Anisacidosis in humans

The fact that fish is a rich source of easily assimilable proteins and polyunsaturated omega-3 fatty acids for humans is known to many by the omnipresent and incredibly inquisitive media. And the fact that fish contains a lot of common and rare vitamins, as well as the lion's share of the elements of the periodic table, does not cause people much surprise. Such information surrounds us everywhere: teachers of biology class told us about it, fish vendors buzzed about this in the market, nutritionists wrote about it in the magazines, even doctors in polyclinics advised to eat more fish, replacing it with heavily digestible meats. But is all the fish so useful, or can this danger also hide a great danger, the name of which is anisacidosis.

Is it possible to get sick from eating fish?

Today we know that fish is a very valuable dietary product, which contains a huge amount of all kinds of substances that have a beneficial effect on our health. But people use fish and fish products as food for a long time, since then, when science existed at the stage of accumulation of life experience. At first it was at the level of the need for food, and over time for many it turned into a hobby.

A product that is available in all respects with different possibilities of its processing and supply to the table attracts people of different gender and age. Low-fat varieties of fish are recommended in the dietary diet, and fatty are useful in that they contain a unique component - fish oil, which contains Omega-3 and Omega-6 polyunsaturated fatty acids, which help the normal functioning of the heart and blood vessels. In addition, fish oil improves brain function, ensures the health of the nervous system and organs of vision, helps to strengthen the immune system, therefore it is recommended for baby food.

It is not surprising that the fish on our table is present both on holidays and on weekdays, and more and more new dishes with this useful product are born.

Such a lyrical description of the use of the fish somehow does not adhere to the word “danger”, but this does not mean at all that it is absent. And in confirmation of this, doctors can cite a whole list of diseases caused by eating fish and various dishes from it, seafood, delicious meat of marine animals.

Most episodes of illness from eating fish are attributed to poisoning associated with improper storage and preparation of fish, toxicoinfection (among them botulism is considered the most terrible) and helminthiasis ( opisthorchiasis, anisacidosis, diphyllobotriosis ).

As for helminth infections, most often, helminth infestation from fish is spoken after drinking river, i.e. Freshwater fish, therefore, many consider sea fish quite safe in this regard. However, scientists have found that even saltwater fish can be a source of parasites, so strict requirements should also be placed on its processing.

Disease from sea fish

Anisacidosis is a disease caused by the entry of parasitic worms of the Anisakidae family into the human body (hence the name of helminthiasis). Anizakids, in turn, represent a large group of nematodes, i.e. Roundworms that live in different varieties of fish. This is how the herring worm (genus Anisakis), the cod worm (Pseudoterranova decipiens), the inhabitants of the flounder (Larval anisakid), the parasites Hister (Hysterothylacium), etc. Are distinguished.

Anisakid worms are small parasites with a body, spindle-shaped, tapering at the ends (especially in the region of the head, where 3 lips are located). Adult sizes vary by gender. The females are usually larger and can reach 6.5 cm in length, while the length of the males is limited to 5 - 5, 5 cm.

Parasites of the Anisakidae family can be found in herring, cod, perc, salmon fishes, as well as in the body of other sea creatures (mollusks, shrimps, squid, octopus) - that is, in almost all the variety of sea fish and seafood coming to the stores and market outlets.

It must be said that small fish and crustaceans are considered only intermediate hosts of nematodes. During their life cycle, anicasides can change several hosts. Large and predatory fish, marine mammals (dolphins, whales, fur seals, etc.), as well as birds that feed on fish, in the nematode larvae reach sexual maturity become the ultimate owner and distributor of parasitic infection in the conditions of sea water bodies. And multiply by laying eggs in a transparent shell oval or round shape. A germ is visible inside the egg.

Together with the feces, the nematode eggs enter the water, where the larvae mature in favorable conditions (at a temperature of 5 to 21 degrees and sunny weather). Depending on environmental conditions, this takes from 3 days to 3 weeks. At the same time, salt in soda is not a hindrance, but on the contrary increases the lifespan of the larvae hatched from eggs. On average, they live in seawater for 3-3.5 months.

The larvae, after they leave the shell of the egg, freely swim in the water near the bottom of the reservoir, where they are swallowed by crustaceans. The crustaceans themselves are food for fish and squid, therefore the larva or mature individual in the body of its first owner falls to the second owner. At the same time, nematodes and their larvae are resistant to an acidic environment, are not digested in the stomach of fish, but ripen and parasitize in it.

