A critical review of anisakidosis cases occurring globally.

A review was conducted to identify the most common causative agents of anisakidosis, the methods used for identification of the causative agents, and to summarize the sources of infection, and patients' demographics. A total of 762 cases (409 articles, inclusive of all languages) were found between 1965 and 2022. The age range was 7 months to 85 years old. Out of the 34 countries, Japan, Spain, and South Korea stood out with the highest number of published human cases of anisakidosis, respectively. This raises the question: Why are there few to no reports of anisakidosis cases in other countries, such as Indonesia and Vietnam, where seafood consumption is notably high? Other than the gastrointestinal tract, parasites were frequently found in internal organs such as liver, spleen, pancreas, lung, hiatal and epigastric hernia, and tonsils. There are also reports of the worm being excreted through the nose, rectum, and mouth. Symptoms included sore throat, tumor, bleeding, gastric/epigastric/abdominal/substernal/lower back/testicular pain, nausea, anorexia, vomiting, diarrhea, constipation, intestinal obstruction, intussusception, blood in feces, hematochezia, anemia, and respiratory arrest. These appeared either immediately or up to 2 months after consuming raw/undercooked seafood and lasting up to 10 years. Anisakidosis commonly mimicked symptoms of cancer, pancreatitis, type I/II Kounis syndrome, intussusception, Crohn's disease, ovarian cysts, intestinal endometriosis, epigastralgia, gastritis, gastroesophageal reflux disease, hernia, intestinal obstruction, peritonitis, and appendicitis. In these cases, it was only after surgery that it was found these symptoms/conditions were caused by anisakids. A range of not only mainly marine but also freshwater fish/shellfish were reported as source of infection. There were several reports of infection with >1 nematode (up to >200), more than one species of anisakids in the same patient, and the presence of L4/adult nematodes. The severity of symptoms did not relate to the number of parasites. The number of anisakidosis cases is grossly underestimated globally. Using erroneous taxonomic terms, assumptions, and identifying the parasite as Anisakis (based solely on the Y-shaped lateral cord in crossed section of the parasite) are still common. The Y-shaped lateral cord is not unique to Anisakis spp. Acquiring a history of ingesting raw/undercooked fish/seafood can be a clue to the diagnosis of the condition. This review emphasizes the following key points: insufficient awareness of fish parasites among medical professionals, seafood handlers, and policy makers; limited availability of effective diagnostic methodologies; and inadequate clinical information for optimizing the management of anisakidosis in numerous regions worldwide.

Primer reporte en Cuba de Anisakis spp. en muestras de pescado en conserva / First report in Cuba of Anisakis spp. in samples of canned fish

Introducción: Las especies de Anisakis representan uno de los grupos parasitarios patógenos transmitidos por alimentos más importantes en relación con sus capacidades zoonóticas y pueden producir una enfermedad emergente llamada anisakiosis. En Cuba, no existen reportes de la enfermedad como tampoco publicaciones sobre la detección del parásito en muestras de productos pesqueros. Objetivo: Identificar larvas de Anisakis spp. en muestras de productos pesqueros. Métodos: Se realizó un estudio para la búsqueda de larvas de Anisakis spp. en muestras de productos pesqueros en conserva recibidos en el Laboratorio de Parasitología de los alimentos del Instituto Nacional de Higiene, Epidemiología y Microbiología de Cuba. Se recibieron 96 muestras de dos marcas diferentes. A cada marca se le asignó las letras A o B para proteger la identidad del fabricante. Las larvas recuperadas fueron previamente aclaradas con lactofenol e identificadas morfológicamente por microscopía. Se utilizaron las claves de identificación para larvas de Anisakis spp. descritas en la literatura. Resultados: El 38,5 por ciento del total de muestras de pescado en conserva analizadas estuvieron parasitadas con larvas de Anisakis spp., con una frecuencia media de 1,2 larvas por cada submuestra. Las larvas fueron clasificadas de tercer estadio y de tipo I. Conclusiones: Por primera vez se identificó en Cuba larvas de Anisakis spp. en muestras de pescado en conserva y se proporcionó datos de interés a las autoridades sanitarias para el fortalecimiento de políticas públicas relacionadas con la calidad e inocuidad de los alimentos(AU)

Introduction: Anisakis species represent one of the most important foodborne pathogenic parasitic groups in relation to their zoonotic capabilities, and can produce an emerging disease called anisakiosis. In Cuba, there are no reports of the disease and there are no publications on the detection of the parasite in samples of fishery products. Objective: To identify Anisakis spp. larvae in samples of fishery products. Methods: A study was conducted to search for Anisakis spp. larvae in samples of canned fish products received at the Laboratory of Food Parasitology of the National Institute of Hygiene, Epidemiology and Microbiology of Cuba. Ninety-six samples of two different brands were received. Each brand was assigned letter A or B to protect the identity of the manufacturer. The larvae recovered were previously rinsed with lactophenol and identified morphologically by microscopy. The identification keys for Anisakis spp. larvae described in the literature were used. Results: 38.5 percent of the total canned fish samples analyzed were parasitized with Anisakis spp. larvae, with a mean frequency of 1.2 larvae per subsample. The larvae were classified as third instar and type I. Conclusions: For the first time in Cuba, Anisakis spp. larvae were identified in canned fish samples and provided data of interest to health authorities to strengthen public policies related to food quality and safety(AU)

Proteome profiling of L3 and L4 Anisakis simplex development stages by TMT-based quantitative proteomics.

