isolated from aquatic environments and can cause intestinal infection, sometimes followed by bacteremia especially in immunocompromised hosts, two possible infection routes were suspected. One route was from the skin injury, leading to bacteremia. Another possible route was per oral: orally taken E. tarda invaded deeper tissues from the intestine and reach the bloodstream, leading to extraintestinal infections, although direct evidence remains elusive. Raw fish eaten 1 week prior is considered to be the most possible contaminated food. Overall mortality rate of E. tarda bacteremia is very high and the clinician should pay attention on characteristic clinical findings of E. tarda infection on cirrhotic patients.

Characterization of ready-to-eat fish surface as a potential source of contamination of Vibrio parahaemolyticus biofilms.

The worldwide consumption of ready-to-eat seafood products has steadily increased due to a range of health benefits. However, depending on the handling or cutting process of raw fish, ready-to-eat sashimi can be exposed to microbiological risks that can lead to foodborne infection by marine pathogens. Since surface characteristics are key factors for microbial adhesion and biofilm formation, the present study aims to determine the correlation between raw fish skin properties and Vibrio parahaemolyticus biofilm formation. We analyzed V. parahaemolyticus biofilms (ATCC 17802; initially inoculated ca. 2 or 4 log CFU/cm2) on fish skin (gizzard shad, pomfret, red snapper, and mackerel; fish species served as sashimi without peeling the skin) formed under simulated marine environments (incubating in artificial seawater with rocking motion at 30 °C, the maximum temperature of seasonal seawater) for 24 h. The characteristics of fish skin were determined using confocal laser scanning microscopy/scanning electron microscopy. V. parahaemolyticus showed higher biofilm counts on fish skins than on stainless steel, which was used as a control (P < 0.05). In particular, V. parahaemolyticus formed biofilms with significantly higher levels of bacterial populations on gizzard shad and pomfret (ca. 5 log CFU/cm2; P < 0.05), highlighting the relationship between the biofilm formation level and the characteristics of gizzard shad and pomfret skins. The surface roughness of fish skins, including the main roughness parameters (Ra, Rq, and Rz), influenced the attachment of V. parahaemolyticus (P < 0.05). Additionally, images of V. parahaemolyticus biofilms suggested that different topographical profiles of fish species (e.g., mucus, unique structural features, etc.) could cause V. parahaemolyticus to exhibit different biofilm phenotypes, such as sticking to or entangling on the fish skin surface. The major findings of this study provide various phenotypic adhesions of V. parahaemolyticus to fish skin in considerations of the potential hazard for the consumption of ready-to-eat sashimi served with its skin.

Monks: A Population at Risk for Liver Fluke and Skin-Penetrating Helminths.

Monks cannot cook received raw meat dishes and should walk barefoot while working. This population lacks both a survey of parasitic infection and a proper prevention and control policy. Five hundred and fourteen monks from the Ubolratana, Ban Haet, and Ban Phai Districts of Kh on Kaen Province were enrolled in this study. A stool container and questionnaire were collected from each study participant. Stool samples were processed by formalin ethyl acetate concentration and agar plate culture techniques. We then analyzed the results and risk factors to demonstrate associations. The prevalence of overall parasites, liver flukes, and skin-penetrating helminths were 28.8%, 11.1%, and 19.3%, respectively. Raw fish dish offerings were associated with opisthorchiasis (ORcrude 3.32; 95% CI 1.53-7.20). The risk factors for skin-penetrating helminths were older age (ORcrude 5.02; 95% CI 2.2-11.17), being a long-term ordinate (ORcrude 3.28; 95% CI 1.15-9.34), smoking (ORcrude 2.03; 95% CI 1.23-3.36), and chronic kidney disease with other underlying disease (ORcrude 20.7; 95% CI 2.54-190.1). The protective factors for skin-penetrating helminths were secular education above primary education (ORcrude 0.41; 95% CI 0.25-0.65) and having received health education about parasitic infection (ORcrude 0.47; 95% CI 0.28-0.80). Wearing shoes at times other than alms work does not show a protective effect against skin-penetrating helminths (ORcrude 0.86; 95% CI 0.51-1.46). These findings support the recommendation for a strict Rule of Discipline regarding raw meat ingestion and allowing shoes to be worn for protection against skin-penetrating helminths in high-risk situations.

