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Sushi: raw appeal or raw deal?


The increasing sophistication of American food consumption has significantly increased the number of people eating sushi (raw fish). Unfortunately, this delicacy is also associated with a very real danger--i.e., the possibility of the sushi consumer becoming infected with several types of worms, most commonly the larvae (eggs) of the worm species Anisakidae.

The life cycle of the worm and its vehicle for entry into the digestive tract provoke interest. The worms, being parasites, develop in shellfish that are then ingested by fish and squid. This process allows transfer of the worm larvae. The fish are then eaten by seals, sea lions, walruses, whales and porpoises, which provide the long-term host environment in their gastrointestinal tracts for the worms.

Pacific Ocean fish, including mackerel, herring, salmon, and cod, are the most likely intermediate hosts of the worms and major agents for the transfer to humans. Eating these fish raw or even partially uncooked produces the potential for human infestation with the worms. When eaten, the worm can either die and be eliminated in the stool or live and reside momentarily in the stomach and/or intestine before being coughed up or vomited by its consumer. In some instances, the worm may also remain in the intestine, producing symptoms similar to those associated with ulcers and appendicitis (including severe abdominal pain and even perforation). These symptoms may not appear for more than a week after ingestion and may become chronic.

The only way to effectively rid the sufferer of his or her symptoms is to simply remove the offending foreign matter (i.e., the worms) physically. In order to do this, however, the worms and their eggs must first be sighted. This is why an endoscopy, whereby a tube is inserted orally or anally, is considered the best approach to both the diagnosis and the treatment of worm infection. Mere stool examination does not aid in diagnosis because worms never mature and produce eggs.

Health officials believe that the number of cases of worm infestation among Americans is greatly underreported and underdiagnosed. Although it is apparently possible to identify the presence of worms in fish flesh, the growing popularity of sushi has produced inadequately trained food handlers to select and prepare the fish. Consider the risks and make your own choice. We urge caution. (New England Journal of Medicine, April 27, 1989; 320:1124-6.)
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Title Annotation:Anisakidae infection
Publication:Medical Update
Date:Jul 1, 1989
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