Anisakis simplex is a parasitic nematode that can cause anisakiosis and/or allergic reactions in humans. The presence of invasive third-stage larvae (L3) in many different consumed fish species and the fourth-stage larvae (L4) in marine mammals, where L3 can accidentally affect to humans and develop as far as stage L4. World Health Organization and food safety authorities aim to control and prevent this emerging health problem. In the present work, using Tandem Mass Tag (TMT)-based quantitative proteomics we analyzed for the first time the global proteome of two A. simplex development stages, L3 and L4. The strategy was divided into four steps: (a) protein extraction of L3 and L4 development stages, (b) high intensity focused ultrasound (HIFU)-assisted trypsin digestion, (c) TMT-isobaric mass tag labeling following by high-pH reversed-phase fractionation, and (d) LC-MS/MS analysis in a LTQ-Orbitrap Elite mass spectrometer. A total of 2443 different proteins of A. simplex were identified. Analysis of the modulated proteins provided the specific proteomic signature of L3 (i.e. pseudocoelomic globin, endochitinase 1, paramyosin) and L4 (i.e. neprilysin-2, glutamate dehydrogenase, aminopeptidase N). To our knowledge, this is the most comprehensive dataset of proteins of A. simplex for two development stages (L3 and L4) identified to date. SIGNIFICANCE: A. simplex is a fish-borne parasite responsible for the human anisakiosis and allergic reactions around the world. The work describes for the first-time the comparison of the proteome of two A. simplex stages (L3 and L4). The strategy is based on four steps: (i) protein extraction, (ii) ultra-fast trypsin digestion under High-Intensity Focused Ultrasound (HIFU), (iii) TMT-isobaric mass tag labeling followed by high-pH reversed-phase fractionation and (iv) peptide analysis using a LTQ-Orbitrap Elite mass spectrometer. The workflow allows to select the most modulated proteins as proteomic signature of those specific development stages (L3 and L4) of A. simplex. Obtained stage-specific proteins, could be used as targets to control/eliminate this parasite and in future eradicate the anisakiosis disease.

[Recognition of excretory/secretory antigens of Anisakis type I and evolution of IgE in experimentally infected rats]. / Reconocimiento de los antígenos excretores/secretores de Anisakis tipo I y evolución de la IgE en ratas infectadas experimentalmente.

INTRODUCTION: Anisakis spp., during parasitism, release excretory-secretory antigens that, in contact with the human immune system, can trigger a hypersensitivity response mediated by IgE, causing various allergic symptoms. OBJECTIVES: To evaluate the IgE response in Wistar rats after infection with L3 larvae of the parasite Anisakis spp. METHODS: Some determining factors involved in the technique have been improved in this work, such as: the concentration of polyacrylamide used in the preparation of the gels, the antigen concentration used, and the temperature required for denaturation of proteins. RESULTS: Immune responses (Ag-Ab) observed by the immunoblotting technique showed a greater intensity with serum obtained after reinfection, which have recognized proteins that may correspond to the major antigen Ani s 1 and other polypeptides of interest in the diagnosis of human anisakiasis. CONCLUSION: This paper concludes that immunoblotting is a useful technique to detect IgE antibodies against Anisakis proteins.

Anisakiosis: primer diagnóstico en Buenos Aires, Argentina / Anisakiosis: first diagnosis in Buenos Aires, Argentina

La anisakiosis es una parasitosis causada por larvas de Anisakis spp., Pseudoterranova spp., Contracaecum spp. e Hysterothylacium spp. La infección es endémica en Japón, España, Holanda, Inglaterra, Escandinavia y la zona costera del Pacífico de Sudamérica. El hombre se infecta por el consumo de pescado crudo, mal cocido o salado que contiene larvas infectantes en sus tejidos o vísceras. Se presenta el caso de una niña de 9 años residente en la provincia de Buenos Aires, de muy baja condición socioeconómica, que eliminó a través de sus heces una larva de tercer estadío de anisákido. Hasta nuestro conocimiento, éste representaría el primer caso registrado de anisakiosis humana en Buenos Aires, Argentina.