Asymptomatic gastric anisakiasis detected in gastric cancer screening: A case report.

Anisakiasis is a parasitic disease caused by Anisakis simplex and has become an emerging zoonosis as preferences for eating raw or undercooked seafood have become more common. Few case reports of asymptomatic anisakiasis have been published to date. A 79-year-old asymptomatic man underwent esophagogastroduodenoscopy (EGD) for gastric cancer screening. The gastroenterologist diagnosed superficial gastritis without any malignant lesions but found an Anisakis larva while reviewing EGD images. The physician performed a second EGD and removed the larva. The patient reported that he ate the flatfish sashimi for dinner on the day before the first EGD. This case indicates the existence of asymptomatic gastric anisakiasis, indicating that anisakiasis incidence may have previously been underestimated.

A case of Shewanella algae-induced bacteremia in Japan: Case report and literature review.

Shewanella algae (S. algae) is a rare bacterium that causes infectious diseases in humans. Herein, we present a case of an 84-year-old man with S. algae-induced bacteremia and performed a review of 12 cases identified via a literature search and this case. Literature review of previous reports in Japan have revealed that 69.2% of patients with S. algae-induced bacteremia had a history of contact with fresh fish. Appropriate interviews of patients, especially in the hot season, and the accurate identification of the causative bacterium, by using techniques such as MALDI-TOF-MS and genetic testing, are necessary if S. algae or other bacteria from the genus Shewanella are detected in blood-culture tests.

A curious case of Lactococcus garvieae bacteremia associated with adenocarcinoma.

Lactococcus garvieae is a pathogen typically acquired from the consumption of raw seafood or unpasteurized dairy products. Here, we present the unique case of a middle-aged gentleman who presented with back pain, originally thought to be muscle spasms due to poor posture and heavy lifting. Initial radiological imaging showed evidence of a lumbar epidural abscess and lung nodule. Upon further work-up, L. garvieae was isolated in blood and abscess cultures. It was later hypothesized that the L. garvieae bacteremia might have an association with adenocarcinoma of the lung.

Determination of the Most Efficient Household Technique for the Reduction of Pesticide Residues from Raw Fish Muscles.

Substantial quantities of pesticides are routinely applied to enhance agricultural crop production. Pesticides used in this way continuously accumulate in the environment and in foods. Harvested crops contain pesticide residues at various concentrations, with potential harmful impacts on human health. Hence, it is of value to identify techniques for the effective decontamination of tainted foods. However, cleaning with water or household agents, e.g., acetic acid and sodium bicarbonate, are recognized treatments for the efficient degradation of pesticides from vegetables and fruits. There is an apparent void of information about the decontamination treatments for raw fishes using household agents that are affordable for all classes of consumers. Hence, the present study was performed to determine the most efficient household technique for reducing pesticide residue levels from precooked raw fish to ensure the utmost food safety. Fish muscles of four species of fishes, viz., Clarias gariepinus, Channa striatus, Anabas testudineus and Trichogaster trichopterus, were treated with six treatments: washing with running tap water (T1), dipping in normal water (T2), dipping in 2% salt solution (T3), dipping in 2% vinegar (T4), dipping in 0.1% sodium bicarbonate solution (T5) as well as dipping in 0.1% sodium bicarbonate solution + 2% vinegar + 2% salt solution + lemon juice (T6), as fish muscle is the major consumable portion of fish. The current study demonstrated that the removal percentage of lindane, heptachlor, aldrin, endosulfan, dieldrin, endrin, DDT, methoxychlor and cypermethrin residues against the treated household treatments, in downward order, were soaking in 0.1% sodium bicarbonate solution + 2% vinegar + 2% salt solution + lemon juice solution (T6) > soaking in 2% vinegar (T4) solution > soaking in 0.1% sodium bicarbonate (T5) solution > soaking in 2% salt (T3) solution > washing with running tap water (T1) > soaking in stable normal water (T2). The treatment of raw fish muscle samples by soaking them in 0.1% sodium bicarbonate solution + 2% vinegar + 2% salt solution + lemon juice was found to be the most efficient household treatment, performing significant reductions (%) in pesticide concentration: 72−80% (p < 0.05) in Channa striata, 71−79% (p < 0.05) in Clarias gariepinus, 74−80% (p < 0.05) in Anabas testudineus as well as 78−81% (p < 0.05) in Trichogaster trichopterus before cooking.

