Anisakidae parasites in frozen fish fillets intended for human consumption / Parásitos anisákidos en filetes de pescado congelado destinados a consumo humano

Introduction: Anisakiasis is a human parasitic disease caused by the consumption of raw fish or shellfish containing larvae of the Anisakidae family. It is currently considered an emerging disease of public health interest. Objective: To identify the presence of larvae of the Anisakidae family in samples of frozen raw fish fillets intended for human consumption in markets in Medellín and its metropolitan area in Antioquia, Colombia. Materials and methods: A cross-sectional study was carried out, in which larvae of the Anisakidae family were detected and identified in frozen raw fish fillets from three representative markets in Medellín and its metropolitan area. A total of 384 ready for consumption fillets were analyzed (197 sawfish, 137 salmon, 37 tuna, and 13 hake), using the pressing and ultraviolet light method. Taxonomic keys were used to identify the collected parasites and to establish its genus. Conventional PCR and Sanger sequencing was performed to determine the species. Results: Four larvae were found in 4 of the 384 (1.04%) fillets (CI95% 1.04 ± 1.01%). The species of fish in which the larvae were found was sawfish (Scomberomorus spp.) and the genus and species of the larvae was established as Anisakis pegreffii. Conclusions: According to the study, the presence of Anisakis parasites in frozen raw fish fillets in the influence area is evident.

Introducción. La anisakiasis es una infección producida por parásitos de la familia Anisakidae, transmitida a los humanos por el consumo de pescado o mariscos crudos. En la actualidad, se considera una enfermedad emergente de interés en salud pública. Objetivo. Identificar la presencia de larvas de la familia Anisakidae en muestras de filetes de pescado crudo congelado destinados a consumo humano, en mercados de Medellín y su área metropolitana en Antioquia (Colombia). Materiales y métodos. Se realizó un estudio transversal, en el cual se buscó la presencia de larvas de la familia Anisakidae en filetes de pescado crudo congelado de tres mercados representativos de Medellín y su área metropolitana. Se analizaron 384 filetes listos para el consumo (197 sierras, 137 salmones, 37 atunes y 13 merluzas). Cada filete fue analizado mediante el método de prensado y luz ultravioleta. Los parásitos recolectados se identificaron a partir de claves taxonómicas para establecer el género, así como PCR convencional y posterior secuenciación Sanger, para determinar la especie. Resultados. Se encontraron 4 larvas en 4 de los 384 filetes (1,04 %) (IC95% 1,04 ± 1,01 %). Las larvas encontradas fueron identificadas como Anisakis pegreffi y el tipo de pescado en el cual se encontraron fue la sierra (Scomberomorus spp.) Conclusiones. De acuerdo con el estudio realizado, se evidencia la presencia de parásitos anisákidos en filetes de pescado crudo congelado en el área de influencia.

Anisakis and anisakidosis: hosts and case reports in South America. Systematic review / Anisákidos y anisakidosis: reportes de caso y hospedadores en América del Sur. Revisión sistemática

Abstract Introduction: Anisakidosis is a disease caused by the consumption of raw or undercooked seafood parasitized by nematode larvae of the family Anisakidae. Even though it is a public health issue in Europe and Asia, it is relatively unknown in South America. Objective: To present case reports on anisakidosis and the intermediate hosts of Anisakis reported in South America. Materials and methods: A systematic review was conducted in Medline, Cochrane, Embase, LILACS and Scopus using a structured search of MeSH and DeCS descriptors. The search strategy included publication period: inception of each database-September 2018; languages: English, Spanish, and Portuguese; and study types: case reports and observational cross-sectional studies. The review was complemented with an unstructured search in SciELO and Google Scholar. Results: The initial search yielded 172 articles. After removing duplicates and reviewing the inclusion criteria, 69 studies were selected for full analysis: 19 case reports and 50 host records. The most reported form of anisakidosis was gastrointestinal anisakidosis with 45 cases; this infectious disease was caused by a single larva in 41 people (91.1%). Reports of 95 species of fish for human consumption parasitized by larvae of the genera Anisakis, Contracaecum, Pseudoterranova and Hysterothylacium were identified in Argentina (22 fish species), Brazil (34 species), Chile (15 species), Colombia (17 species), Ecuador (8 species), Peru (7 species), Uruguay and Venezuela (2 species each). Conclusion: Anisakidosis is a latent risk in South America, so it is necessary to establish effective regulations for efficiently controlling the appearance of this parasitic disease in the region. Furthermore, the general population should receive more information about the precautions regarding saltwater fish consumption.