Anisakiosis is a parasitosis produced by Anisakis spp., Pseudoterranova spp., Contracaecum spp. and Hysterothylacium spp. larvae. The infection is endemic in Japan, Spain, Holland, England, Scandinavia and the South America’s Pacific Coast. Man becomes infected after eating raw, incompletely cooked, or salted fish which contains the infecting larvae in their tissues or viscera. We present the case of a 9 year old female child residing in the province of Buenos Aires, with a very low socio-economical level, who eliminated a third stage anisakido larvae with her feces. As far as we know, this would represent the first case of human anisakiosis registered in Buenos Aires, Argentina.

Anisakiosis / Anisakiosis

Anisakis simplex es un nematodo de distribución mundial que infecta a los consumidores de pescado crudo o poco cocido. El ciclo vital del parásito puede incluir uno o más hospedadores intermediarios y como hospedadores definitivos mamíferos marinos y grandes peces en los cuales la larva se desarrolla hasta alcanzar el estadio adulto. El hombre es un huésped accidental. Las manifestaciones clínicas de la anisakiosis dependen del lugar del tracto digestivo en que la larva se deposite. Los síntomas se desarrollan como resultado de procesos inflamatorios que se producen en la mucosa de la pared gástrica cuando penetra en ella la larva. Para prevenir esta patología no se debe consumir pescado crudo o que no haya sido congelado previamente durante 48 h, ni pescado fresco que no haya sido cocinado al menos durante 20 min. a más de 60 °C. La incidencia de la anisakiosis está en aumento en los últimos tiempos, por lo que resulta importante conocer sus manifestaciones más características, tanto clínicas como epidemiológicas y de laboratorio, especialmente porque en Venezuela hay elevado consumo de pescado, aunque no se tenga casos. Las manifestaciones más frecuentes son urticaria/angioedema recidivante y dolores abdominales ¿Cuántos de estos síntomas quedan sin diagnóstico en las consultas médicas diarias?.

Anisakis simplex is a widely distributed nematode infecting consumers of raw or undercooked fish. Life cycle of the parasite might include one or more intermediate hosts and sea mammals and big fishes as definitive hosts in which larvae develop to its adult stage. Man is an accidental host. Clinical manifestations of anisakiasis depend on the site of dwelling of larvae in the digestive tract. Symptoms develop as the result of an inflamatory process in the gastric mucosae wall due to the penetration of larvae. Prevention of this pathology relies in avoiding ingestion of raw fish or fish that hasn't been previously frozen at least 48 hours or cooked during at least 20 minures above 60º C. Incidence of anisakiasis is increasing, thus it is important to know and discuss its clinical, epidemiological and laboratory patterns, specially in Venezuela, where we register a high ingestion of fish without case register. Most common clinical features are: urticaria, recidivant angio-oedema and abdominal pain.

Pseudoterranovosis y sushi / Pseudoterranovosis and sushi

Se comunica un caso de ingestión accidental de Pseudoterranova decipiens. A raíz de esta paciente se revisan los principales conceptos relativos a esta naciente patología en Chile. El consumo de platos preparados con pescados crudos como el sushi, sashimi, cebiche y mariscal es cada vez más popular. A través de la ingesta de hospederos intermediarios usados en la preparación, se puede adquirir la larva de tercer estadio de Anisakis simplex o P. decipiens. Estos parásitos pueden provocar gastritis aguda que se manifiesta inmediatamente después de consumido el pescado crudo. En ocasiones puede haber compromiso intestinal e invasión del tracto gastrointestinal con manifestaciones en otros órganos. Se asocia a manifestaciones alérgicas como urticaria, angioedema y shock anafiláctico. La larva se elimina en forma espontánea en la mayoría de los casos, pero en otros debe removerse por vía endoscópica. En Chile, es más frecuente la presencia de P. decipiens, que por lo general no migra a la mucosa gástrica, no invade y produce pocos síntomas. Las medidas de prevención son no comer pescados crudos, cocinarlos a temperaturas elevadas o congelación previa a la preparación de los alimentos, para inactivar las larvas.

A case of accidental ingestión of Pseudoterranova decipiens is reported, on account of this patient we review main concepts related to this emerging pathology in Chile. Consumption of raw fish in different preparations such as sushi or sashimi, cebiche and seafood is becoming more and more popular. Through intermediary hosts used in the preparation, one can acquire the third stage larval of Anisakis simplex or P. decipiens. These parasites frequently cause gastritis, acutely after the consumption of raw fish, or more rarely intestinal involvement. It may also cause allergic symptoms such as urticaria, angioedema and anaphylactic shock. The larvae is eliminated spontaneously in most cases; others need to be removed by upper gastrointestinal endoscopio examination. In Chile, the most common species is P. decipiens, which are generally no invasive, rarely migrate beyond the stomach and cause mild or no symptoms. Prevention strategies include avoid eating raw fish or undercooked seafood containing the parasite, to cook food with high temperatures or to freeze raw fish prior to preparation of meals, which inactivates the larvae.