Detection and characterization of Kudoa thunni from uncooked yellowfin tuna (Thunnus albacares) in Southeast Asia.

Myxosporean parasites Kudoa spp. have been reported in several marine fish species worldwide. However, little is known about the contamination of these parasites in raw fish in Southeast Asia, where the consumption demand of uncooked fish is increasing. In 2019, the occurrence of several cases of raw yellowfin tuna (Thunnus albacares) obtained from retail shops with the presence of unknown white, nodular cysts within the musculature have raised public health concerns for the consumption of raw marine fish in Vietnam. Microscopic examination revealed numerous myxospores with the quadratic shape of the Kudoidae. Morphologically, stained spores detected in this study are suspected to Kudoa thunni. To confirm the suspected Kudoa species, further examination of the 18S small-subunit (SSU) was conducted and the results of nucleotide sequence analysis obtained from nodular cysts revealed 99.18-100% identity to that of Kudoa thunni sequences available in GenBank. Detection of K. thunni infection in tuna in Southeast Asia highlights the need for appropriate surveillance and control measures to ensure high quality standards and safety on raw fish production and consumption.

IgE-mediated gastroallergic anisakiasis with eosinophilic oesophagitis: a case report.

BACKGROUND: Anisakiasis is an emerging zoonosis caused by the fish parasitic nematode Anisakis infecting the gastrointestinal tract. CASE PRESENTATION: We describe a case of a 58-year-old woman diagnosed with gastro-allergic anisakiasis, in which the patient developed an acute food-induced IgE-mediated hypersensitivity reaction as well as concurrent gastro-intestinal manifestations after consumption of raw fish. The patient presented with epigastric pain, anaphylaxis and acute dysphagia caused by eosinophilic oesophagitis. DISCUSSION: Anisakis allergy should be considered as causative agent in patients presenting with acute urticarial rash, anaphylaxis and/or abdominal manifestations, especially when symptoms occur after consumption of seafood. Moreover, eosinophilic oesophagitis may be a rare but important complication of Anisakis infection. Endoscopic evaluation with esophageal biopsies should therefore be considered if suggestive symptoms are present. Patients with confirmed gastroallergic anisakiasis are advised to properly freeze or cook fish prior to consumption, although caution is advised, since heat-stable allergen proteins have been described. An adrenaline auto-injector should be prescribed.

Tackling Vibrio parahaemolyticus in ready-to-eat raw fish flesh slices using lytic phage VPT02 isolated from market oyster.

The opportunistic pathogen V. parahaemolyticus is a major causative agent for seafood-borne illness worldwide. It also causes severe vibriosis in aquaculture animals, affecting seafood production with huge economic loss. These issues are getting worse due to the current global warming in oceans, spread of antibiotic resistance, and changes in consumer preference toward ready-to-eat (RTE) food items including seafood. To answer the urgent need for sustainable biocontrol agents against V. parahaemolyticus, we isolated and characterized a novel lytic bacteriophage VPT02 from market oyster. VPT02 lysed antibiotic resistant V. parahaemolyticus strains including FORC_023. Moreover, it exhibited notable properties as a biocontrol agent suitable for seafood-related settings, like short eclipse/latent periods, high burst size, broad thermal and pH stability, and no toxin/antibiotic resistance genes in the genome. Further comparative genomic analysis with the previously reported homologue phage pVp-1 revealed that VPT02 additionally possesses genes related to the nucleotide scavenging pathway, presumably enabling the phage to propagate quickly. Consistent with its strong in vitro bacteriolytic activity, treatment of only a small quantity of VPT02 (multiplicity of infection of 10) significantly increased the survival rate of V. parahaemolyticus-infected brine shrimp (from 16.7% to 46.7%). When applied to RTE raw fish flesh slices, the same quantity of VPT02 achieved up to 3.9 log reduction of spiked V. parahaemolyticus compared with the phage untreated control. Taken together, these results suggest that VPT02 may be a sustainable anti-V. parahaemolyticus agent useful in seafood-related settings including for RTE items.

