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Anisakis

Anisakis is a genus of parasitic nematodes belonging to the family Anisakidae within the phylum Nematoda, class Chromadorea, and order Rhabditida.^[1] These roundworms are primarily associated with marine environments, where they infect a wide range of aquatic hosts, and they pose a significant zoonotic risk to humans through the consumption of raw or undercooked seafood, leading to the disease known as anisakiasis.^[2] Currently, nine species are recognized in the genus, including the zoonotically important Anisakis simplex (sensu stricto) and A. pegreffii, which are distinguished through molecular techniques such as PCR-based genotyping targeting ribosomal and mitochondrial DNA regions.^[3] The life cycle of Anisakis species is complex and involves multiple hosts: eggs are released into seawater by adult worms residing in the stomachs of definitive hosts, primarily cetaceans like whales and dolphins, where they embryonate and hatch into first-stage larvae (L1).^[2] These larvae are ingested by microcrustaceans such as krill, developing into second-stage larvae (L2), and then third-stage larvae (L3) upon consumption by fish, squid, or other paratenic hosts, where they encyst in tissues like the viscera, muscles, or peritoneum.^[4] The cycle completes when an infected intermediate host is eaten by a definitive host, allowing the L3 larvae to mature into adults and reproduce; humans serve as accidental dead-end hosts when ingesting viable L3 larvae via undercooked marine fish (e.g., herring, cod, anchovies) or cephalopods.^[5] In humans, infection typically manifests as acute gastrointestinal anisakiasis, with symptoms including severe epigastric pain, nausea, vomiting, and allergic reactions appearing within hours to days of ingestion, though the larvae rarely develop further and are usually expelled or removed endoscopically.^[2] Beyond acute cases, Anisakis can trigger chronic allergic responses, such as urticaria, angioedema, or anaphylaxis, even from heat-stable allergens in cooked or processed fish, with A. simplex allergens like Ani s 1, Ani s 2, and Ani s 3 being the most studied and immunogenic.^[5] Globally, anisakiasis incidence is highest in regions with high raw seafood consumption, such as Japan (an estimated ~20,000 cases annually as of 2018–2019), Spain, and Pacific South America, with estimates exceeding 20,000 cases annually worldwide as of the late 2010s, though underreporting is common due to self-limiting symptoms.^[6] Prevention relies on proper cooking (to at least 63°C internal temperature) or freezing (e.g., -20°C for 7 days or -35°C until solid then -20°C for 24 hours) of seafood, alongside visual inspection and regulatory controls in fisheries.^[7]

Taxonomy

Genus Overview

Anisakis is a genus of parasitic nematodes belonging to the phylum Nematoda, class Secernentea, order Ascaridida, and family Anisakidae.^[8] The genus was first described by French zoologist Félix Dujardin in 1845 as a subgenus of Ascaris to encompass nematodes found in the stomachs and intestines of cetaceans.^[8] The name Anisakis derives from the Greek words anisos (unequal) and akis (point), alluding to the characteristic unequal length of the male spicules.^[9] Key defining traits of the genus include their role as obligate parasites with complex marine life cycles that progress through invertebrate intermediate hosts, such as crustaceans, and transport hosts like fish and cephalopods, culminating in definitive hosts that are marine mammals including whales, dolphins, and seals.^[2] Humans act as accidental dead-end hosts upon ingesting infective larvae through raw or undercooked seafood, leading to the zoonotic disease anisakiasis without further transmission.^[2] These nematodes are typically reddish or pinkish in their larval form due to ingested host blood, though adults in definitive hosts are whitish and thread-like.^[8] Historically, classification within the genus has evolved through morphological and molecular revisions; initially encompassing fewer species based on 19th- and 20th-century descriptions, modern genetic analyses have identified nine valid species and clarified distinctions from related anisakid genera such as Pseudoterranova, which shares the family but differs in host specificity and larval morphology.^[10] Early synonyms for species like A. simplex included Eustoma rotundatum and Ascaris marina, reflecting initial uncertainties in nematode taxonomy before Dujardin's grouping.^[8] These reclassifications, particularly in the late 20th century, separated Anisakis from broader anisakid groupings using criteria like spicule structure and genetic markers.^[10]

