History

Fact Explanation
Tingling sensation of the mouth or throat Occurs due to the movement of the worms. Patients complain this while or after or while eating raw or undercooked fish or squid. [1]
History of ingestion of raw meat fish or squid [3] The larvae are transmitted to the human via ingestion of raw meat and see food.
Coughing and or vomiting of worms [1] Sometimes worms in the esophagus may come out with vomiting and cough.
Nausea and or vomiting [4] Patients may have nausea and vomiting even after few hours of ingestion of larvae infested food.
Abdominal pain and or distention [1,2,4] Most of the time it is sudden onset epigastric pain. Some patients have intermittent abdominal pain which may last years undiagnosed. [2] Intestinal obstruction causes abdominal distention due to musosal edema in intestinal anisakiasis. [7]
Diarrhea [1,2,4] Patients often complain of blood and mucus diarrhea. May start after few hours of consuming the food. [4]
Fever [1,2] Not a constant feature.
Allergic reactions [1,6] Skin rash, urticaria [2] and itching are common. The allergens of the dead worm causes allergic reactions. Rarely anaphylaxis can occur. [4]
Pleuritic type chest pain Extra gastrointestinal anisakiasis will cause pleural inflammation. When the inflamed parietal and visceral pleura rubs against each other it causes pain. [5]
References
  1. Anisakiasis. Centers for Disease Control and Prevention. [online] [viewed 19 April 2014] Available from: http://www.cdc.gov/parasites/anisakiasis/faqs.html
  2. SAKANARI J. A. MCKERROW J.H. Anisakiasis. Clin. Microbiol. Rev. [online] 1989, 2(3):278. [viewed 19 April 2014] Available from: DOI: 10.1128/CMR.2.3.278.
  3. DAVID A.J.M., GIRDWOOD R.W.A., PETER L. C. Treatment of anisakiasis with albendazole. The Lancet [online] 6 July 2002: 360 (9326) 54. [viewed 19 April 2014] Available from: doi:10.1016/S0140-6736(02)09333-9
  4. TERESA A. M., MALCOLM W. K. Anisakis simplex: from Obscure Infectious Worm to Inducer of Immune Hypersensitivity. Clin Microbiol Rev. [online] Apr 2008; 21(2): 360–379. [viewed 19 April 2014] Available from: doi: 10.1128/CMR.00012-07
  5. MATSUOKA H, NAKAMA T, KISANUKI H, et al. A case report of serologically diagnosed pulmonary anisakiasis with pleural effusion and multiple lesions. Am J Trop Med Hyg [online] 1994;51:819-22 [viewed 19 April 2014] Available from: http://www.ajtmh.org/content/51/6/819.short
  6. LOPEZ-SERRANO MC, GOMEZ AA, DASCHNER A, et al. Gastroallergic anisakiasis: findings in 22 patients. J Gastroenterol Hepatol 2000;15:503-6. [online] [viewed 19 April 2014] Available from: DOI: 10.1046/j.1440-1746.2000.02153.x
  7. NAWA Y, HATZ C, BLUM J: Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis[online] 2005, 41:1297-1303. [viewed 19 April 2014] Available from: doi: 10.1086/496920

Examination

Fact Explanation
Fever [1,3] Some patients can be febrile.
Abdominal examination Diffuse abdominal tenderness is evident. [1] The inflammatory reaction may create a mass which might be felt. [4]
Pleuritic rub Pleural inflammation causes pleural rub. [2]
Skin lesions [1,5] Patients may have urticarial and skin rash.
References
  1. SAKANARI JA, MCKERROW JH. Anisakiasis. Clin Microbiol Rev. [online] 1989 Jul;2(3):278-84. [viewed 19 April 2014] Available from: DOI: 10.1128/CMR.2.3.278.
  2. MATSUOKA H, NAKAMA T, KISANUKI H, et al. A case report of serologically diagnosed pulmonary anisakiasis with pleural effusion and multiple lesions. Am J Trop Med Hyg [online] 1994;51:819-22 [viewed 19 April 2014] Available from: http://www.ajtmh.org/content/51/6/819.short
  3. Anisakiasis. Centers for Disease Control and Prevention. [online] [viewed 19 April 2014] Available from: http://www.cdc.gov/parasites/anisakiasis/faqs.html
  4. NAWA Y, HATZ C, BLUM J: Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis[online] 2005, 41:1297-1303. [viewed 19 April 2014] Available from: doi: 10.1086/496920
  5. LOPEZ-SERRANO MC, GOMEZ AA, DASCHNER A, et al. Gastroallergic anisakiasis: findings in 22 patients. J Gastroenterol Hepatol 2000;15:503-6. [online] [viewed 19 April 2014] Available from: DOI: 10.1046/j.1440-1746.2000.02153.x