An investigation of Human Clonorchiasis prevalence in an Endemic County in Guangxi Zhuang Autonomous Region, China, 2016.

To effectively promote the implementation of interventions, the identification of high-risk groups and the characteristics of Clonorchis sinensis infection in endemic regions are needed. In a clonorchiasis-endemic area, local residents were randomly enrolled for helminth egg examination in June 2016. The prevalence in subpopulations as well as the knowledge, attitudes, and behaviours and the factors influencing clonorchiasis in egg-positive populations were analysed. A total of 2282 local residents participated in the survey; the C. sinensis prevalence was 48.6% (1109 persons). A higher prevalence was found in males (62.6%) than in females (29.7%). People older than 30 years had the highest prevalence (52.7%-57.6%). Among the 888 persons who were infected with C. sinensis and participated the questionnaire investigation, 19.0% (169/888) knew that it could cause cancer. In addition, 60.6% of people reported that they intended to keep eating raw fish despite knowing the risk of infection. The two primary reasons for continuing to eat raw fish were the disease being regarded as not serious (38.3%) and the belief that anti-parasite medications are effective (39.6%). A total of 94.4% (797/844) of responders reported eating raw fish more frequently in the home than outside of the home. Our study revealed a notably high C. sinensis prevalence in the study area. Awareness of clonorchiasis disease severity should be increased among high-risk individuals and families in highly endemic areas.

[New eating habits, new parasitic risks: The example of fish]. / De nouvelles habitudes alimentaires, de nouveaux risques parasitaires : l'exemple du poisson.

INTRODUCTION: In the past decades, the massive explosion of "Japanese" restaurants serving raw fish popularised new culinary habits in France. At the same time, consumers have made a habit of preparing raw or pickled fish dishes themselves at home. As a result, the identification of live parasitic worm larvae in raw fish flesh is common and a source of concern for professionals or amateur cooks. Sometimes, these worms are spit out or removed after fibroscopy in patients developing severe epigastric pain quickly after eating raw fish. This paper is aiming at having a quick review of the main parasites transmitted to humans by eating raw fish in France. METHODS: This article is based on the personal experience of the authors, on references preferentially from the French literature and on the results of the Fish Parasites (ANR) research program. RESULTS: From 2011 to 2014, Fish-Parasites (ANR) assessed the prevalence of parasitism in sea and freshwater fish belonging to 29 species. About 57% of sea fish were parasitised by Anisakidae. Larvae of Dibothriocephalus latus were found in pike, perch, and burbot in Lake Geneva but in none of the fish examined from Annecy or Le Bourget lakes. Concerning human anisakidosis, a retrospective survey was carried out in the years 2010 to 2014 among all medical parasitology laboratories from university hospitals in France. Thirty-seven cases of anisakidosis have been reported, including 18 cases of allergic anisakidosis. Six additional cases of severe Anisakidae allergy were reported to the National Allergovigilance Network over the same period. CONCLUSIONS: Despite the increase in consumption of raw fish, and compared to previous studies, cases of anisakidosis are decreasing, but their allergenic potential is increasing. The incidence of dibothriocephalosis, after some trend of emergence on the shores of Lake Geneva some 20 years ago, is currently decreasing, but sporadic cases of importation are still reported. Actions with professionals (investigation, providing of information) and research programs on management of parasitic risk control are being pursued and have resulted in an update of the technical instruction of the French General Directorate for Food on the control of parasitic risk in fish.

Umai Dish Preparation Practices and Food Safety Behaviors in Bintulu Locals on Borneo Island, Malaysia.