Species Classification

The genus Anisakis currently encompasses six valid species, with Anisakis simplex (Rudolphi, 1809) Dujardin, 1845 designated as the type species; three additional species from historical clade 3 (A. physeteris (Delyamure, 1942), A. brevispiculata (Dollfus, 1966), A. paggiae (Mattiucci et al., 2005)) have been reclassified into the genus Skrjabinisakis based on recent phylogenetic analyses.^[11]^[12] The remaining key species include A. simplex s.s., A. pegreffii (Campana-Rouget & Biocca, 1955), A. berlandi (Mattiucci et al., 2009), A. typica (Diesing, 1860) Baylis, 1920, A. ziphidarum (Paggi et al., 2005), and A. nascettii (Mattiucci et al., 2014), along with A. oceanica (Johnston & Mawson, 1951) Davey, 1971 and A. similis (Baird, 1853) Baylis, 1920 recognized in some classifications.^[11]^[13] These species are distinguished primarily through morphological features of adult worms, such as spicule length and tail morphology, combined with host specificity in marine mammals.^[10] Certain taxa within the genus remain of uncertain status, classified as taxa inquirenda, including A. insignis (Diesing, 1851) and A. salaris (Gmelin, 1790).^[14] No confirmed records of A. dolosa as a distinct entity were identified in recent classifications, though it may represent a historical synonym under review.^[10] Molecular phylogeny has been instrumental in resolving cryptic species complexes within Anisakis, utilizing nuclear ribosomal internal transcribed spacer (ITS) regions and mitochondrial cytochrome c oxidase subunit I (COI) genes.^[15] For instance, the A. simplex sensu lato complex has been delineated into distinct sibling species, including A. simplex sensu stricto, A. pegreffii, and A. berlandi, based on sequence divergences exceeding 1-2% in these markers, which reveal subtle morphological variations in larval forms such as mucron position.^[16] These genetic tools have clarified hybridization events, particularly between A. simplex s.s. and A. pegreffii, aiding precise species identification.^[17] Post-2020 genomic and transcriptomic studies have reinforced these distinctions, confirming the reclassification of clade 3 species to Skrjabinisakis and recognizing at least six anthropophilic species potentially involved in human infections within Anisakis, though A. simplex s.s. and A. pegreffii predominate, with emerging evidence for A. typica and A. berlandi in allergic responses.^[11] Analyses of mitochondrial cox2 and nuclear markers in Northeast Atlantic samples have highlighted high genetic diversity and panmictic populations, supporting the recognition of additional cryptic lineages without altering core species counts.^[17] These updates underscore the role of next-generation sequencing in refining Anisakis taxonomy amid increasing reports of zoonotic cases.^[18]

Morphology

Larval Form

The third-stage larvae (L3) of Anisakis represent the infective stage primarily encountered in intermediate hosts such as fish and squid, posing a risk for human exposure through consumption of raw or undercooked seafood. These larvae typically adopt a tightly coiled configuration, often described as a "watch-spring" spiral, within host viscera or musculature.^[5] When uncoiled for measurement, they exhibit a cylindrical body attenuated at both ends, with lengths ranging from 19 to 36 mm and widths of 0.3 to 0.6 mm.^[19] The larvae appear milky white or translucent, facilitating their detection in host tissues.^[19] Distinctive morphological features of the L3 include a prominent boring tooth at the anterior extremity, which aids in tissue penetration, and the absence of lateral alae along the body.^[20] ^[21] The posterior end bears a short mucron, a small tail spine measuring approximately 0.02 to 0.03 mm, while the esophagus comprises a muscular anterior section leading to a glandular ventricular bulb, with an oblique esophagointestinal junction.^[20] ^[22] Species-specific variations are evident in larval dimensions and structures; for instance, A. simplex L3 larvae average around 20 mm in length and 0.55 mm in width, whereas A. typica specimens are narrower (mean width 0.29 mm) with a more cylindrical mucron compared to the cone-shaped one in A. simplex.^[20] ^[22] In contrast, A. physeteris L3 (classified as type II) lack a mucron and exhibit a shorter ventricle relative to body length.^[20] At the histological level, the larval cuticle is rigid and transversely striated, providing protection during migration.^[20] The somatic musculature features tall, prominent cells that enable vigorous movement and burrowing into host tissues.^[21] The excretory system includes an anterior pore and narrow Y-shaped lateral cords extending from the muscular layer, supporting osmoregulation and penetration adaptations.^[21] These L3 larvae are integral to the parasite's life cycle, migrating to definitive cetacean hosts upon ingestion.^[2]

Adult Form

Adult Anisakis nematodes reside in the stomachs of definitive hosts, primarily cetaceans, and are significantly larger than the larval stages. Females measure 20–35 cm in length, while males are 15–30 cm long, with a cylindrical body attenuated at both ends.^[23] The anterior end features three prominent lips, each with a bilobed projection bearing a single dentigerous ridge, and interlabia are absent. The esophagus consists of a long anterior muscular portion transitioning to a glandular ventriculus that is typically longer than wide. Males possess paired spicules longer than 1.5 mm, equal in length, without a gubernaculum, and well-developed caudal alae; the vulva in females is located near the midbody.^[24]