Even if the fish dies, the larvae in search of food move from the gastrointestinal tract to the eggs or milt, muscle tissue, and then into the water, where they can easily wait for the next owner.

Further, infected fish or squid can become the food of large predatory fish, marine mammals, fish-eating birds, in the digestive tract and the body of which they will continue their livelihoods, development, reproduction. A fish infected with nematodes can be caught by a person and get on the table to it, and then the next owner of the parasites becomes a person who is diagnosed with "ankazidoz".

It must be said that the anicaside larvae have adapted rather well to survival in adverse conditions. Salinity of water does not matter for them, therefore both saline and fresh-water reservoirs can become a habitat for nematodes. Larvae 1-3 stages of maturation tolerate high temperatures well and die only at 60 degrees. Yes, the temperature below zero they are not afraid. Thus, in the fish frozen to a temperature of minus 18 degrees, the larvae can last up to 2 weeks, and at minus 30 they die for 10 minutes.

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Causes of the anizacidosis

So, we already know that the source of human infection with nematodes from the Anisakidae family is fish that have not been heat treated or frozen at very low temperatures. But you need to understand that we are talking here not only about raw fish, which we don’t eat in any way, as opposed to the countries of the East, and Japan in particular.

According to statistics, the first case of the disease was detected in Holland more than half a century ago. But this was only the beginning. At present, anisacidosis has become a problem in many countries of Europe, Southeast Asia, the USA, and Canada. Some traditions of the inhabitants of the Far East and the northern regions of Russia also do not contribute to a decrease in the incidence, because eating them raw, dried, smoked fish at temperatures below 60 degrees Celsius and caviar is one of the risk factors for anisacidosis.

The popularization in our country of food systems in which meat is recommended to be replaced by more useful and easily digestible fish leads to the need to somehow diversify your table, inventing new ways of cooking fish and seafood. But often we adopt the traditions of other countries where fish has long been a popular food product (Japan, Korea, China, the countries of Southeast Asia, etc.).

By the way, the Japanese traditional dish “sushi” that is gaining popularity in our country, which often contains pieces of raw fish and seafood, is among the leaders among the factors contributing to the infection with anisacides. It would seem that the Japanese in this case would have had to get sick with anisacidosis. Why is this not happening?

The fact is that cautious Japanese have certain requirements for the preparation of fish dishes. River fish must be heat treated. Raw to the land and other traditional Japanese dishes include only oceanic and marine fish, while some species of fish (such as salmon or tuna) must first go deep-frozen, which means the death of parasite larvae.

By intercepting the traditions of other countries, we don’t really care about meeting such requirements. The increasing demand for sushi and dishes from actually raw fish implies the creation of a large number of institutions where these dishes are cooked, but their owners do not really care about the health of visitors, because profit comes to the fore. A room decorated in the Japanese style does not guarantee the quality of the products served in it.

At risk of anisacidosis are lovers of salted and pickled sea or ocean fish. According to statistics, the level of infestation with helminths of fish from the Okhotsk, Barents, and Baltic Seas reaches 45-100%. It would seem safer to buy ocean fish, but even here everything is not so smooth, because fish caught in the Pacific or Atlantic Ocean are also often contaminated. At the same time, nematodes of the Anisakidae family were also found in almost 30% of Pacific squid caught.

Salted, smoked (especially cold smoked), dried, dried, pickled fish is used by both adults and children, and this suggests that any fan of such food can get sick. Only children withstand such diseases with intoxication and body sensitization harder than adults. And then there are many careless parents with unconventional tastes are beginning to offer their children to try sushi or other fish delicacies.

But you need to understand that for anisidi larvae it is not so important how much herring will be salted on our table. They are not afraid of salt or vinegar. Only deep freezing or sufficient heat treatment can destroy the parasites.

And not only herring, cod, salmon or salmon can be infected with anisacides. Parasites are also found in other varieties of fish: capelin, halibut, flounder, various species of salmon, pollock, heke, blue whiting, mackerel, sardine, etc. It is clear that crustaceans (the same shrimp), squid, octopus, mussels present on the shelves of stores can also be infected. And this is not the most pleasant news for fans of sea and ocean fish, as well as seafood delicacies.

