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Anisakiasis Migrans

  Anisakiasis (Anisakiasis Migrans) is an internal organ migration disease caused by infective stage larvae of Anisakiasis in humans who consume raw or semi-raw sea fish and soft-bodied animals such as squids. The initial stage of infection often manifests as acute abdomen. The chronic stage often presents with recurrent abdominal绞痛, formation of gastrointestinal or extraintestinal eosinophilic granulomas.

Table of Contents

1. What are the causes of Anisakiasis Migrans?
2. What complications can Anisakiasis Migrans easily lead to?
3. What are the typical symptoms of Anisakiasis Migrans?
4. How to prevent Anisakiasis Migrans?
5. What laboratory tests need to be done for Anisakiasis Migrans?
6. Diet recommendations and禁忌 for Anisakiasis Migrans patients
7. Conventional methods of Western medicine for the treatment of Anisakiasis Migrans

1. What are the causes of Anisakiasis Migrans?

  The adult Anisakiasis worms parasitize in the stomachs of marine mammals such as whales, dolphins, seals, etc. The eggs are excreted into the seawater with feces and hatch into larvae. The larvae are eaten by crustaceans such as shrimps and further develop into infective stage larvae in their bodies. After being eaten by sea fish such as herring, cod, squid, and Japanese seven-gill eel, saury, herring, mackerel, and octopus, the infective stage larvae reside in their muscles or peritoneal cavity. After being eaten by whales, the larvae penetrate the stomach wall and continue to develop into adults.

2. What complications can Anisakiasis Migrans easily lead to?

  Once the larvae penetrate the stomach and intestinal wall of the digestive tract and enter the peritoneal cavity, they migrate to the liver, kidney, pancreas, lung, ovary, mesentery, and other places, causing the spread of infection, leading to severe phlegmon, eosinophilic abscesses, and granulomas in various organs, becoming ectopic Anisakiasis. The mucosa of the throat and oral cavity can also be involved. Under the stimulation of larvae, diffuse peritonitis, ulceration of the intestinal mucosa, and even intestinal perforation may occur.

3. What are the typical symptoms of Anisakiasis Migrans?

  After humans consume raw or semi-raw sea fish and squids with infective stage larvae, Anisakiasis larvae parasitize in the human stomach and small intestinal mucosa, especially more common in the ileum. Once the larvae penetrate the stomach and intestinal mucosa of the digestive tract and enter the peritoneal cavity, they migrate to the liver, kidney, pancreas, lung, ovary, mesentery, and other places, causing severe phlegmon, eosinophilic abscesses, and granulomas in various organs, becoming ectopic Anisakiasis. The mucosa of the throat and oral cavity can also be involved. Under the stimulation of larvae, diffuse peritonitis, ulceration of the intestinal mucosa, and even intestinal perforation may occur.

  Based on epidemiological data, there is a history of consuming raw or semi-raw sea fish, and typical clinical symptoms are the main basis for diagnosis. Endoscopy can detect esophageal or gastric larvae to confirm the diagnosis. Diagnosis of ectopic lesions is difficult. Latex agglutination test, enzyme-linked immunosorbent assay can assist in diagnosis.

4. How to prevent Anisakiasis Migrans?

  In the medical history, it is necessary to inquire in detail about the medication history, food history, and other allergic histories. The absolute value of eosinophils in peripheral blood exceeding 3.0×10^9/L supports the diagnosis of the disease. Blood IgE determination shows high levels. If the disease is suspected to be caused by the migration of canine or feline ascarids in the body, an enzyme-linked immunosorbent assay (ELISA) can be performed to detect antibodies against canine or feline ascarids, in order to differentiate from human ascaris infection. Secondly, fish should be cooked thoroughly before consumption; it is stipulated that relevant fish must be frozen at -20℃ for 24 hours before entering the market.

5. What laboratory tests are needed for anisakiasis migration

  1. Peripheral blood examination

  Eosinophils in peripheral blood are larger than normal, containing large granules, the number of cells increases, accounting for 20% to 70% of the total white blood cell count, and the direct count of eosinophils is usually around 3.0×109/L.

  2. Immunological examination

  Parasite antibody tests in the blood can be positive; IgE can be as high as 2300ng/ml, and those with liver enlargement often show hyperglobulinemia.

  3. Parasite egg examination

  Parasite eggs found in bronchoalveolar lavage fluid and 24h sputum can have positive findings.

  4. Skin test examination

  Skin test with parasitic skin test fluid can be positive.

  5. Gastroscopy

  Esophageal or gastric larvae can be detected to confirm the diagnosis. Diagnosis of ectopic lesions is difficult, latex agglutination test, enzyme-linked immunosorbent assay can assist in diagnosis.

  6. Other auxiliary examinations

  The chest X-ray shows fluffy patchy shadows, the scope is not specified, the shadow can disappear in a short period of time, and then appear again soon, the location can migrate and is not fixed. Sometimes, atelectasis of the lung may be shown.

6. Dietary taboos for patients with anisakiasis migration

  1. When using fish, it should be cooked thoroughly before eating; it is stipulated that relevant fish must be frozen at -20℃ for 24 hours before entering the market.

  2. Choose easily digestible liquid foods such as vegetable soup, congee, egg soup, egg pudding, milk, etc.

  3. Diet should be light and low in grease, meeting the nutritional needs while also enhancing appetite. White rice porridge, millet porridge, adzuki bean porridge, and side dishes such as sweet sauce, turnip, pickled radish, or bean curd can be provided. Light and refreshing dishes are recommended.

7. Conventional methods for treating anisakiasis migration in Western medicine

  Severe patients can first use adrenal cortical hormones to alleviate symptoms and reduce the number of blood eosinophils. The daily dose of prednisone (prednisone) is 1-2mg/kg, taken continuously for 3-5 days. After obtaining temporary efficacy, continue to find the cause so as to carry out etiological treatment. The disease of esophageal or gastric anisakiasis can be removed under endoscopy. Patients with ectopic lesions can take albendazole, 500mg each time, three times a day, for three consecutive days. Surgery may be necessary if necessary.

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