Life Cycle

Developmental Stages

The life cycle of Anisakis species is indirect and involves multiple hosts across marine food webs. Unembryonated eggs are released into seawater through the feces of definitive hosts, primarily cetaceans such as whales and dolphins. In seawater, the eggs embryonate over a period of 3 to 21 days, depending on temperature (e.g., 3 days at 21 °C, 21–22 days at 5 °C), undergoing two molts within the eggshell before hatching as ensheathed first-stage larvae (L1).^[2]^[25] These L1 larvae are ingested by small crustaceans like copepods, where they develop into second-stage larvae (L2) in the host's hemocoel. When the crustacean is consumed by fish, squid, or other marine invertebrates, the L2 molt into infective third-stage larvae (L3), which migrate and encyst in tissues such as the viscera, muscles, peritoneum, or mesenteries of these intermediate or paratenic hosts.^[2]^[4] The L3 larvae do not develop further in paratenic hosts but remain viable. In humans, who act as accidental dead-end hosts, ingested L3 larvae may penetrate the gastrointestinal mucosa but do not mature.^[5]

Reproduction

Anisakis species are dioecious nematodes with separate sexes, exhibiting rare or absent hermaphroditic tendencies.^[26] Internal fertilization occurs during mating within the stomach and intestines of definitive hosts, such as marine mammals.^[27] Males attach to females using spicules and a gubernaculum to facilitate copulation against the hydrostatic pressure in the host's gut.^[27] Adult females produce a high number of eggs, with daily fecundity ranging from approximately 24,000 to 30,000 eggs per female in species like A. simplex and A. pegreffii.^[26] These nematodes are oviparous, releasing unembryonated eggs that are passed in the feces of the definitive host.^[2] In seawater, the eggs embryonate over a period of 3 to 21 days, depending on temperature, before hatching.^[25] No parthenogenesis has been reported in Anisakis, ensuring genetic diversity is maintained through sexual reproduction and multiple infections in hosts, which promote gene flow.^[28]

Occurrence and Ecology

Geographic Distribution

Anisakis nematodes exhibit a cosmopolitan distribution primarily in temperate and cold marine waters worldwide, with highest prevalences recorded in the North Atlantic and North Pacific Oceans, including coastal regions of Japan and Europe. These parasites are notably absent from freshwater environments and tropical seas, as their life cycle and larval survival depend on specific salinity levels typically found in oceanic conditions. For instance, Anisakis simplex is prevalent along the European Atlantic coasts and in the Japanese Pacific waters, where marine salinity supports egg hatching and larval development.^[29]^[30] Recent environmental changes, particularly climate warming, have contributed to expansions in Anisakis distribution, with increased prevalence observed in previously less affected areas such as the Mediterranean Sea. Expansions in the Mediterranean, such as westward shifts of A. typica, have been documented since around 2010, linked to rising sea temperatures that facilitate larval migration and host availability in warming waters.^[31] A meta-analysis indicates substantial increases in Anisakis abundance in marine mammal prey species over the past half-century, including a 283-fold rise from 1978 to 2015, attributed in part to cetacean population recovery following whaling moratoriums, alongside climatic influences on distribution.^[32] Zoonotic hotspots for human Anisakis infections, known as anisakiasis, are concentrated in regions with high consumption of raw or undercooked marine fish. An estimated ~20,000 cases occur annually in Japan (as of 2018-2019), representing the majority of global incidents, while Europe sees significant numbers in Spain (estimated 7,700–8,300 annually) and the Netherlands due to culinary practices involving herring and anchovies.^[6] In contrast, the Americas experience low incidence overall, with exceptions in Alaska's fisheries where infections occur in salmon and other cold-water species, though cases remain rare compared to Asian and European rates.^[33]^[34]

Hosts and Transmission

The definitive hosts of Anisakis nematodes are primarily marine mammals, including cetaceans such as whales and dolphins, and pinnipeds such as seals from the families Otariidae and Phocidae.^[35] Adult worms reside and mature in the stomachs and digestive tracts of these hosts, where they reproduce and release embryonated eggs into the marine environment via feces.^[10] Intermediate hosts include small crustaceans, particularly euphausiids (such as krill) and copepods (especially calanoid species), which ingest the eggs and allow the first- and second-stage larvae (L1–L2) to develop in their hemocoel.^[35] These infective third-stage larvae (L3) are then transmitted to paratenic hosts through predation within the marine food web, including over 160 species of fish such as herring (Clupea harengus), cod (Gadus morhua), and salmon (Salmo salar), as well as more than 40 species of squid like Todarodes sagittatus.^[10] In these paratenic hosts, the L3 larvae encyst in the viscera, musculature, or body cavity, with prevalence rates reaching up to 100% in some wild-caught fish populations and intensities up to ~20 larvae per kilogram in species such as salmon.^[36] Piscivorous birds and humans serve as accidental paratenic hosts, where larvae do not develop further but can survive temporarily.^[35] Transmission occurs through a fecal-oral route embedded in the trophic structure of marine ecosystems, with eggs hatching in seawater and progressing through hosts via consumption.^[10] In humans, infection arises accidentally from ingesting raw or undercooked seafood containing viable L3 larvae, such as in sushi, sashimi, or ceviche, posing a risk primarily in regions with high consumption of uncooked marine products like Japan, where thousands of cases are reported annually.^[35] There is no direct human-to-human transmission. Ecologically, elevated larval burdens in fish stocks, potentially exacerbated by overfishing and shifts in predator-prey dynamics, have led to a reported 283-fold increase in Anisakis abundance since the late 1970s, impacting marine mammal health, fish quality, and fishery sustainability.^[32]

