Anisakidosis diagnosticada tras la expulsión de vermes en deposiciones: forma poco frecuente de diagnóstico en humanos / Anisakidosis diagnosed after expulsion of worms in stools: a rare form of diagnosis in humans

Resumen La anisakidosis es una zoonosis parasitaria accidental y cosmopolita de los seres humanos, siendo su hospedero definitivo los mamíferos marinos como lobos de mar, focas y delfines, entre otros. El ser humano se infecta por el consumo en estado larvario del nemátodo de la familia Anisakidae presentes en pescados y mariscos crudos como la merluza o el congrio. Los helmintos se ubican preferentemente en el tubo digestivo alto, observándose la regurgitación del parásito a la boca o evidenciándose durante la realización de una endoscopía digestiva alta. En forma infrecuente las larvas pueden migrar al peritoneo o seguir su paso por el intestino delgado y colon, siendo inhabitual la expulsión por las deposiciones. Presentamos el caso de una expulsión dos larvas L3 de la familia Anisakidae en deposiciones.

Abstract Anisakidosis is an accidental and cosmopolitan parasitic zoonosis of human beings, its definitive host being marine mammals such as sea lions, seals and dolphins, among others. Humans are infested by consumption in the larval stage of the nematode of Anisakis present in raw fish and shellfish such as hake or conger eel. The infestation is preferably located in the upper digestive tract, observing the regurgitation of the parasite to the mouth or becoming evident during an upper gastrointestinal endoscopy. In rare cases, the larvae can migrate to the peritoneum or continue their passage through the small intestine and colon, with expulsion in stools being unusual. We present a case of expulsion of two larvae of the Anisakidae family in feces.

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.

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.

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.

The Mucosal Changes and Influencing Factors in Upper Gastrointestinal Anisakiasis: Analysis of 141 Cases / 대한소화기학회지

BACKGROUND/AIMS: Anisakiasis is a well known parasitosis resulted from eating raw seafoods and there were many reports of cases. However, its endoscopic and clinical characteristics have not been reviewed well. The aim of this study was to clarify the gastric mucosal changes and influencing factors of upper gastrointestinal (UGI) anisakiasis. METHODS: We analyzed retrospectively the endoscopic and clinical characteristics of 141 cases with UGI anisakiasis diagnosed during UGI endoscopy, based on the review of medical records. The patients' data were collected consecutively from October 1999 through September 2006. RESULTS: In the 141 patients with UGI anisakiasis, the peak age was the 40s (44.7%). The female to male ratio was 1.82:1. The most prevailed season was winter (41.1%). The most frequent symptom was acute epigastric pain and 76.6% of the patients developed symptoms within 12 hours after the ingestion of raw seafoods. The greater curvature of body was the most preferred site of anisakid larvae. The median time from meal to symptom onset was shortest in esophageal location and longest in fundus location (3 vs. 18.7 hours). The various mucosal changes were observed and the most frequent mucosal change was edema (90.8%). Submucosal tumor was also found in 31.9% of the patients. The severity of mucosal change was related inversely with the time interval from meal to endoscopy (p=0.048). CONCLUSIONS: Anisakiasis presented various mucosal changes depending on the time interval from ingestion of raw seafood to endoscopy. Delayed endoscopy may lead chronic mucosal change and cause difficulty in the detection of anisakiasis. Therefore, the prompt endoscopic examination is required for the patients presenting acute gastrointestinal symptoms after taking raw fish.

Anisakiasis en un paciente portadora de una pequeña hernia hiatal: Caso clínico / Anisakiasis in a patient with a small hiatal hernia: Report of one case

We describe the presence of anisakiasis in a patient who had a small hiatal hernia. A 60 year-old women presented general malaise, burning pain, flatulence, persistent nausea and abdominal distension during five days before consulting. She referred that she ate a dish of marinated raw fish with lemon and pepper ("cebiche") and after a few hours the symptoms began. An esophagogastroscopy showed a white colour larva of approximately three cm with the cephalic end partially adhered and localized in the mucosa of the hiatal hernia. During the procedure the worm was easily extracted. The morphologic study of the specimen identified it as a stage IV larva of Pseudoterranova sp. The clinical condition of the patient improved after the extraction of the parasite.