ABSTRACT: Umai is a popular, traditional, native dish of the Melanau ethnic group in Sarawak. It is prepared using thin slices of raw marine fish marinated with calamansi juice and seasoned with other ingredients. The local people believe that the acidity of the citrus juice, along with the use of salt and spice, can slightly cook the fish and remove the fishy smell. The aim of this study was to investigate (i) the different umai handling and preparation practices and (ii) the personal experience of umai consumption among respondents. A purposive sample of 100 umai makers, divided into two equal groups, professionals and nonprofessionals, participated in the study. We found that Spanish mackerel and hairfin anchovy were ranked first and second in the list of species chosen for making umai, with the former mostly preferred by the professional group, as opposed to the latter, which was preferred by the nonprofessional group. Black pomfret was ranked third, where it is equally preferred by both groups. About 20% of respondents would freeze the raw fish chunks prior to preparing umai, as opposed to 26% who would sun dry their fish. Other techniques, such as salting and marinating (using calamansi juice), were also used during the preparation of umai. Most of the respondents indicated that they would consider the umai ready to eat soon after marinating (with all ingredients) the raw fish. One-third of both respondent groups indicated that they would chill the umai dish at 4°C for 30 min before serving. The respondents could not provide any rationale behind these food preparation practices. Overall, this study provides evidence of the different preparation methods for umai. These practices can thus be considered important targets for public health education campaigns seeking to improve food safety surrounding this food group.

Detection of cylindrospermopsin and its decomposition products in raw and cooked fish (Oreochromis niloticus) by analytical pyrolysis (Py-GC/MS).

The presence of the toxin cylindrospermopsin is increasingly frequent in samples from different ecosystems and it is a serious problem both at environmental level and for animal and human health. To be able to prevent CYN exposure risk, it is important to have suitable analytical methods, but also quick and economical ones. Analytical pyrolysis coupled to GC/MS (Py-GC/MS) represents an important alternative for the rapid detection, characterization or "fingerprinting" of different materials. However, it has been less studied with cyanotoxins up to date. The present work aims to investigate: 1) the suitability of Py-GC/MS for detection of CYN and its decomposition products in raw and cooked fish samples before consumption and 2) the influence of the different cooking methods on the presence of different CYN degradation products detected by Py-GC/MS. For first time, these results present that Py-GC/MS could be a rapid and economical alternative for the detection and monitoring of CYN and its degradation products (DP. m/z 290.1, 169.1 and 336.2) in raw or cooked fish. Moreover, the changes induced in CYN and DP by cooking could be amenable and detected by Py-GC/MS.

Bacterial content and characterization of antibiotic resistant Staphylococcus aureus in Danish sushi products and association with food inspector rankings.

This study examined the prevalence and phenotypic and genotypic antibiotic resistance patterns of Staphylococcus aureus in sushi from 20 Danish outlets. Microbial quality of sushi products and food inspector ranking of outlets were assessed and results for thirteen of the outlets were compared with findings from a previous study in 2012. Inspector rankings were similar in the two studies. The mesophilic aerobic counts were slightly lower (p = 0.0296) in 2017 than in 2012 with average values of the 13 shops of 5.2 log CFU/g and 5.7 log CFU/g, respectively. In both studies E. coli was only found in the products from outlets that did not have consistently superior rankings. On the other hand prevalence and average counts of Staphylococcus spp. were slightly higher in 2017 (p = 0.0286) but no methicillin-resistant S. aureus (MRSA) were observed in the present study. Methicillin-sensitive S. aureus (MSSA) were, however, isolated from 18.7% of sushi products with an average count below 2 log CFU/g. Based on spa and multilocus sequence typing (MLST), isolates belonged to clonal complex CC7 (t2016), CC20 (t7836), CC45 (t065, t127, t362), CC88 (t1998) and CC398 (t164, t331, t1451). The Panton-Valentine leukocidin (PVL)-encoding gene lukF was detected only in isolates of the t065 spa-type whereas the scn gene from the ΦSa3 prophage was detected in 76.5% of the isolates, supporting that the majority of isolates were of likely human origin. Thirty-six isolates (70.6%) were resistant to at least one of the antibiotic compounds tested. Antibiotic resistance genes that confer resistance to ß-lactams (blaZ) and macrolides (ermC) were detected in 33.3% and 9.8% of isolates, respectively. The tet(K) gene that encode tetracycline resistance was only found in a t7836 strain. Overall, this study indicates that S. aureus in sushi products in Denmark do not represent a major food safety hazard due to, firstly, the low temperature and limited time of storage of product may prevent significant growth and production of toxic levels of enterotoxin of this species. Secondly, the S. aureus isolates obtained did not include MRSA variants and none of them encoded PVL that constitute one of the virulence factors in pathogenesis. Several MSSA isolates contained however genes encoding antibiotic resistance, which emphasize the potential role of foods as vehicles for transmission of such variants.