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Re-thinking raw fish

Friday, September 2017 09:08:11:54

Parasite becoming more common in the U.S.

A paper published Thursday in BMJ Case Reports says cases of anisakiasis are on the rise in the West due to the increasing popularity of sushi and other dishes involving raw or under-cooked fish. The report gives the example of a Portuguese man who was suffering vomiting, fever, and stomach pain. He told doctors he had recently eaten sushi, and they discovered an anisakis larva attached to his stomach lining, CTV News reports. According to CNN, the anisakis is a parasitic worm that lives in mackerel, squids, salmon, herring, cod, red snapper, and halibut.

There's no treatment for anisakiasis, which can also cause bowel obstruction and digestive bleeding, besides physical removal of the anisakis larva, which can require surgery, the Guardian reports. Anisakiasis is common in Japan due to the prevalence of raw fish in the diet, with between 2,000 and 3,000 cases diagnosed per year. But cases are starting to pop up in the US and elsewhere in the West. To avoid getting the parasite, patronize high-quality sushi restaurants. "Properly trained sushi chefs can detect anisakis larvae," one doctor says. "They are grossly visible in the fish." Or if you're making sushi at home, freeze the fish for at least four days beforehand to kill the larvae. (Tapeworm believed to be only in Asian salmon found in US.)

Anisakiasis, or herring worm disease, is a parasitic disease caused by nematodes (worms) that attach to the wall of the esophagus, stomach, or intestine

From the Center for Disease Control and Prevention

What is anisakiasis?

Anisakiasis, or herring worm disease, is a parasitic disease caused by nematodes (worms) that attach to the wall of the esophagus, stomach, or intestine. The best ways to prevent this disease is to avoid eating raw or undercooked fish or squid.

How does one become infected?

When certain infected marine mammals (such as whales or sea lions) defecate into the sea, eggs are released and become infective larvae while in the water. These larvae are ingested by crustaceans, which are then eaten by fish or squid. When humans eat raw or undercooked infected fish or squid, they ingest nematode larvae. Once inside the human body, the larvae can invade the gastrointestinal tract. Eventually, the parasite dies and produces an inflamed mass in the esophagus, stomach, or intestine.

Some people experience a tingling sensation after or while eating raw or undercooked fish or squid. This is actually the worm moving in the mouth or throat. These people can often extract the worm manually from their mouth or cough up the worm and prevent infection. Also, some people experience vomiting as a symptom and this can often expel the worm from the body.

Where is anisakiasis found?

Anisakiasis is most commonly found in areas where eating raw fish is popular, such as Japan. However, since eating undercooked fish is becoming more common, there have been cases seen in the United States, Europe, South America, and other areas of the world. Anyone who eats undercooked or raw fish or squid is at risk.

How is it diagnosed?

A history of eating undercooked fish or squid is helpful. Diagnosis is generally made by endoscopy, radiography, or surgery if the worm has embedded.

Can anisakiasis be transmitted human to human?

No. Anisakiasis cannot be transmitted human to human.

What are the signs and symptoms?

The signs and symptoms of anisakiasis are abdominal pain, nausea, vomiting, abdominal distention, diarrhea, blood and mucus in stool, and mild fever. Allergic reactions with rash and itching, and infrequently, anaphylaxis, can also occur.

How can I prevent anisakiasis?

Do not eat raw or undercooked fish or squid.

The FDA recommends the following for seafood preparation or storage to kill parasites.

Cooking (Seafood in General)

Cook seafood adequately (to an internal temperature of at least 145° F [~63° C]).

Freezing (Fish) At -4°F (-20°C) or below for 7 days (total time), or At -31°F (-35°C) or below until solid, and storing at -31°F (-35°C) or below for 15 hours, or At -31°F (-35°C) or below until solid and storing at -4°F (-20°C) or below for 24 hours.

What is the treatment?

The treatment for anisakiasis may require removal of the worm from the body by endoscopy or surgery.

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