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Anisakis simplex-from Obscure Infectious Worm to Inducer ofImmune Hypersensitivity PowerPoint Presentation

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Description : Anisakis simplex: from Obscure Infectious Worm to Inducer ofImmune Hypersensitivity

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Anisakis simplex: from Obscure Infectious Worm to Inducer of Immune Hypersensitivity ELYN DOHAR IDARIN ARITONANG FANNY ANGGRAENI OCTAVIANI DEPARTEMEN PARASITOLOGI FK UI
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INTRODUCTION The consumption of raw or undercooked fish may lead to infection with several helminths, but the nematode worm species most commonly involved in human infections is Anisakis simplex, and Pseudoterranova decipiens is less frequent but still common
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The majority of anisakiasis cases have been described by Japanese authors , reflecting the frequent consumption of raw fish in that country. Cases have now been reported from the five continents of Asia (Korea), Europe (The Netherlands, France, the United Kingdom, Spain, Germany, Italy, and others), Africa (Egypt), and the Americas (the United States, including Alaska and Hawaii; Canada; and South American countries) as well as from New Zealand.
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Since the 1960s, the term anisakiasis has been used to designate not only the human disease caused by the third-stage larvae (L3) of Anisakis spp. but also the human disease caused by L3 of other members of the Anisakidae family. In 1988, a group of experts on the standardized nomenclature of animal parasite diseases recommended the use of three different terms: (i) anisakidosis for disease caused by any member of the family Anisakidae, (ii) anisakiasis for disease caused by members of the genus Anisakis, and (iii) pseudoterranovosis for disease caused by members of the genus Pseudoterranova
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Human anisakid infections frequently cause gastrointestinal symptoms, which may be associated with mild to severe immunological usually allergic-type, reactions. In addition, some patients show more-generalized hypersensitivity reactions, without any associated digestive disorders. We therefore consider that anisakid larvae may be responsible for four clinical forms of illness in humans: gastric, intestinal, and ectopic anisakidosis and allergic forms.
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EPIDEMIOLOGY
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A number of fish dishes are considered to be high risk for the contraction of anisakidosis, including Japanese sushi and sashimi, Filipino bagoong, Dutch salted or smoked herring, Scandinavian gravlax, Hawaiian lomi-lomi and palu, South American ceviche, and Spanish boquerones en vinagre. The preparation of these dishes may involve methods (salting, curing, marinating, pickling, and smoking at 40°C, etc.) which are generally sterilizing for other food-borne pathogens but not for anisakids
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PREVENTION
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Usually within a few hours after the ingestion of a living worm, A. simplex causes an acute and transient infection that may lead to abdominal pain, nausea, vomiting, and/or diarrhea. Some patients develop syndromes simultaneously exhibiting clinical manifestations of allergy and infection after eating living parasites; this was first described by Kasuya and coworkers and represents a borderline disease between parasitic infection and allergy termed “gastroallergic anisakiasis
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Epidemiological studies in Japan have found that anisakiasis is more frequent in coastal populations and among 20- to 50-year-old males. The main fish species transmitting anisakidosis are the spotted chub mackerel (Scomber japonicus) and the Japanese flying squid (Todarodes pacificus). There is a study reported by Cheng (1971) that was unable to find human anisakiasis in Taiwan (reviewed by Smith and Wootten), and we are aware of only a single case published since then. It is not clear why there is a difference between Chinese and Japanese populations in the prevalence of the condition, given that fish consumption is common in both. Cheng suggested that anisakidosis cases are not common in China because Chinese eat fish at the end of meals, when the stomach is full, unlike Japanese.
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Other authors investigating the killing activities of vegetable condiments used in both traditional Chinese “raw fish cooking” and medicine have found that perilla leaves (Perilla frutescens) and ginger rhizomes (Zingiber officinale) are lethal for L3. In Western Europe, herring (Clupea arengus) is the main species involved, although cases with other species that were insufficiently cooked (microwaved, grilled, or shallow fried) have also been reported. In Spain, most cases have been related to the consumption of pickled anchovies (Engraulis encrasicholus)
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Pseudoterranovosis (caused by the so-called “codworm”) is unusual in south Japan and Europe but it is more frequent in the United States and Canada and has also been reported in Korea and Chile. The main transmitters of pseudoterranovosis appear to be Pacific cod (Gadus macrocephala) and the Pacific halibut (Hippoglossus stenolepis) in Japan and the red snapper (Sebastes spp.) in the United States
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Allergic Symptoms
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It should be borne in mind, however, that specific immunoglobulin E (IgE) detection by ImmunoCAP assay can overestimate the number of sensitized subjects, so the above estimates may be exaggerated. However, there is clearly cause for concern, and a need for further analysis using more-refined methods and serodiagnostic tools.
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PATHOGENICITY Protective responses to intestinal nematodes are associated with the production of Th2 cytokines and the resulting mastocytosis, IgE response, and eosinophilia, all of which are typical of allergic reactions and immune responses to tissueparasitic helminthes Most helminth infections induce chronic rather than acute disease, even in cases of very high levels of parasites, and parasitic helminths have developed mechanisms to overcome and evade host immune responses to secure their survival.
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Differences may therefore be expected between A. simplex pathogenesis and that caused by other helminths in humans. Over the last few years, studies have indicated that, as with other helminth infections, the pathological changes occurring within the gastrointestinal tract during infection with A. simplex are the combined result of the direct action of the larva during tissue invasion and of the complex interaction between the host immune system and the substances released by, or contained within, the parasite.
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Invasive Mechanisms
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Immunopathologic Mechanisms Subsequent experimental studies in orally infected guinea pigs and rabbits confirmed that sensitization (quantified as antibody response) and lesions were of greater severity following reinfection. These lesions were of a nature consistent with type I, type III, and type IV hypersensitivity reactions that may be involved in the immunopathology of anisakiasis
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Eosinophilia Eosinophil adhere to the nematode’s epicuticle in the presence of antibodies (particularly in the oral region where the ES products are localized) releasing cytotoxic factors which, though apparently not capable of damaging the nematode’s cuticle, are probably responsible for a great deal of tissue damage observed surrounding the parasite in both acute and chronic infections.
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Eosinophil concentration in damaged areas may be due not only to the release of numerous chemotactic factors by T lymphocytes, mast cells, and basophils but also to the secretion of chemotactic substances for these cells by the parasite. Surprisingly, although systemic eosinophilia is frequently associated with helminthic diseases, for anisakidosis it is described in fewer than 30% of cases. Eosinophils appear to be incapable of destroying A. simplex larvae directly in vitro, but eosinophil infiltration of the tissue surrounding the parasite is one of the most distinctive features of the local inflammatory lesions observed for anisakiasis.
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Innate Immune Responses
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Although the TLR family is an important class of sensors for innate recognition of parasites, other non-TLR pattern recognition systems may also be involved.