Resumen Introducción. La anisakidosis es una parasitosis ocasionada por el consumo de pescado de mar crudo o semicrudo parasitado por larvas de nematodos de la familia Anisakidae. En Europa y Asia es un problema de salud pública; sin embargo, en América del Sur es poco conocida. Objetivo. Identificar los reportes de caso de anisakidosis y los hospedadores intermediarios de anisákidos reportados en América del Sur. Materiales y métodos. Se realizó una revisión sistemática en Medline, Cochrane, Embase, LILACS y Scopus mediante la búsqueda estructurada de términos MeSH y DeCS. Estrategia de búsqueda: periodo de publicación: inicio de cada base de datos-septiembre de 2018; idiomas: inglés, español y portugués; tipos de estudio: reportes de caso y estudios transversales observacionales. La revisión fue complementada con una búsqueda no estructurada en SciELO y Google Scholar. Resultados. La búsqueda inicial arrojó 172 artículos. Una vez removidos los duplicados y revisados los criterios de inclusión, se seleccionaron 69 estudios para análisis completo: 19 reportes de caso y 50 registros de hospedadores. La forma de anisakidosis más reportada fue la gastrointestinal, con 45 casos, donde la parasitosis fue causada por una larva única en 41 casos (91.1%). Se identificaron reportes de 95 especies de peces para consumo humano parasitadas por los géneros Anisakis, Contracaecum, Pseudoterranova e Hysterothylacium en los siguientes países: Argentina (22 especies), Brasil (34 especies), Chile (15 especies), Colombia (17 especies), Ecuador (8 especies), Perú (7 especies), Venezuela (4 especies) y Uruguay (2 especies). Conclusión. La anisakidosis es un riesgo latente para América del Sur, por lo que es necesario instaurar normativas efectivas para controlar su aparición en la región y brindar más información a la población general sobre las precauciones necesarias en relación con el consumo de pescado de agua salada.

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

Anisakiasis como diagnóstico diferencial de dolor abdominal agudo en urgencias / Anisakiasis as differential diagnosis of acute abdominal pain at the emergency department

La anisakiasis es una zoonosis cada vez más prevalente especialmente en países europeos, causada por la ingesta del nemátodo del género Anisakis en su tercer estadio larvario tras el consumo de pescado crudo o poco cocido. Puede producir una afectación gastrointestinal y también una reacción de hipersensibilidad a las proteínas del parasito. Presentamos un caso de anisakiasis gástrica acompañada de hipersensibilidad (forma gastroalérgica) tras la ingesta de pescado crudo.

Anisakiasis is a zoonosis with an increasing prevalence, especially in European countries, caused by the ingestion of the nematode of the genre Anisakis in its third larvae stage after consuming undercooked or raw fish. It may produce gastrointestinal symptoms and hypersensitivity reactions to the proteins of the worm. We present a case of gastric anisakiasis accompanied by hypersensitivity symptoms (gastroallergic form) after the ingestion of raw fish.

