Anisakis Simplex

Anisakis simplex (herring worm), Pseudoterranova (Phocanema, Terranova) decipiens (cod or seal worm), Contracaecum spp., and Hysterothylacium (Thynnascaris) spp. are anisakid nematodes (roundworms) that have been implicated in human infections caused by the consumption of raw or undercooked seafood. Some evidence exists that the nematode larvae move from the viscera to the flesh if the fish hosts are not gutted promptly after catching. The life cycles of all the other anisakid genera implicated in human infections are similar. These parasites are known to occur frequently in the flesh of cod, haddock, fluke, pacific salmon, herring, flounder, and monkfish.

In North America, anisakiasis is most frequently diagnosed when the affected individual feels a tingling or tickling sensation in the throat and coughs up or manually extracts a nematode. In more severe cases there is acute abdominal pain, much like acute appendicitis accompanied by a nauseous feeling. Symptoms occur from as little as an hour to about 2 weeks after consumption of raw or undercooked seafood. One nematode is the usual number recovered from a patient. With their anterior ends, these larval nematodes from fish or shellfish usually burrow into the wall of the digestive tract to the level of the muscularis mucosae (occasionally they penetrate the intestinal wall completely and are found in the body cavity).

In cases where the patient vomits or coughs up the worm, the disease may be diagnosed by morphological examination of the nematode. (Ascaris lumbricoides, the large roundworm of humans, is a terrestrial relative of anisakines and sometimes these larvae also crawl up into the throat and nasal passages.) Other cases may require a fiber optic device that allows the attending physician to examine the inside of the stomach and the first part of the small intestine. These devices are equipped with a mechanical forceps that can be used to remove the worm. Other cases are diagnosed upon finding a granulomatous lesion with a worm on laparotomy. A specific radioallergosorbent test has been developed for anasakiasis, but is not yet commercially marketed.

Severe cases of anisakiasis are extremely painful and require surgical intervention. Physical removal of the nematode(s) from the lesion is the only known method of reducing the pain and eliminating the cause (other than waiting for the worms to die). The symptoms apparently persist after the worm dies since some lesions are found upon surgical removal that contain only nematode remnants. Stenosis (a narrowing and stiffening) of the pyloric sphincter was reported in a case in which exploratory laparotomy had revealed a worm that was not removed.