Four cases of gastric submucosal mass suspected as anisakiasis

Anisakiasis is a parasitic disease caused by ingestion of raw fish infected with anisakid larvae. Endoscopic changing patterns of submucosal lesions in chronic gastric anisakiasis have not been known yet. Here we report 4 cases of suspected gastric anisakiasis which were improved during follow-up periods without surgical treatment. The patients presented with abdominal pain, nausea and vomiting after consuming raw marine fish, and visited our gastroenterology outpatient department. Their endoscopic findings showed firm and yellowish submucosal masses accompanied with eccentric erosions. Histologic findings showed severe eosinophilic infiltrations. In blood tests, peripheral eosinophil counts and total IgE levels were elevated. We believed that all cases were caused by larval anisakid infections. The submucosal mass lesions disappeared during the follow-up periods of 2 to 4 mo.

Enzyme-linked immunosorbent assay and Western blot antibody determination in sera from patients diagnosed with different helminthic infections with Anisakis simplex antigen purified by affinity chromatography

An evaluation of the sensitivity and the specificity of the Anisakis simplex antigens purified by affinity chromatography was performed using sera from patients diagnosed with Anisakis sensitisation and sera from patients previously diagnosed with different helminthic infections. Only the sera of the patients diagnosed with Schistosoma mansoni or Onchocerca volvulus parasitic infections were negative against the A. simplex antigen and its purified fractions (PAK antigen: A. simplex antigen purified using columns prepared with anti-A. simplex rabbit IgG and PAS antigen: PAK antigen purified using columns prepared with anti-Ascaris suum rabbit IgG). However all the sera were positive against the A. suum antigen. In all the sera from the patients diagnosed with Anisakis sensitisation, the antibody levels detected using the purified antigens (PAK and PAS antigens) were lower than the observed using the A. simplex crude extract with the highest diminution in the case of the IgG. When these same sera were tested against the A. simplex crude extract by Western blot, several bands of high molecular masses were observed as well as, intense bands at 60 and/or 40 kDa. A concentration of these last proteins was observed in the PAK and the PAS antigens. When the sensitivity and the specificity determinations were performed, only seven of the 38 patients diagnosed of Anisakis sensitisation were positive, as well as, the sera from the patients diagnosed with parasitisms by Echinococcus granulosus or Fasciola hepatica.

Un caso de anisakiosis en un adulto / An adult anisakiosis case

Un paciente de 38 años de edad con antecedentes de haber comido pescado crudo (mariscal) doce horas antes, presentó un severo dolor gástrico y eliminó por vía bucal una larva de nematodo de aproximadamente 20 mm de largo. La endoscopia mostró una leve gastritis, sin evidenciar la presencia de otras larvas o lesiones ulcerosas. El dolor desapareció totalmente a las dos semanas luego de un tratamiento con antihistamínicos y analgésicos

Aspectos ecológicos de la relación parasitaria entre larvas de contracaecum sp. nematoda, anisakidae y serrasalmus spilopleura kner, 1860, pisces, characidae en poblaciones naturales del nordeste argentino / Ecological relationships between contracaecum sp. larvae and the host serrasalmus spilopleura kner, 1860 in natural populations of northeastern Argentina

From february 1987 to february 1989, the populational biology of contraceacum sp. (larvae) in its paratenic host, the fish serrasalmus spilopleura kner, 1860, was studied in two ponds in a subtropical permanent habitat northeastern of Argentina. Fishes from Ramada Paso pond presented 80 percent of prevalence asn 1 to 132 larvae per fish while fishes from aeroclub pond presented 63 percent of prevalence and 1 to 184 larvae per fish. Fishes collected from aeroclub pon have shown a high prevalence of infection during the first period of study (1987), diminishing the folowing year. In fishes from Ramada Paso pond the prevalence varied not significatively during the two years. Prevalence and mean intensity of infection increase with body lengh and weigth of the hosts. Sex of hosts is not an influential factor in parasitic level. The lenitic closed environmental (Ramada Paso pond) evidenced the greatest larvae mean intensity and prevalence. Althougt, the lenitic open environmental (aeroclub pond) showed the greatest parasitic number of individuals in an infrapopulation. The spatial dispersion in both ponds were agregated and fit well a negative binomial model. Neverthelees, the aeroclub pond presented the greastest overdispersion

Anisaquíase; zoonose parasitária emergente no Brasil? / Anisiakiasis: an emergent parasitic zoonosis Brazil?