Pathogenesis

Man becomes the ultimate host of anisakid larvae, where they lose the ability to mature and produce offspring. But, given the relatively long lifespan of young nematodes (in the human body, they can exist from 2 weeks to 3 months), their parasitism in the human body cannot go unnoticed.

The larvae are no longer isolated from the digestive system along with the feces, but remain and parasitize in it. At the same time, they can replace the dislocation, making a hole in different parts of the gastrointestinal tract and penetrating into the abdominal cavity.

Since it is impossible to understand by eye whether a fish is a carrier of a parasitic infection, many people will think, and is it not dangerous to eat fish at all, maybe you should stop eating this tasty and healthy product? Do not rush to extremes, because we already know that anicadosis larvae die when heated at temperatures above 60 degrees and frozen at temperatures below 30 degrees. It turns out that lovers of fried, boiled, stewed, baked fish have nothing to worry about, all the living creatures inside them die during the heat treatment.

Frozen fish that is kept at low temperatures for several months is also unlikely to become a source of anicaside, especially if it was gutted in time and placed in a freezer. It turns out that the source of a parasitic infection can be only that fish that has not been subjected to prolonged freezing (or short-term, but at a temperature below minus 30 degrees) or sufficient heat treatment. Thus, dangerous, fish products include raw, salted (remember that the larvae are not afraid of salt!) Or pickled, dried, dried, smoked at low temperatures fish. It is these products that become sources of infection for humans and animals.

The first signs of anisacidosis may appear 1-2 weeks after consuming contaminated food. During the incubation period, a person may not notice changes in his state of health, and the larvae that do not adhere to the stomach walls may be released when they cough or vomit. Next, young nematodes begin to settle in the membrane of the digestive tract (mainly the stomach and small intestine, but some individuals can also be found in the walls of the pharynx and large intestine), penetrating the mucous and submucous layers of the head end.

At the sites of larval infestation, an inflammatory process occurs with the formation of seals formed by eosonophils (a type of leukocyte, an increase in the number of which is observed during allergic reactions and parasitic infections), the appearance of tissue edema, ulcers and small hemorrhages (hemorrhages). In place of eosonophilic infiltrates (accumulation of eosonophils) granulomas (inflammatory nodules or tumors), foci of necrosis and perforation of the walls of organs (most often the intestines) are formed.

The development of the inflammatory reaction is associated not only with a violation of the integrity of the mucous membrane of the gastrointestinal organs, but also with the fact that the waste products of the larvae cause sensitization of the body. What manifests itself in the form of various symptoms of allergies (edema, rash). Toxic-allergic effects on the body are also observed during the formation of granulomas. And, despite the fact that the life span of anizakid larvae in the human body is limited to 2-3 months, symptoms of intoxication and sensitization of the body can manifest in a person for several months and years.

The inflammatory process, accompanied by irritation of the nerve endings in the intestinal walls and neuro-reflex reactions (muscle spasm), often leads to obstruction of the organ. No less dangerous is the situation when the larvae cause intestinal perforation and cause peritonitis (inflammation of the peritoneum).

Since the stomach and intestines communicate with other organs involved in the digestive process, it is not surprising that anicaside larvae that are resistant to aggressive media can penetrate into the gallbladder, pancreas, liver ducts. In these organs, they also cause the development of inflammatory reactions and the appearance of granulomas.

Speaking about the ways of infection with helminths of the Anisakidae family, it should be borne in mind that in addition to eating heat-treated infected fish there are other opportunities to get an unfriendly "lodger". Eggs and larvae of 1 degree have small sizes (about 1 mm), therefore they can be not noticed in fish mince or when cutting fish. They can remain on the cutting board and the hands of the one who worked with the fish, and from there get to other products or in the mouth to the person.

No wonder that one of the important requirements for the prevention of helminth infections is the use of a separate cutting board for fish. It is also strongly not recommended to try raw minced meat or whole fish for the degree of their salinity. After finishing work with fish, you need to wash your hands with special care, and during work try not to touch them with other foods, especially those that will not be heat treated in the future. It so happened that these living beings that serve as a healthy food for humans, more often than others, become carriers of any infection.

Symptoms of the anizacidosis

It is difficult to say when the person who ate the infected fish has the first symptoms of indisposition. It may take several hours or several days when the patient does not even remember what the gastrointestinal symptoms may be associated with. It often happens, so many people who are infected simply do not associate their ill health with fish.