Health Implications

Anisakiasis

Anisakiasis is a zoonotic disease in humans resulting from the accidental ingestion of third-stage larvae (L3) of nematodes from the genus Anisakis, typically embedded in raw or undercooked marine fish or cephalopods.^[2] Humans serve as dead-end hosts, as the larvae cannot mature or reproduce in the human body, leading to an invasive but usually self-limiting infection confined to the gastrointestinal tract.^[37] The condition is most commonly associated with Anisakis simplex sensu stricto, though other species like A. pegreffii and Pseudoterranova spp. can also cause it.^[6] Upon ingestion, the L3 larvae penetrate the gastric or intestinal mucosa within hours, eliciting an intense inflammatory response characterized by edema, eosinophilic infiltration, and the formation of granulomas around the embedded parasites.^[37] This pathogenesis triggers acute symptoms such as epigastric pain, nausea, vomiting, and diarrhea, typically onsetting 1 to 12 hours post-ingestion, though abdominal discomfort may persist or intensify over 24 to 48 hours.^[2] In severe cases, larvae migration can lead to complications like intestinal obstruction or perforation, occurring in less than 1% of reported instances.^[38] Chronic infections are rare, with most cases resolving within 1 to 2 weeks without intervention, though residual granulomatous lesions may mimic other conditions such as appendicitis, gastric ulcers, or Crohn's disease.^[38] Epidemiologically, anisakiasis is underreported globally due to diagnostic challenges and misattribution of symptoms, with estimates suggesting thousands of cases annually worldwide. Recent reviews indicate a steady increase in reported anisakidosis cases globally since 2000, with a temporary decline during the COVID-19 pandemic; cumulative documented cases reached approximately 76,000 by 2017, though underreporting persists.^[39]^[40] Japan reports the highest incidence, with approximately 19,737 confirmed cases per year as of 2018–2019 health insurance data (estimates remain similar as of 2025), accounting for over 90% of global notifications; Europe, particularly Spain, sees 7,700–8,320 cases annually (as of 2017), while other regions like South America and the Pacific coast report lower but increasing numbers linked to rising raw seafood consumption.^[6] From 1965 to 2022, at least 762 cases were documented across 34 countries in published literature, highlighting its emergence in areas with growing sushi and ceviche traditions.^[38] Diagnosis relies primarily on endoscopic visualization of the coiled larvae in the gastric or intestinal wall, often allowing immediate removal during the procedure, with a sensitivity of up to 80% in acute cases.^[37] Serological tests detecting specific IgE or IgG antibodies against Anisakis antigens provide supportive evidence, particularly in subacute presentations (70–80% sensitivity), while PCR amplification of larval DNA from biopsy tissue confirms species identity and rules out mimics like peptic ulcers or tumors.^[37] Symptoms frequently overlap with acute abdomen conditions, necessitating imaging such as CT or ultrasound to identify eosinophilic granulomas or free fluid.^[2] Treatment focuses on mechanical removal of the larvae via endoscopy, which is curative in most gastric cases and preferred over surgery due to lower invasiveness; surgical intervention is reserved for intestinal or ectopic migrations causing obstruction or perforation.^[37] Antiparasitic drugs like albendazole are generally ineffective against embedded larvae and are not routinely recommended, though they may be considered adjunctively in severe or disseminated infections; the disease often self-resolves in 1 to 2 weeks absent allergic complications.^[2] Allergic responses, such as urticaria or anaphylaxis, can occur independently or alongside invasion and are addressed in related sections. Prevention centers on inactivating larvae through proper food handling: cooking fish to an internal temperature above 60°C for at least 1 minute or freezing at -20°C for 7 days (total time) or -35°C for 15 hours effectively kills Anisakis L3 per FDA guidelines; EU regulations permit -20°C for 24 hours following visual inspection, but recent studies suggest longer freezing may be needed for complete inactivation.^[7]^[41] Regulatory measures, including EU mandates for visual inspection and mandatory freezing of raw fishery products destined for consumption, alongside Hazard Analysis and Critical Control Points (HACCP) protocols in seafood processing, have reduced incidence in compliant regions.^[37] Consumers in high-risk areas are advised to avoid raw or lightly cured fish unless commercially treated.^[2]