Discute-se a importância dos nematóides Anisakis simplex e Pseudoterranova, responsáveis pela anisaquíase, doença parasitária do homem, contraída após o consumo de pescado marinho cru, semi-cru ou defumado. Faz-se a atualizaçäo da biologia, no que se refere ao ciclo de vida dos parasitas e sua distribuiçäo geográfica; e da epidemiologia da infecçäo por Anisakidae, incluindo sua transmissäo ao homem, prevalência e hospedeiros marinhos. As larvas de terceiro ou quarto estágio destes parasitas säo encontradas com maior frequência na carne de arenque, salmäo, hadoque e bacalhau. Faz-se uma revisäo a respeito dos sintomas, diagnóstico, tratamento e prevençäo. Dá-se destaque especial ao Brasil, onde a infecçäo humana ainda näo foi registrada, apesar de larvas de Anisakidae terem sido encontradas em peixe-espada (Trichiuris lepturus L.), anchovas (Pomatomus saltatriz) e pargos (Pagrus pagrus), capturados no litoral do Rio de Janeiro. Acredita-se que, em futuro próximo, poderá ser possível observar os primeiros casos de anisaquíase no homem, devido à crescente popularidade dos restaurantes e fast-food brasileiros, especializados em sashimi e sushi.

Alergia a Anisakis simplex: estudios clínicos e inmunológicos y reactividad cruzada con otros parásitos / Allergy by Anisakis simplex: clinical and immunological study and cross-reactivity with other parasites

El Anisakis simplex es un parásito perteneciente a la familia Anisakidae, de la clase nematodos, que vive en el tubo digestivo de grandes mamíferos marinos y parasita accidentalmente al hombre al ingerir pescado crudo o poco cocinado. Recientemente se ha implicado como posible factor etiológico de reacciones alérgicas inducidas tras la ingesta de pescado parasitado. En el presente estudio investigamos la posible sensibilización a antígenos de A. simplex en 11 pacientes que presentaron reacciones alérgicas tras la ingesta de pescado. También se estudió la existencia de reactividad cruzada con otros parásitos. En todos los pacientes se demostró, mediante pruebas inmunológicas "in vivo" e "in vitro", la existencia de un mecanismo de hipersensibilidad inmediata a antígenos de A. simplex. Las pruebas cutáneas con el extracto comercial, así como la determinación de IgE específica por técnica CAP y la liberación de histamina frente a este parásito fueron positivos, confirmando la sensibilización mediada por anticuerpos IgE a antígenos de Anisakis. Al estudiar la posible reactividad cruzada con otros parásitos (Ascaris lumbricoides, Echinococcus granulosus) por medio del inhibición del CAP, ésta resultó muy escasa para Ascaris lumbricoides, por lo que en estos pacientes dicha reactividad cruzada parece poco relevante. En cambio la inhibición del CAP a Eschinococcus granulosus con A. simplex llegó hasta el 30-60 por ciento, sugiriendo la existencia de cierto grado de reactividad cruzada entre ambos parásitos, aunque estén más alejados taxonómicamente. Debido a que el Anisakis simplex es un parásito ubicuo, ya que infecta a pescados y mariscos en mares de todo el mundo, sugerimos que ante la historia de manifestaciones alérgicas tras la ingesta de esta clase de alimentos, se investigue la sensibilidad a este parásito, además de los antígenos propios de los frutos de mar. Por otra parte, se debería estudiar la posible sensibilización a A. simplex en los pacientes a los cuales se les detecta IgE específica a E. granulosus, descartándose con anterioridad la enfermedad hidatídica.