What symptoms can talk about the introduction of anizakid in the digestive tract? Much depends on the localization of the parasite. It is usually found in the lumen of the stomach, so the symptoms resemble the manifestations of gastrointestinal diseases of the inflammatory type, occurring in the acute form (gastritis, stomach ulcer), or the usual food poisoning.

Anisacidosis of gastric localization can be manifested by severe pain in the stomach, nausea, and vomiting (in vomit, blood is sometimes found as a result of the appearance of hemorrhages). Patients often complain that they are in a fever, while the temperature can stay in the vicinity of subfebrile indicators (37-38 degrees) and rise higher. In people with a tendency to allergies, allergic reactions can occur (lung-like urticaria or severe, such as, for example, angioedema).

In the intestinal localization of nematodes, pronounced symptoms of the disease do not always appear, and if they do, they are usually less pronounced than in the gastric localization of the parasite. There may be complaints of pain in the umbilical or right iliac region, abdominal discomfort, and increased flatulence.

With a severe form of gastrointestinal anisacidosis, its manifestations are in many ways similar to the symptoms of acute appendicitis. But there are other forms of the disease, depending on the location of the pathogen. So from the stomach nematodes can go back into the esophagus and pharynx, and the patient will feel a lump in the throat, irritation and pain when swallowing.

Return to the oral cavity threatens the migration of larvae into the bronchopulmonary system. In this case, symptoms that are not at all characteristic of poisoning or helminth infections can appear: cough with poor sputum production, bronchial obstruction, i.e. Violations of the patency of the bronchi (hard breathing, whistling and wheezing on the exhale). The pain in this case can be localized both along the esophagus and in the chest, which is more like bronchitis.

It was also reported about episodes when parasites were localized in the pharynx, penetrating into the submucosal layer, loose tissues of the tonsils and even penetrated into the tongue, which happens with a non-invasive form of the disease if the larvae are not fixed in the mucous and submucosal layer and move freely in the lumen of the digestive tract. At the same time, doctors found edema of the throat or tongue, and patients complained of pain in the throat, especially when trying to swallow, as is the case with angina.

From the intestine and stomach, anicaside larvae can migrate to other organs of the digestive system. In this case, symptoms of pancreatitis (pressing pain on the left side of the abdomen just below the waist), cholecystitis (usually biliary colic), inflammation of the liver (pain on the right, elevated liver enzymes) may appear.

As you can see, the manifestations of anisacidosis can be so different that even an experienced doctor does not always immediately put the correct diagnosis. A patient can be taken to the hospital with “appendicitis” in case of severe illness, suspected that he has “bronchitis” in case of broncho-pulmonary symptoms, or even treat “Crohn's disease” in a blurred clinical picture.

By the way, in the latter case, the disease often takes a chronic course: the nematode larvae die within 2-3 months, but under the influence of their metabolic products, the body's sensitization increases, and it reacts particularly acutely to any negative factors, stimulating inflammatory processes. This is usually due to exacerbation of symptoms in the absence of the pathogen itself.

Complications and consequences

The pain syndrome of any localization is a rather unpleasant thing, which noticeably affects the quality of a person's life: it worsens mood, promotes rapid fatigue, reduces efficiency, causes irritability. If she does not pass a long time, it can even cause depression. But in case of anizakizode, pain syndrome can be either weak, annoying, or pronounced, painful, which in both cases is unpleasant.

And the very realization that a worm lives inside you (and often not one) in some people causes a strong dislike for your own body, even vomiting and hysterics, which is typical of women. But the lack of information about the cause of indisposition also promises nothing good. A variety of manifestations of the same disease sometimes becomes the cause of an incorrect diagnosis. It is clear that the prescribed treatment usually does not bring the desired result, and can only push the parasite to change the location.

Even more dangerous is the clinical picture, in which the symptoms are very mild. A person can simply ignore them and not consult a doctor. The most meager symptoms are usually observed in the intestinal localization of anicaside larvae. But here lies the greatest danger, since the introduction of parasites into the intestinal walls is fraught with its perforation and the release of the contents into the abdominal cavity. And this in turn guarantees inflammation of the peritoneum, in other words, peritonitis, about the danger of which we have already heard more than enough. So such an unpleasant neighborhood can even be fatal.

Other complications of anisacidosis can be exacerbations of existing gastrointestinal diseases (in particular, gastric and duodenal ulcers), stenosis (narrowing) of the ileum and intestinal obstruction. Migration of nematodes into the abdominal cavity, ovaries, liver, etc. May provoke inflammation and impaired functionality of other organs.