Anisakidosis

Anisakidosis is a term that collectively refers to a human infection caused by larvae of the family Anisakidae. Because Anisakis simplex was the main cause, it was originally called anisakiasis or anisakiosis, but since other parasites such as Pseudoterranova decipiens also cause similar diseases, the family name is now used as the diagnostic name. Anisakidosis cases have been increasing steadily owing to the propagation of the Japanese raw-fish-eating culture, such as sushi and sashimi, around the world; the traditional raw-fish-eating habits of individual countries; the establishment of marine mammal protection laws; and the development of endoscopic diagnostic techniques. The disease continues to occur in Korea, where most human parasites are believed to have been eradicated and is probably the most common parasitic disease encountered in clinical practice. Anisakidosis is a disease associated with acute abdominal pain. Anisakid larvae can invade the entire digestive tract and abdominal cavity and cause abdominal pain and a variety of digestive system symptoms. Thus, the history of eating raw fish is very important for its differential diagnosis. The lack of a precise understanding of the pathogenesis and clinical course of this disease may lead to unnecessary surgery. Anisakidosis may also manifest as allergic symptoms. Therefore, it is necessary to understand anisakidosis from the perspective of public health, food hygiene, and preventive medicine.

Clinical and Endoscopic Features of Colonic Anisakiasis in Korea

To analyze the clinical and endoscopic features of colonic anisakiasis. A retrospective chart review of 20 patients with colonic anisakiasis, who were diagnosed by colonoscopy at 8 hospitals between January 2002 and December 2011, was performed. Patients’ mean age was 53.6±10.74 years. Seventy percent patients were men. Acute abdominal pain was a common symptom that mostly developed within 48 hr after the ingestion of raw fish, and which lasted for 1–28 days. Sixty percent patients had ingested raw fish before the diagnosis of colonic anisakiasis and 40% patients were incidentally found to have colonic anisakiasis during the screening colonoscopies. Leukocytosis and eosinophilia were each found in 20% of the patients. In all patients who underwent colonoscopy, the worms were removed with biopsy forceps, except in 1 case, and a definite diagnosis of anisakiasis was made. In some cases of colonic anisakiasis, colonoscopy may be helpful in the diagnosis and treatment to avoid surgical intervention.

Molecular Identification of Anisakis Larvae Extracted by Gastrointestinal Endoscopy from Health Check-up Patients in Korea

Anisakiasis is a zoonotic disease induced by anisakid nematodes, and endoscopic inspection is used for a diagnosis or remedy for it. Anisakis simplex, Anisakis physeteris, and Pseudoterranova decipiens had been reported to be the major species causing human infections, particularly, in Japan. However, in Korea, recent studies strongly suggested that Anisakis pegreffii is the major species of human infections. To support this suggestion, we collected anisakid larvae (n=20) from 20 human patients who were undergone gastrointestinal endoscopy at a health check-up center in Korea, and molecular identification was performed on the larvae using PCR-RFLP analysis and gene sequencing of rDNA ITS regions and mtDNA cox2. In addition, anisakid larvae (n=53) collected from the sea eel (Astroconger myriaster) were also examined for comparison with those extracted from humans. The results showed that all human samples (100%) were identified as A. pegreffii, whereas 90.7% of the samples from the sea eel were A. pegreffii with the remaining 9.3% being Hysterothylacium aduncum. Our study confirmed that A. pegreffii is the predominant species causing human anisakiasis in Korea, and this seems to be due to the predominance of this larval type in the fish (sea eels) popularly consumed by the Korean people. The possibility of human infection with H. aduncum in Korea is also suggested.

Ginger oil (Zingiber officinale) in the fight against larvae of Contracaecum sp. that cause human zoonoses / Óleo de gengibre (Zingiber officinale) no combate a larvas de Contracaecum sp. causadoras de zoonoses humanas