Allergic Reactions

Allergic reactions to Anisakis primarily arise from an IgE-mediated hypersensitivity to antigens from the nematode, which can occur through ingestion of viable or dead larvae in raw or undercooked fish, leading to symptoms such as urticaria, angioedema, and anaphylaxis even without active parasitic invasion.^[35] Sensitization can also develop via non-ingestive routes, including inhalation or direct skin contact with larval antigens, particularly in occupational settings.^[42] This Type I hypersensitivity is triggered by exposure to thermostable allergens persisting in processed fish products.^[43] Prevalence of Anisakis sensitization is notably higher in coastal populations with frequent raw fish consumption, such as in Spain, where seroprevalence reaches up to 22.1% in asymptomatic individuals and 50-60% among those with allergic symptoms; in the Basque Country, it accounts for approximately 10% of anaphylaxis cases and 32% of urticaria cases in adults aged 40-60 years.^[35]^[44] Cross-reactivity with antigens from Ascaris lumbricoides complicates assessment due to shared nematode proteins, potentially leading to false positives in diagnostic tests.^[35] The pathophysiology involves specific IgE antibodies binding to Anisakis simplex allergens, designated Ani s 1 through Ani s 14, which are predominantly excretory-secretory products or somatic antigens; key examples include the heat-stable Ani s 1 (a major allergen) and Ani s 4 (a cystatin protease inhibitor), both implicated in systemic reactions.^[43]^[35] These allergens provoke mast cell degranulation, releasing histamine and other mediators that cause immediate hypersensitivity. In gastroallergic anisakiasis, an acute form combining allergic and gastrointestinal symptoms, exposure leads to urticaria, abdominal pain, and potential anaphylaxis shortly after ingestion.^[35] Diagnosis relies on a history of raw fish exposure alongside in vivo and in vitro tests; skin prick tests using crude Anisakis extracts detect sensitization with good sensitivity, while specific IgE assays via ImmunoCAP® quantify antibodies to recombinant allergens like Ani s 1 and Ani s 3, though cross-reactivity with Ascaris may reduce specificity.^[35]^[45] Management centers on strict avoidance of raw or undercooked fish, as cooking or freezing kills larvae but does not denature allergenic proteins; for acute episodes, intramuscular epinephrine is the first-line treatment, supplemented by antihistamines and corticosteroids.^[35] Desensitization protocols are not established, and no vaccine exists. Post-2015 studies have highlighted emerging occupational allergies among fish processors, with sensitization rates up to 46.4% due to repeated aerosolized or contact exposure to larval antigens during handling.^[44]^[42]

Identification and Detection

Diagnostic Methods

Diagnosis of Anisakis infections in humans primarily relies on clinical presentation combined with direct visualization and laboratory confirmation. Endoscopy remains the gold standard for detecting gastric anisakiasis, allowing for the gross identification of coiled larvae embedded in the mucosal layer during upper gastrointestinal procedures, often followed by endoscopic removal to alleviate symptoms and confirm the diagnosis.^[23]^[46] Biopsy samples obtained during endoscopy can undergo histopathologic examination, revealing characteristic coiled larvae within inflammatory granulomas or eosinophilic infiltrates in the tissue.^[47]^[48] Serological tests, such as enzyme-linked immunosorbent assay (ELISA), detect specific IgE or IgG antibodies against Anisakis antigens in patient serum, aiding in cases where larvae are not directly observed. However, these assays suffer from low specificity due to cross-reactivity with other nematodes, including Ascaris and Toxocara, leading to false positives in individuals with prior exposure to unrelated helminths.^[49]^[50]^[51] Imaging modalities like ultrasound and computed tomography (CT) scans are used to evaluate abdominal symptoms suggestive of anisakiasis, such as masses or inflammation, but they are non-specific and primarily support differential diagnosis. Ultrasound may reveal bowel wall thickening, segmental edema of valvulae conniventes, or hyperperistalsis in the small intestine, while CT often shows gastric or intestinal wall stratification, fat stranding, and ascites without uniquely identifying the parasite.^[52]^[53]^[54] In fisheries and food safety contexts, visual inspection methods, including candling and UV light illumination, are employed to detect Anisakis larvae in fish fillets. Candling involves transilluminating fillets on a light table to spot surface larvae, achieving approximately 90% sensitivity for superficial detections when enhanced with UV fluorescence, though efficacy drops significantly for embedded parasites.^[55]^[56]^[57] For more reliable quantification in processed fish products, the artificial digestion method is standard, involving enzymatic breakdown of muscle tissue with pepsin and hydrochloric acid (HCl) to recover larvae, as outlined in ISO 23036-2:2021 guidelines for microbiology of the food chain. This technique filters and sediments the digestate to isolate viable or non-viable larvae, providing a comprehensive assessment of contamination levels despite potential underestimation of viability post-freezing.^[58]^[59]^[60]

