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 Clinical Characteristics of Anisakis Allergy in Korea

Anisakidae larvae can cause anisakiasis when ingested by humans. Although several groups have reported a gastrointestinal Anisakis allergy among people in Spain and Japan, our report is the first to summarize the clinical features of 10 Anisakis allergy cases in Korea. We enrolled 10 Korean patients (6 men and 4 women) who complained of aggravated allergic symptoms after ingesting raw fish or seafood. Sensitization to Anisakis was confirmed by detecting serum specific IgE to Anisakis simplex. The most common manifestation of anisakiasis was urticaria (100%), followed by abdominal pain (30%) and anaphylaxis (30%). All patients presenting with these symptoms also exhibited high serum specific IgE (0.45 to 100 kU/L) to A. simplex. Nine patients (90%) exhibited atopy and increased total serum IgE levels. The fish species suspected of carrying the Anisakis parasite were flatfish (40%), congers (40%), squid (30%), whelk (10%), and tuna (10%). Anisakis simplex should be considered as a possible causative food allergen in adult patients presenting with urticaria, angioedema, and anaphylaxis following the consumption of raw fish or seafood.

Vibrio vulnificus infection in São Paulo, Brazil: case report and literature review

Non cholera Vibrio may cause conjunctivitis, wound infection, gastroenteritis and serious sepsis. Transmission to men is through contact with skin, mucosa or wounds exposed to marine water, and consumption of certain barely cooked or raw seafood, more frequently in the summer. This is one of the first cases of severe infection related to Vibrio vulnificus described in Brazil. The patient was an old man, who ingested seafood in Guarujá, a seashore city near São Paulo, 3 days before hospitalization. He was admitted to the emergency room in an ill state with septic shock. On 2 sets of blood culture a highly virulent microorganism was isolated, Vibrio vulnificus, which leads to sepsis and frequently to death in susceptible patients. The objective of this report was to use this case to discuss clinical aspects, microbiological diagnosis and treatment of the infection caused by this agent, besides the review of epidemiology, associated risk factors and prevention before consuming or getting in contact with seafood, especially in patients with greater susceptibility to this kind of infection.

Acute neuromuscular manifestations in a patient associated with ingesting octopus (Octopus sp)

The authors report neuromuscular manifestations in a 45-year-old woman after consuming octopus meat (Octopus sp.). The patient presented malaise, paresthesias in perioral and extremity areas, intense muscular weakness and arterial hypotension, followed by severe itch and disseminated cutaneous rash. Gastrointestinal manifestations and fever were not observed, reducing the probability of alimentary poisoning. The presence of muscular and neurological symptoms suggests neurotoxin action, which could have been ingested by the victim from the octopus salivary glands or from an accumulation of toxins in the meat, or by an unknown mechanism. There is little known about toxins of the Octopus genus and this communication is important alert to the possibility of poisoning in humans that eat octopus and its differentiation from alimentary poisonings arising from incorrect conservation of seafood.

Os autores relatam um quadro manifestado por sintomas neurológicos e musculares em uma mulher de 45 anos, que surgiu após o consumo da carne de polvo comum (Octopus sp.). A paciente apresentou intenso mal estar, parestesias em extremidades e área perioral, fraqueza muscular intensa e hipotensão arterial, seguidos de prurido importante e uma erupção eritêmato-descamativa disseminada tardia. Não foram observadas manifestações gastrintestinais ou febre, o que reduziu a probabilidade de uma intoxicação alimentar por conservação inadequada do molusco. A presença de sintomas neuro-musculares é sugestiva de ação de neurotoxinas, comprovadamente existentes em muitos gêneros de polvos e que podem ter sido ingeridas através do consumo das glândulas salivares ou acúmulo das toxinas na carne, por algum mecanismo ainda desconhecido. As toxinas dos polvos do gênero Octopus são pouco estudadas e julgamos esta comunicação importante por alertar para a possibilidade do envenenamento nos seres humanos que consomem carne de polvos e ainda sua diferenciação das intoxicações alimentares que ocorrem por conservação inadequada do animal.

An Impacted Clamshell in the Duodenum Mistaken for a Gall Stone

Although most ingested foreign bodies pass through the gastrointestinal tract spontaneously, those that are sharp, pointed, or large require removal to avoid serious complications. Here we report an interesting case of a 60-year-old man who swallowed a clamshell that passed through the pylorus and was caught in the duodenum. Radiologic findings made it look like a biliary stone. Endoscopic retrieval of the clamshell with a Dormia Basket was performed safely and the patient was discharged uneventfully on the day of the procedure.

Prevalence of adverse food reactions and food allergy among Thai children.

INTRODUCTION: Adverse food reactions are not uncommon among children. Several of these reactions are IgE-mediated. Prevalence of adverse food reactions among Thai children has not been fully explored. OBJECTIVES: The objectives of the study are (1) to determine prevalence of adverse food reactions and food allergy among Thai children, (2) to determine types of foods producing such reactions, (3) to study clinical manifestations of these reactions, and (4) to study various risk factors relating to food adverse reactions among these children. MATERIAL AND METHOD: A total of 656 Thai children were surveyed (188 subjects between 6 months to 3 years of age and 468 subjects between 3 to 6 years of age). The study was a cross-sectional study. Parents answered food allergy questionnaire. Families with children reporting adverse food reactions were invited to participate in further investigation for food allergy with skin prick testings and food challenges. RESULTS: Forty-one of 656 children (6.25%) were reported to experience prior food reactions by questionnaire survey. Common foods reported to be the cause of reactions among younger children were cow's milk and eggs whereas seafood, particularly shrimp, was the most commonly reported food for older children. Three of 21 children underwent food challenge had positive challenges. Skin prick tests to incriminated food were all positive in these three children. Significant risk factors for developing adverse food reactions among these children were personal allergic history (OR = 4.89, CI 2.2-10.75) and family history of allergy (OR = 2.87, CI 1.42-5.89). CONCLUSION: Prevalence of adverse food reactions using food allergy questionnaire was 6.25%. From a limited number of those with positive food challenges, prevalence of IgE-mediated food allergy among this group of Thai children is estimated to be 0.45% (CI 0.01-0.8%).

Evaluation of consistency between local and imported seafood allergen extracts.

BACKGROUND: Seafood is a common cause of food allergy in Thai adults and children. Skin prick test is a safe and convenient way to screen seafood allergy. To date, the Allergy Unit, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University uses imported extracts for seafood skin prick test. The extracts are expensive and may not be the same species as seafood in Thailand. OBJECTIVES: To compare the consistency between local seafood allergen extracts prepared by the Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University and imported seafood allergen extracts. METHODS: The study was a prospective comparative trial performed in children who attended the Pediatric Allergy Clinic, Siriraj Hospital from March 1999 to October 2000. The skin prick test was performed with the local seafood allergen extracts prepared by a pharmacist from the Department of Pharmacology and the imported seafood allergen extracts included shrimp, fish and crab. Histamine and normal saline were used as positive and negative control respectively. The positive result was recorded when wheal reaction was > or = 3 mm larger than negative control. RESULTS: Eighty eight patients (57 boys and 31 girls) were included in this study. The average age was 7.7 years (1-15 years). Half of the patients had a history of seafood allergy. The study showed probable consistency between imported and local skin prick test of shrimp and crab extracts (kappa = 5-7) but no consistency between imported and local skin prick test of fish extracts (kappa < 5). The study also showed no consistency between history of seafood and skin prick test result. CONCLUSION: Local seafood allergen extracts from the Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University are safe but they cannot replace the imported seafood allergen extracts. Further investigations about sensitivity and specificity of both kinds of allergen extracts are necessary.