Anisakid nematode helminths have great importance in public health, with several reports of human infections causedby larvae of these parasites in several countries of the world. These parasites are common in freshwater and marine fish,with man as an accidental host. Contamination occurs when humans feed on raw fish in the form of sushi, sashimi, andceviche, which are infected by the larval stages of these nematodes. In Brazilian rivers there are records of these larvaein Astyanax altiparanae (lambaris) and Geophagus brasiliensis (pearl cichlid), which are species widely distributed in theNeotropical region, especially in Brazil. These diseases are little-known by Brazilian health professionals because theirfrequency is still low, mainly due to the population's low fish consumption and the difficulties medical professionals havein diagnosing them. The present study aimed to evaluate the larvicidal action of ginger essential oil (Zingiber officinale) onlarvae of Contracaecum sp. removed from the visceral cavity of pearl cichlid and lambaris collected from the lake at IngáPark, Maringá, PR, in the year 2016. Two hundred and thirty-four fish specimens were necropsied, and their larvae weretested to verify the larvicidal effect of ginger. Of these fish, 123 were parasitized, equivalent to 52.5%, of which 181 larvaewere collected, all from the coelomic cavity. Ginger essential oil proved to be a promising larvicide, promoting larvaldeath in vitro. This larvicidal action was observed at different times and concentrations, showing the efficacy of ginger oilin combating this zoonosis. It is suggested that new natural products be tested for this purpose, as the number of peoplewho consume raw fish in Brazil continues to increase

Os helmintos nematoides anisaquídeos possuem grande importância em saúde pública, havendo vários relatos deinfecções humanas causadas pelas larvas desses parasitos em vários países do mundo. Esses parasitas são comuns empeixes de água doce e marinhos, tendo o homem como hospedeiro acidental. A contaminação ocorre quando os sereshumanos se alimentam de peixes crus na forma de sushi, sashimi e ceviche, infectados pelos estados larvais dessesnematoides. Nos rios brasileiros há registros dessas larvas em Astyanax altiparanae (lambaris) e Geophagus brasiliensis(acará ou papa-terra), que são espécies amplamente distribuídas na região Neotropical, em especial no Brasil. Essasdoenças são pouco conhecidas pelos profissionais da saúde brasileiros, pois sua frequência ainda é pequena, devido aobaixo consumo de peixes pela população e às dificuldades no diagnóstico pela classe médica. O presente estudo tevecomo objetivo avaliar a ação larvicida do óleo essencial de gengibre (Zingiber officinale) em larvas de Contracaecumsp. retirados da cavidade visceral de acarás e lambaris, coletados no lago do Parque do Ingá, Maringá, PR no ano de2016. Nesse sentido, 234 espécimes de peixes foram necropsiados e suas larvas testadas para verificar o efeito larvicidado gengibre. Destes peixes, 123 estavam parasitados, equivalendo a 52,5%, dos quais coletou-se 181 larvas, todas nacavidade celomática. Essas substancias mostraram-se promissores larvicidas, promovendo a morte das larvas no teste invitro do óleo essencial do gengibre. Essa ação larvicida foi observada em tempos e concentrações diferentes, mostrandoa eficácia do óleo de gengibre no combate a essa zoonose. Sugere-se que novos produtos naturais sejam testados comesse objetivo, pois é crescente o aumento no número de pessoas que passaram a se alimentar de peixes crus no Brasil

Anisakiasis Induced Segmental Jejunum Obstruction / 대한소화기학회지

Human anisakiasis is a disease caused by an infestation of the third stage larvae of family anisakidae. The ingested larvae invade the gastrointestinal wall, causing clinical symptoms that include abdomen pain, nausea, and vomiting. Although enteric anisakiasis is extremely rare, it can induce intestinal obstruction. We report a case in which emergency surgery was needed due to intestinal obstruction that coincided with symptoms related to anisakiasis, along with a brief literature review.