Molecular Techniques

Molecular techniques have revolutionized the identification and epidemiological surveillance of Anisakis species, enabling precise differentiation among cryptic taxa within the genus that are morphologically indistinguishable, particularly in larval stages. These methods target genetic markers such as ribosomal DNA (rDNA) and mitochondrial DNA (mtDNA), providing robust tools for species-level resolution in complex samples from fish hosts and human infections. By leveraging polymerase chain reaction (PCR)-based approaches, researchers can track zoonotic transmission pathways and assess infection risks in marine ecosystems. One widely adopted technique is PCR-restriction fragment length polymorphism (PCR-RFLP) analysis of the internal transcribed spacer (ITS) region in rDNA, which distinguishes species within the A. simplex complex, including A. simplex s.s. and A. pegreffii. This method involves amplifying the ITS-1–5.8S–ITS-2 fragment using specific primers, followed by digestion with restriction enzymes to generate species-specific banding patterns; for instance, A. pegreffii can be identified by characteristic fragments around 380 bp and 130 bp after amplification and restriction. PCR-RFLP has been instrumental in genotyping larvae from diverse geographic regions, confirming genetic homogeneity or subtle variations that inform population structure and hybrid detection.^[61]^[62]^[63] Sequencing of the mtDNA cytochrome c oxidase subunit I (COI) gene serves as a standard DNA barcoding approach for rapid identification of Anisakis species, effectively resolving cryptic diversity by comparing sequences against reference databases. The typical 655 bp COI fragment allows for phylogenetic placement, with intraspecific similarities often exceeding 99% and interspecific thresholds around 95% divergence enabling separation of sibling species like A. pegreffii and A. simplex s.s. This technique has proven valuable in verifying parasite identities across life stages and hosts, supporting traceability in seafood supply chains and epidemiological studies of zoonotic strains.^[64]^[65] Quantitative PCR (qPCR), often using SYBR Green chemistry, facilitates the sensitive quantification of Anisakis larvae in fish tissues, detecting as few as one larva per 75 g of sample (equivalent to <0.02 larvae/g). This method amplifies target genes like ITS or mtDNA, correlating cycle threshold values with larval counts via mathematical models (e.g., R² > 0.99 for 0–50 larvae), and qPCR methods have been developed and applied in research for EU monitoring since around 2018. Such quantification aids in assessing contamination levels in commercial fisheries and enforcing hygiene standards.^[66]^[67]^[68] Recent advancements include TaqMan-based qPCR assays for species-specific detection targeting ITS and mtDNA regions, offering improved specificity over SYBR Green methods, as demonstrated in comparative studies as of 2025. Additionally, recombinase polymerase amplification (RPA) combined with lateral flow dipstick (LFD) assays enable rapid, visual detection of A. simplex s.s. and A. pegreffii in seafood without specialized equipment, enhancing on-site screening in fisheries since 2024.^[69]^[67] Metagenomic approaches employing next-generation sequencing (NGS) enable the characterization of mixed Anisakis infections in host tissues, simultaneously identifying multiple species and hybrids without prior isolation. By sequencing total DNA from environmental or fish samples, NGS reveals community compositions and genetic variants, as demonstrated in studies of larval microbiomes and hybrid genotypes in sympatric regions. These techniques have applications in outbreak tracing, such as analyzing parasite diversity in Mediterranean cetacean hosts to link infections across food webs.^[70]^[71]^[29] Compared to traditional morphological methods, molecular techniques offer superior accuracy for degraded or archived samples, such as formalin-fixed tissues from human cases, where larval structures are obscured. They also enhance tracking of zoonotic potential by providing species-specific data essential for risk assessment, such as distinguishing allergenic strains like A. pegreffii in epidemiological surveys.^[72]^[73]

