CASTROENTEROLOCY 1986:90:1047-50 Invasive Anisakiasis A Case Report From Hawaii THOMAS L. DEARDORFF, TAKAKAZU FUKUMURA, and RICHARD B. RAYBOURNE Fishery Research Branch, Food and Drug Administration, Dauphin Island, Alabama; T. Fukumura Clinic, Honolulu, Hawaii; and Division of Microbiology, Food and Drug Administration, Washington, D.C. A confirmed case of penetration into the stomach wall by an anisakine nematode, to our knowledge the first in the United States, is reported. A viable third-stage larva of Anisakis simplex was removed from a woman in Hawaii who had eaten fresh, raw salmon. A serodiagnostic test showed the serum of the patient to be positive for A. simplex-specific Ig& at days 11 and 60 postinfection. Our results indicate that eating fresh, raw salmon exposes consumers to a significant health risk. The zoonotic disease anisakiasis involves the pene- tration of larval marine ascaridoid nematodes into or through the gastrointestinal tract of a host. The most commonly implicated agent of anisakiasis is the third-stage larva of Anisakis simplex. Consumption of raw or inadequately prepared seafood serves as the source of human infection. The potential for transmission of anisakine larvae to humans exists in areas where raw marine fishes and invertebrates are eaten routinely. For instance, hundreds of cases of anisakiasis have been diag- nosed in Japan (l,2). In the United States, where the current trend of eating raw, inadequately cooked, lightly salted, or marinated seafood products has increased, the number of reported cases of exposure to fishborne parasites has also increased. Recently, 10 cases from California (3,4) and 6 cases from Alaska (5) were reported. The dietary habits common among Hawaii’s nu- merous ethnic groups presumably would make those islands a prime area for anisakiasis; however, no cases had been previously reported. This paper de- scribes the first case of anisakiasis from Hawaii and Received May 3, 1985. Accepted October 5, 1985. Address requests for reprints to: Dr. Thomas L. Deardorff, Fishery Research Branch, Food and Drug Administration, Box 158, Dauphin Island, Alabama 36528. is the first confirmed case in the 1Jnited States of active penetration into the stomach wall by a larva belonging to the genus Anisakis. A previously re- ported case in the United States showing evidence of tissue involvement indicated larval penetration into the cecum (6). The penetration of anisakine larvae into various areas of the gastrointestinal tract may invoke a vari- ety of clinical conditions that often make diagnosis of the disease difficult. Piagnosis is complicated even further because some patients display only mild symptoms or no symptoms of the disease. Oshima (1) reported the misdiagnosis of 153 cases of stomach anisakiasis from one hospital in 1 yr. To assist in our diagnosis of anisakiasis, we used a recently developed serodiagnostic test for human anisakiasis on the patient’s sera. For methodology and preparation of antigen from the larval nema- todes, we followed the procedures reported by Desowitz et al. (7). Case Report A 34-yr-old Japanese woman, who had resided in Hawaii all her life, presented on August 8,1984, complain- ing of sporadic epigastric pain. The onset of pain occurred -1 wk earlier, generally noticeable in the early morning. Pain was occasionally associated with nausea. In one instance, the patient experienced pain radiating to her left shoulder during epigastric distress. No vomiting was ex- perienced, her abdomen was not distended, and her stools were normal. The patient’s history revealed that she often ate raw fish [e.g., tuna, salmon, abalone, and poki). She remembered eating raw salmon for dinner on August 5th at about 6:00 PM and being awakened at about 5:00 AM the following morning with what she assumed to be “hunger pangs.” Before eating the salmon, she had not eaten fresh raw fish within 48 h.
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