Differential Diagnoses

Fact Explanation
Acute abdomen [1,6] Causes like appendicitis [2,5], pancreatitis, choledocholithiasis, cholelithiasis, gallbladder empyema, diverticulitis, pelvic Inflammatory disease and other causes should be considered.
Intestinal obstruction Mucosal inflammation causes reactive intestinal obstruction in intestinal anisakiasis. [3]
Peptic ulcer disease [1,6] Endoscopic findings of ulcers may lead to the diagnosis of peptic ulcer disease. In anisakiasis a worm can be seen in the middle of the ulcer when carefully looked for. [7]
Tuberculosis peritonitis [1] Abdominal swelling, and abdominal pain is common. Differentiating features include fever and night sweats, anorexia and weight loss. ESR is elevated and tuberculin skin test becomes positive in some patients. [8]
Allergic reaction Some patients with anisakiasis present with allergic reactions. This may mimic an allergic reaction due to any other common cause (food allergy, drug allergy). [4]
Diphyllobothriasis A parasitic infestation caused by fish tapeworm. This can result in vitamin B12 deficiency anemia. [3]
Ileitis Ileitis can be due to various reasons and anisakiasis is only one of them. Other infective causes include Yersinia species, non-typhoidal Salmonella, Clostridium difficile, Mycobacterium tuberculosis, Actinomycosis, Cytomegalovirus and Histoplasmosis. Spondyloarthropathies, Henoch-Schönlein purpura, and small-bowel neoplasms are non-infective causes. [9]
Neoplasm Extraintestinal anisakiasis may produce inflammatory masses which are felt as neoplastic lesions. [4]
References
  1. SAKANARI JA, MCKERROW JH. Anisakiasis. Clin Microbiol Rev. [online] 1989 Jul;2(3):278-84. [viewed 19 April 2014] Available from: DOI: 10.1128/CMR.2.3.278.
  2. RUSHOVICH AM, RANDALL EL, CAPRINI JA, WESTENFELDER GO. Omental anisakiasis: a rare mimic of acute appendicitis. Am J Clin Pathol. [online] 1983 Oct;80(4):517-20. [viewed 19 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/6624718
  3. YUKIFUMI N., CHRISTOPH H., JOHANNES B. Sushi Delights and Parasites: The Risk of Fishborne and Foodborne Parasitic Zoonoses in Asia. Clin Infect Dis. [online] 2005: 41 (9): 1297-1303. [viewed 19 April 2014] Available from: doi: 10.1086/496920
  4. NAWA Y, HATZ C, BLUM J: Sushi delights and parasites: the risk of fishborne and foodborne parasitic zoonoses in Asia. Clin Infect Dis[online] 2005, 41:1297-1303. [viewed 19 April 2014] Available from: doi: 10.1086/496920
  5. LOPEZ-SERRANO MC, GOMEZ AA, DASCHNER A, et al. Gastroallergic anisakiasis: findings in 22 patients. J Gastroenterol Hepatol 2000;15:503-6. [online] [viewed 19 April 2014] Available from: DOI: 10.1046/j.1440-1746.2000.02153.x
  6. JOAQUÍN V., ELISA L., MARÍA E. S., ROCÍO L., JAVIER L. R. Spontaneous splenic rupture and Anisakis appendicitis presenting as abdominal pain: a case report. Journal of Medical Case Reports. [online] 2012, 6:114. [viewed 19 April 2014] Available from: doi:10.1186/1752-1947-6-114
  7. MATSUI T, IIDA M, MURAKAMI M, KIMURA Y, FUJISHIMA M, YAO Y, TSUJI M. Intestinal anisakiasis: clinical and radiologic features. Radiology [online] 1985, 157:299-302. [viewed 19 April 2014] Available from: http://pubs.rsna.org/doi/abs/10.1148/radiology.157.2.4048435?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
  8. MANOHAR A., SIMJEE A.E.,HAFFEJEE A.A., PETTENGELL K.E. Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five year period. Gut. [online] Oct 1990; 31(10): 1130–1132. [viewed 19 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1378737/
  9. STEVEN DILAURO, NANCY F. CRUM-CIANFLONE. Ileitis: When It Is Not Crohn's Disease. Curr Gastroenterol Rep. [online] Aug 2010; 12(4): 249–258. [viewed 19 April 2014] Available from: doi: 10.1007/s11894-010-0112-5