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Re‐evaluation of certain aspects of the EFSA Scientific Opinion of ...
Apr 22, 2024 · ... temperate or cold-water habitats. In recent years, several reports ... Impact of temperature, salinity and light on hatching of eggs of Anisakis ...
[24]
An update and ecological perspective on certain sentinel helminth ...
Oct 13, 2023 · The present review focuses on the diversity and ecology of specific marine trophically transmitted helminth endoparasites (TTHs) of the Mediterranean ...
[25]
Meta‐analysis suggests that, for marine mammals, the risk of ...
Mar 10, 2024 · Anisakis and Pseudoterranova have complex life cycles (Figure 1). Anisakis spp. nematodes infect cetaceans as their definitive host, and ...
[26]
Detecting Gaps in Knowledge: The Case of the Anisakis in ... - MDPI
Aug 6, 2024 · About 20,000 anisakiasis cases are reported worldwide yearly, mostly in Japan, Spain, the Netherlands, and Germany [9]. ... Detecting Gaps in ...
[27]
Anisakiasis Annual Incidence and Causative Species, Japan, 2018 ...
Although our survey methods differed, we demonstrated that Japan had an average of 19,737 anisakiasis cases per year during 2018–2019.Missing: Netherlands | Show results with:Netherlands
[28]
The “New Disease” Status of Human Anisakiasis and North ...
Six confirmed cases have been reported from North America. Human infections are acquired from consumption of raw, underheated, insufficiently frozen or lightly ...
[29]
Anisakidae and Anisakidosis: A Public Health Perspective - PMC
The family Anisakidae comprises, among others, the genera Anisakis Dujardin, 1845, Phocanema Myers, 1959 (Pseudoterranova Krabbe, 1878), and Contracaecum ...Missing: synonyms reclassifications
[30]
Occurrence and prevalence of fish-borne Anisakis larvae in the ...
Feb 7, 2015 · This study compares with the reports given by (Chen and Shih, 2015) , that Anisakis larvae showed a high prevalence rate of 72.8% in spotted ...
[31]
Biology, Epidemiology, Clinical Features, Diagnosis, and Treatment ...
Jun 30, 2021 · Similar to anisakiasis, diphyllobothriasis is caused by consumption of raw or inadequately cooked fish containing infective parasite larvae.
[32]
A critical review of anisakidosis cases occurring globally - PMC - NIH
May 26, 2023 · A total of 762 cases (409 articles, inclusive of all languages) were found between 1965 and 2022. The age range was 7 months to 85 years old.Results · Case Reports · Causative Agents And...Missing: genomic post-
[33]
Anisakis Sensitization in the Croatian fish processing workers - NIH
Jan 27, 2020 · It was reported that allergic reactions to Anisakis allergens can also occur without a previous infection either by inhalation or direct contact ...Missing: post- | Show results with:post-
[34]
Anisakis Allergy: Is Aquacultured Fish a Safe and Alternative Food to ...
Currently, about 14 allergens have been described, among which Ani s1 and Ani s4, both highly heat-resistant, appear central in Anisakiasis anaphylaxis and ...
[35]
Occupational disease due to Anisakis simplex in fish handlers
... (Spain), this parasite is responsible for 10% of anaphylaxis cases and 32% of urticaria cases in adults aged 40-60 years, around 300 cases/year. Anisakis ...
[36]
Anisakis simplex recombinant allergens increase diagnosis ...
Mar 2, 2012 · Results: SPTs and ImmunoCAP assays were positive in 18 and 17% of tolerant patients, respectively. All A. simplex-allergic patients had positive ...
[37]
Anisakiasis - Infectious Diseases - Merck Manual Professional Edition
Anisakiasis can be diagnosed by gross visualization of the larvae with upper endoscopy. Diagnosis can also be made by histopathologic examination of endoscopic ...
[38]
Gastric and enteric anisakiasis successfully treated with Gastrografin ...
Anisakiasis usually occurs in the stomach, and can easily be diagnosed via gastroscopy and treated with endoscopic extraction.
[39]
HISTOPATHOLOGIC ALTERATIONS ASSOCIATED WITH Anisakis ...
At gross inspection the larvae were coiled inside a connective tissue capsule at the surface of the pyloric caeca, pancreatic tissue, liver and large intestine.
[40]
Invasive Anisakiasis - Gastroenterology
Recently,. 10 cases from California (3,4) and 6 cases from. Alaska (5) were reported. ... With cases of anisakiasis increasing world- wide, it seemed remarkable ...
[41]
Human antibody recognition of Anisakidae and Trichinella spp. in ...
A particular problem in serological tests for nematodes is cross-reactivity. ... The latter five samples may represent cross-reactivity in the ELISA test ...
[42]
Allergenic cross-reactivity between third stage larvae of ...
The specific IgE determination results may reflect cross-reactivity between A. simplex and H. aduncum or cosensitization to both nematodes. Sensitization to ...
[43]
Evidence of IgE-Mediated Cross-Reactions between Anisakis ... - NIH
