Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Anisakiasis 125

Anisakiasis.........................................

J. GORDON FRIERSON, MD

history & physical

History

■Exposure: Ingestion of poorly cooked fish, resulting in ingestion of

larval forms of Anisakis simplex or Pseudoterranova decipiens. The

larvae invade intestinal wall of stomach or small bowel to level of

submucosa, causing inflammatory swelling. Occasionally perfora-

tion of small bowel occurs.

Signs & Symptoms

■Depending on location of worms: Worm may migrate to pharynx

in absence of other symptoms. May see epigastric pain, abdominal

pain, nausea, vomiting. Abdominal examination may be normal,

or may show tenderness over affected bowel, sometimes peritoneal

signs (especially in case of perforation). Allergic reactions, including

anaphylaxis, can occur.

tests

■Basic tests: blood: normal, or eosinophilia. High WBC in case of per-

foration.

■Basic tests: urine: normal

■Specific tests: If worm appears in pharynx, identify worm.

■Gastroscopy in case of gastric anisakiasis. Otherwise diagnosis is

clinical unless surgery required for peritoneal signs.

■Other tests: In intestinal form: barium studies may show narrowed

inflamed area in ileum. Serology available on research basis, not

usually helpful at bedside. Skin testing if allergic reaction present.

differential diagnosis

■Gastric form: peptic ulcer, cholecystitis, pancreatitis

■Intestinal form: appendicitis, Crohn’s disease, diverticulitis, mesen-

teric adenitis, Angiostrongylus costaricensis infection

management

What to Do First

■Assess severity and need for possible surgery. IV fluids if needed.

General Measures

■Ascertain source of infection.