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Gastric anisakidosis due to Pseudoterranova decipiens larva
Letters to the Editor
Gastric anisakidosis due to Pseudoterranova decipiens larva
1
2
of inadequately-cooked fish infested by anisakidae larvae leads to human anisakidosis. In France, although anisakidosis is often suspected in cases of sudden gastric or intestinal pain, proof of this disease remains uncommon.’We report a case of anisakidosis due to Pseudoterranova decipiens larva in a patient of Cambodian origin living in France. A 40-year-old man complained of intense epigastric pain for 10 days, with no other symptoms. His trouble had started 3 hours after a meal of coalfish, prepared according to a Tahitian recipe with lemon juice. He was the only diner affected and had never had similar trouble. He had a gastroscopy. A larva was extracted from the great curvature of the epigastric mucosa. This was followed by clinical improvement. The slightly orange-coloured larva, 2-2 cm long and 0-8 cm wide, was still alive. It was identified by its macroscopic and microscopic characteristics as a P decipiens, stage L4, larva (figure).
SIR-Ingestion
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4
5
Hubert B, Bacou J, Belvere H. Epidemiology of human anisakidosis. Incidence and sources in France. Am J Trop Med Hyg 1989; 40: 301-03. Schantz PM, McAuley J. Current status of food borne parasitic zoonoses in the United States. Southeast Asian J Trop Med Publ Health 1991; 22 (suppl): 65-71. Huang WY. Anisakidés et anisakidoses humaines: enquête sur les Anisakidés des poissons commerciaux du marché parisien. Ann Parasitol Hum Comp 1988; 63: 197-208. Kakizoe S, Kakizoe H, Kakizoe K, et al. Endoscopic findings and clinical manifestation of gastric anisakidosis. Am J Gastroenterol 1995; 90: 761-63. Matsuoka H, Nakama T, Kisanuki H, et al. A case report of serologically diagnosed pulmonary anisakidosis with pleural effusion and multiple lesions. Am J Trop Med Hyg 1994; 51: 819-22.
Dissociation between cerebral clinical picture
imaging and
(April 6, p 965)’ reminded us of one of patients. A 32-year-old lawyer was admitted to our hospital in 1994. 4 weeks before admission he had fallen on his head while skiing and since then complained of a continuous, severe, left-sided headache. A computed tomography scan of his brain showed a left subdural haematoma and a large arachnoid cyst in the right frontotemporal region. The skull had expanded on the side of the cyst. The haematoma was evacuated through two burrholes. There were no postoperative problems and the patient fully recovered and resumed his work. His postoperative scan showed a large cyst and an obvious midline-shift to the left (figure). The cyst, which displaced (and/or replaced)2 the temporal and part of the frontal and parietal lobes and had an obvious mass effect, was a surprising finding in this patient because he had studied law and was on the staff of a local university. He had a vague history of birth trauma. His further SiR-Baudoin’s letter
our
Anterior part of the Pseudoterranova decipiens larva showing characteristic morphological criteria Anterior part of the larva (A) with three prominent lips, thick article and an exuvia from the anterior L3 stage (B) and characteristic glandular oesophageal ventricle obliquely truncated (C).
Figure:
The incidence of anisakidosis in France is probably underestimated, although a fairly low incidence would be expected since seafish is usually either cooked or been deepfrozen. However, as in other countries,2 an increased incidence of this parasitosis is to be expected, because of the extremely high infestation of sea fish,3 and the popularity of Asian raw-fish dishes. P decipiens is often found in the stomach rather than the intestine. This case shows that intense pain may be induced by only one larva which may continue to live in gastric mucosa at least 15 days after ingestation. There may also be severe allergic reactions in chronic infestations. and larva migrans syndrome.’ *Claudine Pinel, Michel Beaudevin, René Chermette, Renée Grillot, Pierre Ambroise-Thomas *Departement de Parasltologie-Mycologle, Centre Hospltalier Universitaire de Grenoble B, P 217. 38053 Grenoble, France; Cabinet de Gastro-enterologie, Echlrolles. France: and Ecole Nationale Vétérinalre. Maisons-Alfort. France
Figure: Postoperative CT-scan of the brain: conspicuous on the right side and a left subdural
arachnoid cyst haematoma
1829
Gastric anisakidosis due to Pseudoterranova decipiens larva
1
2
of inadequately-cooked fish infested by anisakidae larvae leads to human anisakidosis. In France, although anisakidosis is often suspected in cases of sudden gastric or intestinal pain, proof of this disease remains uncommon.’We report a case of anisakidosis due to Pseudoterranova decipiens larva in a patient of Cambodian origin living in France. A 40-year-old man complained of intense epigastric pain for 10 days, with no other symptoms. His trouble had started 3 hours after a meal of coalfish, prepared according to a Tahitian recipe with lemon juice. He was the only diner affected and had never had similar trouble. He had a gastroscopy. A larva was extracted from the great curvature of the epigastric mucosa. This was followed by clinical improvement. The slightly orange-coloured larva, 2-2 cm long and 0-8 cm wide, was still alive. It was identified by its macroscopic and microscopic characteristics as a P decipiens, stage L4, larva (figure).