Investigations - for Diagnosis

Fact Explanation
Full blood count Shows leukocytosis. [2] Eosinophilia may not be evident in the acute illness. [3]
Endoscopy [1,2] Gastric anisakiasis can be diagnosed and worms can be removed as well. [3] Mucosal inflammation, edema, erosions and ulcerations can be seen. [4,5] Eosinophilic granulomas occur with chronic infestation.
Barium meal [1] Radiological evaluation will show areas of luminal narrowing, filling defects, irregular thickenings of the intestinal wall. This is due to intestinal edema and due to presence of worms. [3,6]
Surgical biopsy [1] Anisakiasis involving the small intestine is diagnosed with small intestinal biopsies and confirmation of specific histological changes.
References
  1. Anisakiasis. Centers for Disease Control and Prevention. [online] [viewed 19 April 2014] Available from: http://www.cdc.gov/parasites/anisakiasis/faqs.html
  2. SAKANARI JA, MCKERROW JH. Anisakiasis. Clin Microbiol Rev. [online] 1989 Jul;2(3):278-84. [viewed 19 April 2014] Available from: DOI: 10.1128/CMR.2.3.278.
  3. YUKIFUMI N., CHRISTOPH H., JOHANNES B. Sushi Delights and Parasites: The Risk of Fishborne and Foodborne Parasitic Zoonoses in Asia. Clin Infect Dis. [online] 2005: 41 (9): 1297-1303. [viewed 19 April 2014] Available from: doi: 10.1086/496920
  4. BIRCHER AJ, GYSI B, ZENKLUSEN HR, AERNI R. Eosinophilic esophagitis associated with recurrent urticaria: is the worm Anisakis simplex involved? Schweiz Med Wochenschr [online] 2000;130:1814-9. [viewed 19 April 2014] Available from: http://europepmc.org/abstract/MED/11130147
  5. JOAQUÍN V., ELISA L., MARÍA E. S., ROCÍO L., JAVIER L. R. Spontaneous splenic rupture and Anisakis appendicitis presenting as abdominal pain: a case report. Journal of Medical Case Reports. [online] 2012, 6:114. [viewed 19 April 2014] Available from: doi:10.1186/1752-1947-6-114
  6. MATSUI T, IIDA M, MURAKAMI M, KIMURA Y, FUJISHIMA M, YAO Y, TSUJI M. Intestinal anisakiasis: clinical and radiologic features. Radiology [online] 1985, 157:299-302. [viewed 19 April 2014] Available from: http://pubs.rsna.org/doi/abs/10.1148/radiology.157.2.4048435?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Management - General Measures

Fact Explanation
Health education Raw or undercooked fish or squid should not be consumed. Meat and see food should be cooked, smoked or frozen before consumption. [1,2,3]
Intestinal decompression with nasogastric tube Larvae can survive in human body for few days. In intestinal obstruction nasogastric tube will decompress the intestine and also protects the airway in drowsy patients. [3]
References
  1. Anisakiasis. Centers for Disease Control and Prevention. [online] [viewed 19 April 2014] Available from: http://www.cdc.gov/parasites/anisakiasis/faqs.html
  2. DAVID A.J.M., GIRDWOOD R.W.A., PETER L. C. Treatment of anisakiasis with albendazole. The Lancet [online] 6 July 2002: 360 (9326) 54. [viewed 19 April 2014] Available from: doi:10.1016/S0140-6736(02)09333-9
  3. TERESA A. M., MALCOLM W. K. Anisakis simplex: from Obscure Infectious Worm to Inducer of Immune Hypersensitivity. Clin Microbiol Rev. [online] Apr 2008; 21(2): 360–379. [viewed 19 April 2014] Available from: doi: 10.1128/CMR.00012-07

Management - Specific Treatments

Fact Explanation
Surgery Often required for invasive disease, to treat infestation in the small intestine. [1,2]
Endoscopic removal of the worm [3] An option of treatment for gastric and duodenal anisakiasis. [2]
Albendazole (400 or 800 mg for 6–21 days) This is not widely used but found to be effective. [2]
References
  1. SAKANARI JA, MCKERROW JH. Anisakiasis. Clin Microbiol Rev. [online] 1989 Jul;2(3):278-84. [viewed 19 April 2014] Available from: DOI: 10.1128/CMR.2.3.278.
  2. DAVID A.J.M., GIRDWOOD R.W.A., PETER L. C. Treatment of anisakiasis with albendazole. The Lancet [online] 6 July 2002: 360 (9326) 54. [viewed 19 April 2014] Available from: doi:10.1016/S0140-6736(02)09333-9
  3. YUKIFUMI N., CHRISTOPH H., JOHANNES B. Sushi Delights and Parasites: The Risk of Fishborne and Foodborne Parasitic Zoonoses in Asia. Clin Infect Dis. [online] 2005: 41 (9): 1297-1303. [viewed 19 April 2014] Available from: doi: 10.1086/496920