Jul 28, 2021 · In this work, we evaluated IgE-cross reactions by in vivo (skin prick tests with parasites extracts) and in vitro methods (IgE-ELISA and IgE-immunoblot).
[44]
Evaluation of imaging findings in gastrointestinal anisakiasis in ...
Nov 13, 2023 · Both ultrasound and CT were performed on 31 of the cases whereas 25 patients received all three imaging tests. As for the endoscopic studies, ...
[45]
Usefulness of Ultrasound in the Diagnosis of Intestinal Anisakiasis
Mar 10, 2020 · Ultrasound findings of bowel wall thickening, especially segmental edema of the valvulae conniventes, hyperperistalsis, and dilatation of small-bowel loops.
[46]
Gastric anisakiasis suspected by point‐of‐care ultrasound finding in ...
Jul 11, 2025 · This case suggests that point‐of‐care ultrasound can be a powerful diagnostic tool when clinicians suspect gastric anisakiasis.
[47]
Detection of Anisakid Larvae in Cod Fillets by UV Fluorescent ...
Jul 1, 2013 · Using cod fillets as samples, the efficiency of the developed technique was evaluated, and the overall detection ratio was greater than 80%.
[48]
Device for detection of anisakid larvae based on UV fluorescent ...
Using cod fillets as samples, the detection ratio of this technique was calculated as 90.86%, significantly higher than that of traditional candling under ...
[49]
UV-press method versus artificial digestion method to detect ...
To screen the presence of Anisakidae third stage larvae (L3) in fish, fast methods such as the visual inspection and candling have been widely ...
[50]
https://www.jacionline.org/article/S0091-6749%2898%2970364-1/fulltext
[51]
The artificial digestion method underestimates the viability of ...
Mar 20, 2021 · The artificial digestion method kills a significant number of L3 that survived freezing. Thus, it may underestimate viable larvae numbers in processed fish.Missing: 22000 | Show results with:22000
[52]
[PDF] INTERNATIONAL STANDARD ISO 23036-2
The artificial digestion method relies on the enzymatic degradation of muscle fibres in a fluid composed of pepsin and hydrochloric acid followed by filtration ...Missing: recovery 22000<|control11|><|separator|>
[53]
A PCR-RFLP assay for identification of Anisakis simplex from ...
It is a casual agent of a human disease called anisakiosis. We found that the assay based on PCR amplification of the ITS-1–5·8 S–ITS-2 fragment of rDNA and ...
[54]
PCR-RFLP analysis of rDNA ITS for molecular identification of ...
We designed a tetra-primer binding the internal transcribed spacer (ITS) region of 76 samples of Anisakis species and obtained reproducible results. ARMS ...
[55]
Molecular genotyping of Anisakis species from Korean sea fish by ...
We identified restriction fragment length polymorphism patterns of Anisakis pegreffii, Anisakis simplex sensu stricto, Anisakis typica, and a hybrid genotype.
[56]
(PDF) Identification of Anisakis Simplex Using Dna Barcoding
DNA barcoding effectively identifies Anisakis simplex using a 655 base pair mitochondrial COI gene. Average nucleotide composition for A. simplex: A=19.3%, ...
[57]
Nematoda) in fishes from Adriatic Sea - ResearchGate
May 14, 2025 · ... similarity with the corresponding sequences. of. Anisakis ... mtDNA. CO1 gene showed 95. -. 96. %. similarities with the. corresponding sequences ...
[58]
Estimation of the number of Anisakis larvae in commercial fish using ...
In the present work, the capacity of a SYBR Green qPCR protocol to quantify Anisakis larvae in commercial fish was evaluated using experimentally spiked samples ...
[59]
Recombinase polymerase amplification combined with lateral flow ...
Apr 15, 2024 · ... detect Anisakis in surimi fish products, and meant that the method was capable of detecting one larva of 1 mg in 75 g of fish meat (13.3 ppm).
[60]
Re - EFSA Journal
identification of zoonotic species of the genus Anisakis and Phocanema spp., a multiplex qPCR detection assay was devel- oped and commercialised, and ...
[61]
Metagenomics Analysis Reveals an Extraordinary Inner Bacterial ...
Functional insights into the infective larval stage of Anisakis simplex s.s., Anisakis pegreffii and their hybrids based on gene expression patterns. BMC ...
[62]
Functional insights into the infective larval stage of Anisakis simplex ...
Aug 7, 2018 · In particular, the analysis shows that in mixed infections different species and hybrids of Anisakis may produce different kinds and levels ...
[63]
First molecular identification of the zoonotic parasite Anisakis ...
Mar 31, 2011 · Anisakiasis is an important fish-borne zoonosis provoked by larval stages of nematodes belonging to the genus Anisakis.
[64]
Prevalence and molecular identification of zoonotic Anisakis and ...
Mar 1, 2022 · Zoonotic larvae of the family Anisakidae found in several fish species represent a serious risk in public health since they may cause food-borne anisakidosis ...<|control11|><|separator|>