Anisakiasis Involving the Oral Mucosa

Anisakis is a parasite with life cycles involving fish and marine mammals. Human infection, anisakiasis, occurs with the ingestion of raw infected seafood and usually presents with acute or chronic gastrointestinal symptoms from esophageal or gastric invasion. We report a rare caseinvolving the oral cavity. A 39-year-old male presented with oral and sub-sternal pain of one day duration after eating raw cuttlefish. Physical examination revealed areas of erythema and edema with a central white foreign particle on the labial and buccal mucosa. With microscopic field we could remove the foreign material from the lesions. The foreign material was confirmed to be Anisakis. Anisakis was also removed from the esophagus by esophagogastroduodenoscopy. The patient was discharged the following day without complication. Anisakiasis is frequently reported in Korea and Japan, countries where raw seafood ingestion is popular. The symptoms of acute anisakiasis include pain, nausea, and vomiting and usually begin 2–12 hours after ingestion. The differential diagnosis includes food poisoning, acute gastritis, and acute pancreatitis. A history of raw seafood ingestion is important to the diagnosis of anisakiasis. Treatment is complete removal of the Anisakis to relieve acute symptoms and prevent chronic granulomatous inflammation.

Anisakiasis in Southeast Asia: A story of new tropical disease?

Anisakiasis is an important worm infestation. It is seen in some non-tropical countries and becomes an important issue in coastal medicine. However, in the few recent years, there are some reports on occurrence of anisakiasis in tropical countries. In this specific short article, the authors review and present the situation of anisakiasis in Southeast Asia. It can be said that anisakiasis becomes a new focused interest in tropical coastal medicine at present.

Asymptomatic anisakiasis of the colon incidentally diagnosed and treatedduring colonoscopy by retroflexion in the ascending colon / Journal of Rural Medicine

<p>A 74-year-old man with diabetes underwent colonoscopy as routine screening for coloncancer. An <i>Anisakis</i> larva was found incidentally during colonoscopy usingthe retroflexion technique in the ascending colon, and was removed using a forceps.Asymptomatic colonic anisakiasis is very rare, and few reports have described diagnosisand treatment of anisakiasis during colonoscopy by the retroflexion technique in theascending colon. We have reported this rare case along with a literature review.</p>

Anisakiasis in Southeast Asia:A story of new tropical disease?

Anisakiasis is an important worm infestation. It is seen in some non-tropical countries and becomes an important issue in coastal medicine. However, in the few recent years, there are some reports on occurrence of anisakiasis in tropical countries. In this specific short article, the authors review and present the situation of anisakiasis in Southeast Asia. It can be said that anisakiasis becomes a new focused interest in tropical coastal medicine at present.

Morphological and molecular diagnosis of Pseudoterranova decipiens (sensu stricto) (Anisakidae) in imported cod sold in Brazil / Diagnose morfológica e molecular de Pseudoterranova decipiens (sensu stricto) (Anisakidae) em bacalhau importado vendido no Brasil

An anisakid nematode larva found in cod sold in the state of Minas Gerais, Brazil was studied by light and scanning electron microscopy and by a molecular approach. Mitochondrial cytochrome c-oxidase subunit 2 (mtDNA cox-2), 28S rRNA and ITS1, 5.8S and ITS2 regions were amplified using the polymerase chain reaction and sequenced to evaluate the phylogenetic relationships of the larva. The genetic profile confirmed that this larva belongs to the species Pseudoterranova decipiens (sensu stricto). This is the first molecular and ultrastructural study of Pseudoterranova decipiens (sensu stricto) in imported cod sold in Brazil. The health implications of these findings are discussed.

Uma larva de Nematoda anisakídeo encontrada em bacalhau comercializado no Estado de Minas Gerais, Brasil foi estudada por microscopias de luz e eletrônica de varredura e por uma abordagem molecular. As regiões da subunidade 2 da citocromo c-oxidase mitocondrial (mtDNA cox-2), 28S rRNA e ITS1, 5.8S e ITS2 foram amplificadas usando a reação em cadeia da polimerase e sequenciadas para avaliar as relações filogenéticas da larva. O perfil genético confirmou que esta larva pertence à espécie Pseudoterranova decipiens (sensu stricto). Esse é o primeiro estudo molecular e ultraestrutural de Pseudoterranova decipiens (sensu stricto) de bacalhau importado vendido no Brasil. As implicações destes resultados para a saúde são discutidas.