SIR-Ingestion
3
4
5
Hubert B, Bacou J, Belvere H. Epidemiology of human anisakidosis. Incidence and sources in France. Am J Trop Med Hyg 1989; 40: 301-03. Schantz PM, McAuley J. Current status of food borne parasitic zoonoses in the United States. Southeast Asian J Trop Med Publ Health 1991; 22 (suppl): 65-71. Huang WY. Anisakidés et anisakidoses humaines: enquête sur les Anisakidés des poissons commerciaux du marché parisien. Ann Parasitol Hum Comp 1988; 63: 197-208. Kakizoe S, Kakizoe H, Kakizoe K, et al. Endoscopic findings and clinical manifestation of gastric anisakidosis. Am J Gastroenterol 1995; 90: 761-63. Matsuoka H, Nakama T, Kisanuki H, et al. A case report of serologically diagnosed pulmonary anisakidosis with pleural effusion and multiple lesions. Am J Trop Med Hyg 1994; 51: 819-22.
Dissociation between cerebral clinical picture
imaging and
(April 6, p 965)’ reminded us of one of patients. A 32-year-old lawyer was admitted to our hospital in 1994. 4 weeks before admission he had fallen on his head while skiing and since then complained of a continuous, severe, left-sided headache. A computed tomography scan of his brain showed a left subdural haematoma and a large arachnoid cyst in the right frontotemporal region. The skull had expanded on the side of the cyst. The haematoma was evacuated through two burrholes. There were no postoperative problems and the patient fully recovered and resumed his work. His postoperative scan showed a large cyst and an obvious midline-shift to the left (figure). The cyst, which displaced (and/or replaced)2 the temporal and part of the frontal and parietal lobes and had an obvious mass effect, was a surprising finding in this patient because he had studied law and was on the staff of a local university. He had a vague history of birth trauma. His further SiR-Baudoin’s letter
our
Anterior part of the Pseudoterranova decipiens larva showing characteristic morphological criteria Anterior part of the larva (A) with three prominent lips, thick article and an exuvia from the anterior L3 stage (B) and characteristic glandular oesophageal ventricle obliquely truncated (C).
Figure:
The incidence of anisakidosis in France is probably underestimated, although a fairly low incidence would be expected since seafish is usually either cooked or been deepfrozen. However, as in other countries,2 an increased incidence of this parasitosis is to be expected, because of the extremely high infestation of sea fish,3 and the popularity of Asian raw-fish dishes. P decipiens is often found in the stomach rather than the intestine. This case shows that intense pain may be induced by only one larva which may continue to live in gastric mucosa at least 15 days after ingestation. There may also be severe allergic reactions in chronic infestations. and larva migrans syndrome.’ *Claudine Pinel, Michel Beaudevin, René Chermette, Renée Grillot, Pierre Ambroise-Thomas *Departement de Parasltologie-Mycologle, Centre Hospltalier Universitaire de Grenoble B, P 217. 38053 Grenoble, France; Cabinet de Gastro-enterologie, Echlrolles. France: and Ecole Nationale Vétérinalre. Maisons-Alfort. France
Figure: Postoperative CT-scan of the brain: conspicuous on the right side and a left subdural
arachnoid cyst haematoma
1829