Clinical Features:
Within hours after ingestion of infected larvae, violent abdominal pain, nausea, and vomiting may occur.  Occasionally the larvae are coughed up.  If the larvae pass into the bowel, a severe eosinophilic granulomatous response may also occur 1 to 2 weeks following infection, causing symptoms mimicking Crohn's disease.

Laboratory Diagnosis:
Diagnosis can be made by gastroscopic examination during which the 2 cm larvae are visualized and removed, or by histopathologic examination of tissue removed at biopsy or during surgery.

Diagnostic Findings

• Microscopy

Treatment and Prevention:
The treatment of choice is surgical or endoscopic removal.  For additional information, see the recommendations in The Medical Letter (Drugs for Parasitic Infections).  For prevention, adequately cooking fish (60° C) or freezing (-20° C for seven days or -35° C for 15 hours) before ingestion will kill anisakid helminths.