No less dangerous can be anaphylactic reactions caused by anisid allergens in humans, especially in cases where a person has a tendency to be allergic to fish or seafood. Anaphylactic shock and angioedema are sudden allergic reactions that pose a certain risk to a person’s life.

Chronization of the disease as a result of late treatment or lack of it can be considered an extremely unpleasant complication (although it is often a question of making a wrong diagnosis, and then it is not at all what you really have to treat). At the same time, the life cycle of the larvae can end much earlier than the last symptoms leave. Some patients complain for six months or more, and the transition to the chronic form of the disease threatens with the appearance of signs of the disease for several years.

This perspective once again suggests that you can not carelessly treat your health, and parasites have no place in the human body.

Diagnostics of the anizacidosis

So, we gradually came to the question of the need for timely diagnosis of anisacidosis, which makes it possible to get rid of nematodes as quickly as possible and restore the normal functioning of the digestive system (and sometimes not only it). It remains to understand what methods doctors use to identify parasites inside a person and how to get tested for anisacidosis.

If there are symptoms of malaise and there is a suspicion that this is due to the use of fish, you should not think for a long time about which doctor to address with the problem. It is important to contact a general practitioner or family doctor as soon as possible, and already he will give a referral to a parasitologist or a gastroenterologist (depending on which doctor is in the hospital).

Regardless of whether the patient came to the hospital himself or was brought by an ambulance, the doctor will first be interested in the symptoms that have appeared, and after hearing complaints and visually assessing the patient’s condition, he will want to know the details about the patient’s diet in the coming days. If you know that during the last couple of weeks you have consumed sushi, raw, dried, salted, smoked fish or fish and seafood dishes that have not previously been subjected to sufficient heat treatment, you should definitely inform your doctor about this. Such forethought will reduce the likelihood of an erroneous diagnosis, especially if the reason for going to a doctor was a complaint of a sore throat or cough for no reason, and not gastrointestinal symptoms.

Usually, with complaints of gastrointestinal pathologies, doctors prescribe certain laboratory tests. In the absence of vomiting, these will be: complete blood count, urine and feces. If there is vomiting for analysis, vomit can also be taken.

It must be said that laboratory tests do not always reveal anisacidosis larvae. More likely to find them in vomit, while in feces they are found in isolated cases if the parasite has settled in the lumen of the large intestine (but it prefers a thin one). Typically, a blood test is prescribed to detect interstitial parasites, and stool analysis helps to detect helminth eggs. But we already know that anisakids do not reproduce in the human body, which means that their eggs will not be detected in the feces.

With regard to blood tests, it can be detected antibodies (when conducting enzyme immunoassay), produced by our body in response to infection. Such a study is prescribed for suspected interstitial parasites. But the problem is that anisakids cannot be attributed to any of the 2 types of helminths with confidence, therefore it would be illogical to rely only on the results of analyzes. For example, a characteristic increase in the level of leukocytes, and in particular eosinophils, determined during the clinical analysis of blood, is observed with various helminthiases and does not give a clue as to exactly which parasite causes the disease. In addition, a similar pattern can also be observed in the acute course of allergic reactions, infections, gastrointestinal diseases, etc.

A logical question may seem, but why are tests prescribed at all if their results do not provide the necessary information? The need for such studies can be explained by the fact that initially the doctor cannot say with certainty that the patient’s ill health is associated with aniciasis or any other helminthiasis, therefore, he considers any options and causes. In addition, the test results will be useful when the patient will need to prescribe treatment, because they can tell the doctor about the condition of the patient's body and possible violations in it that will be an obstacle in prescribing specific drugs.

Scientists consider the anisacide allergens (prik-test skin test) and the basophil transformation test with an extract of nematodes of the Anisakidae family to be the most specific.

Even more informative than conventional analyzes, with anisacidosis is instrumental diagnostics. In the arsenal of doctors there are 2 popular methods that allow you to identify the larvae that have penetrated the mucous membranes of the gastrointestinal tract, this is x-ray using contrast (especially in the gastric form of the disease) and fibrogastroscopy (endoscopy). In the second case, it is even possible to take a biomaterial (bioptat) for further research if there is swelling and multiple minor erosion on the mucous membrane of the stomach, esophagus or intestines (the parasite is unlikely to be there in proud isolation).

