Comparative Parasitology 67(1) 2000 - Peru State College

Comp. Parasitol.
67(1), 2000 pp. 71-75
An Unusual Case of Anisakiasis in California, U.S.A.
OMAR M. AMIN,M WILLIAM S. EiDELMAN,2 WILLIAM DoMKE,3 JONATHAN BAILEY,3 AND
GEOFFREY PFEiFER2
1 Institute of Parasitic Diseases, P. O. Box 28372, Tempe, Arizona 85285-8372, and Department of Zoology,
Arizona State University, Tempe, Arizona 85287-1501, U.S.A. (e-mail: omaramin@aol.com),
2 The Natural Medicine Center, 1434 East Ojai Avenue, Ojai, California 93023, U.S.A. and
3 634V2 Rose Avenue, Venice, California 90291, U.S.A. (e-mail: colonichydrotherapy@USA.NET)
ABSTRACT. In the first case of its kind, anisakiasis is documented in a 44-yr-old California male whose neck
was penetrated transesophageally by 1 third-stage larva of Pseudoterranova decipiens. The larva subsequently
emerged from the neck region through an ulcerating sore. The larva showed some evidence of development and
is described. The clinical history of the patient is reviewed. The patient subsequently died of causes unrelated
to the anisakiasis infection.
KEY WORDS: anisakiasis, Pseudoterranova decipiens, third-stage larva, human infection, morphology, case
history, California, U.S.A.
Of the many genera of ascaroid (Anisakidae)
nematodes causing anisakiasis in vertebrates
(Myers, 1975), only 2 species cause human infections
in North America (McKerrow and
Deardorff, 1988; U.S. Food and Drug Administration/Center
for Food Safety and Applied
Nutrition [FDA/CFSAN], 1992). The cod worm,
Pseudoterranova decipiens (Krabbe, 1878) Gibson
and Colin, 1981, infects marine mammals,
most importantly seals, in the North Atlantic and
North and South Pacific; the herring worm, Anisakis
simplex (Rudolphi, 1809) Baylis, 1920,
infects marine mammals, particularly whales in
the eastern Pacific and elsewhere in the world
(see Myers [1959, 1975] and Gibson [1983] for
synonymies). Despite the high incidence of
worms of the genus Anisakis in fishes (Myers,
1979) and whales in the western Pacific, human
cases in North America involving larvae of Anisakis
are rare. The higher incidence of human
infection with larvae of the genus Pseudoterranova
(Lichtenfels and Brancato, 1976; Kliks,
1983), particularly in the northern Atlantic coast,
appears to be related to the large seal populations
there (Myers, 1976).
Two patterns of disease describe the clinical
symptomology of anisakiasis in North America.
The asymptomatic luminal condition described
for larvae of Pseudoterranova does not involve
tissue penetration, and worms are expelled by
coughing, vomiting, or defecating. In infections
with larvae of Anisakis, however, penetration of
Corresponding author.
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the gut wall is reported by many observers
(Kates et al., 1973; Lichtenfels and Brancato,
1976; Myers, 1976; Margolis, 1977; Ishikura et
al., 1993). These cases are easily misdiagnosed
as appendicitis, Crohn's disease, gastric ulcer, or
gastrointestinal cancer (McKerrow and Deardorff,
1988; FDA/CFSAN, 1992; Alonso et al.,
1997). Documentation of our present case, however,
demonstrates that larvae of Pseudoterranova
can be as invasive as has traditionally been
described in infections with Anisakis in Holland
and Japan (Oshima, 1972, 1987; Yoshimura et
al., 1979; Ishikura et al., 1993).
In North America, the public health impact of
anisakiasis is limited to consumers of such foods
as sushi and sashimi. Approximately 50 cases
were documented in the United States up to
1988, and fewer than 10 cases have been documented
annually (FDA/CFSAN, 1992) since
the first North American cases in the United
States were documented in the early 1970's (Little
and Most, 1973; Pinkus et al., 1975). The
first confirmed human case of anisakiasis was
reported in Holland in 1960 (Van Theil et al.,
1960), and Holland remains the most important
anisakiasis-endemic region of the world. By
1990, 292 of the 559 European cases were reported
in Holland, whereas 12,586 cases were
reported in Japan. The Japanese cases included
11,629 gastric, 567 intestinal, and 45 extragastrointestinal
cases of infection by Anisakis and
only 335 cases of gastric infection by Pseudoterranova
(Ishikura et al., 1993). This report
documents worm morphology and the clinical
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