Natural products: Perspectives in the pharmacological treatment of gastrointestinal anisakiasis

Objective: To evaluate the activity of different natural products against L3 larvae of Anisakis type I. Methods: Information on investigations into the activity of natural products against the L3 larvae of Anisakis simplex was collected from scientific journals, books, theses and reports via a library and electronic search (using Pubmed, Scopus, Medline, Web of Science and ScienceDirect). The search terms included: natural products, medicinal plants, essential oils, terpenic derivatives, Anisakis, antinematodal activity. Results: In the literature reviewed numerous papers were found concerning the in vitro and in vivo activity against Anisakis type I of various natural products (plant extracts, essential oils and their major components). Analysis of the results showed that in vitro tests the Melaleuca alternifolia essential oil and the ar-turmerone isolated from Curcuma longa displayed the greatest activity. In vivo, the most active compound was perillaldehyde, the main component of Perilla frutescens essential oil. Conclusions: This study shows that some natural products exhibited promising antianisakis properties.

Anisakiasis: Report of 15 Gastric Cases Caused by Anisakis Type I Larvae and a Brief Review of Korean Anisakiasis Cases

The present study was performed to report 15 anisakiasis cases in Korea and to review the Korean cases reported in the literature. Total 32 Anisakis type I larvae were detected in the stomach of 15 patients by the endoscopy. Single worm was detected from 12 cases, and even 9 larvae were found from 2 cases. Epigastric pain was most commonly manifested in almost all cases, and hemoptysis and hematemesis were seen in 1 case each. Symptom manifestations began at 10-12 hr after eating fish in 73.3% cases. Endoscopy was performed 1-2 days after the symptom onset in most cases. The common conger, Conger myriaster, was the probable infection source in 7 cases. In the review of Korean anisakiasis cases, thus far, total 645 cases have been reported in 64 articles. Anisakis type I larva was the most frequently detected (81.3%). The favorable infection site of larvae was the stomach (82.4%). The common conger was the most probable source of human infections (38.6%). Among the total 404 cases which revealed the age and sex of patients, 185 (45.8%) were males, and the remaining 219 (54.2%) were female patients. The age prevalence was the highest in forties (34.7%). The seasonal prevalence was highest in winter (38.8%). By the present study, 15 cases of gastric anisakiasis are added as Korean cases, and some epidemiological characteristics of Korean anisakiasis were clarified.

A Case of Anisakiasis Invading the Oropharynx / 대한이비인후과학회지

Anisakiasis is one of the fish-transmitted infections that result from the accidental ingestion of third-stage larva belonging to the family Anisakidae. A large number of cases of gastric anisakiasis have been reported in countries where the eating of raw fish is customary; however, there have been very few reports of anisakiasis involving the oral cavity and oropharynx. A 46-year-old woman complained of sore throat shortly after eating raw flatfishes. The oropharyngeal examination revealed two living tubular spinning objects in the submucosal layer of left posterior pillar. It was removed with biopsy forceps. We report a very rare and unique case of anisakiasis in oropharynx confirmed by pathologic findings. To best of our knowledge, this is the first case report involving oropharyngeal anisakiasis in Korea.

Chronic gastric anisakiasis provoking a bleeding gastric ulcer

Gastric anisakiasis is a parasitic disease caused by the gastric mucosal penetration of the Anisakis larvae ingested with raw fish. Acute gastric anisakiasis is diagnosed by the endoscopic visualization of Anisakis larvae along with mucosal edema, erythema, hemorrhage, and/or an ulcer, whereas chronic anisakiasis is often observed as a localized tumor commonly occurring in the submucosal layer, and is characterized by eosinophilic granuloma with edema and embedded Anisakis larvae on pathological examination of surgical specimens. We report here a case of chronic gastric anisakiasis provoking a bleeding gastric ulcer, which is a rare clinical manifestation of this condition.