It must be said that endoscopy allows not only to detect anicaside larvae and conduct a more detailed study to determine the localization of parasites, but also to immediately remove those individuals that will be visible through the translucent mucous and submucosal layers. That is why such a study is more preferable, especially if one considers that effective methods for the medical treatment of anisacidosis have not yet been developed.

Anisacidosis with traditional gastrointestinal localization should be differentiated from gastric and duodenal ulcers, exacerbation of gastritis, pancreatitis, cholestitis. Acute food poisoning, appendicitis, colitis, diverticulitis, and tumors in the stomach or intestines can manifest themselves with similar symptoms. In addition, other helminth infections can occur with similar symptoms.

Extraintestinal forms of anisacidosis are similar to acute and tuberculous peritonitis, pancreatic cancer. When returning worms to the pharynx and larynx, it is very important not to succumb to the first impulse and not to diagnose tonsillitis or bronchitis, the treatment of which certainly will not help the patient.

The similarity of anisacidosis symptoms with various unrelated diseases only confirms the need and value of differential diagnosis. But, despite the developed diagnostic methods, most cases of anisacidosis remain unrecognized.

Prevention

Of course, we consider a very unpleasant and to a certain extent dangerous disease, the effective treatment of which with sufficient prevalence of helminthiasis has not yet been developed. In such circumstances, the most appropriate can be considered the exercise of caution and preventive measures that help prevent the disease.

It should be noted that these measures are very simple, but for the sake of health, you may still have to give up some food preferences:

• It is recommended to consume fish from tested reservoirs where parasites are not found. And even in this situation, freshly caught fish should be tried to gut and wash as quickly as possible while it is still alive, because in dead fish the parasites turn into caviar, milt and fish meat, where it is harder to identify them.
• If the fish is purchased in retail outlets and its place of residence is unknown, it is most appropriate to subject it to sufficient heat treatment: boil, bake, fry, etc.
• Lovers of salted, pickled and smoked fish can be recommended to cook it yourself, subject to pre-freezing of fresh fish at a temperature not higher than minus 18 degrees for 2 weeks. At lower temperatures, the freezing time of the fish can be reduced (although not everyone has the opportunity to deep-freeze the fish).
• It is necessary to purchase ready-made salted, pickled and smoked fish in those outlets where products are checked for the presence of worms and other parasites. Do not forget that salt and marinades do not kill anisakids.
• You can never taste raw minced fish or fish pieces on salt. In this case, the kitchen must have a separate board, on which only fish and seafood will be finished. It would be good for these purposes to also have separate dishes and a knife, if there are none, then after cutting the fish, the dishes and kitchen utensils should be subjected to heat treatment.
• In the refrigerator, fresh and salted fish should be tried to be stored separately from products that will not be subjected to heat treatment (gastronomy, cooking, chopped vegetables, etc.). This also applies to freezers, if the temperature in them is lower than recommended for the rapid death of nematodes.
• Fans of sushi and other overseas delicacies of fish and seafood should understand that they put themselves at risk, especially visiting dubious establishments or trying to prepare such dishes at home without knowledge of technology and precautionary measures. Moreover, you should not accustom children to such "treats" for which boiled or baked fish that have been subjected to heat treatment at a temperature of at least 60 degrees for 20 minutes or more will be the best treat.

Anikazidoz - not the only parasitic disease that can get sick from eating sea or river fish. Therefore, thinking about the benefits of this product for our body, we should not forget about the danger that can be hidden inside the aquatic inhabitants of fresh and saline water bodies. Moreover, there are many ways to benefit from the fish without harming yourself and your loved ones.

Forecast

Anisacidosis is a parasitic disease that may have a different incubation period and features. And it is good if a person turns for help in the first hours or days after infection, while the harm from the introduction of anisacide is minimal. In this case, the prognosis of treatment is favorable, although much also depends on the concentration of parasites and the form of the disease (the invasive form usually proceeds and is treated more severely than non-invasive), the applied treatment. It is impossible to expect until the larvae die naturally, because during their stay in the human body, they can do a lot of harm, and the consequences of their activity will have to be treated for more than one month.

The prognosis noticeably worsens with the migration of nematodes and their deepening in the tissue of organs. A severe form of the disease, with negative consequences, is noted during perforation of the intestinal walls or penetration of worms into the lungs.