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Cammilleri G, D’Amelio S, Ferrantelli V, Costa A, Buscemi MD, Castello A, Bacchi E, Goffredo E, Mancini ME, Cavallero S. Identification of Contracaecum rudolphii (Nematoda: Anisakidae) in Great Cormorants Phalacrocorax carbo sinensis (Blumenbach, 1978) from Southern Italy. Vet Sci 2023; 10:vetsci10030194. [PMID: 36977233 PMCID: PMC10057129 DOI: 10.3390/vetsci10030194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
In this study, four dead great cormorant Phalacrocorax carbo sinensis (Blumenbach, 1978) specimens, collected from the coasts and lakes of Southern Italy, were examined by necropsy for the detection of Contraceacum sp. The adults and larvae found were subjected to morphological analysis and molecular identification by PCR-RFLP. A total of 181 Contracaecum specimens were detected in all of the four great cormorants examined (prevalence = 100%), showing an intensity of infestation between nine and ninety-two. A co-infestation by adult and larval forms of Contracaecum rudolphii was found only in one of the great cormorants examined. Following molecular investigations, 48 specimens of C. rudolphii A and 38 specimens of C. rudolphii B were detected, revealing co-infestation solely for the great cormorant from Leporano Bay (Southern Italy). Our results showed an opposite ratio between C. rudolphii A and C. rudolphii B in Pantelleria and in Salso Lake (Southern Italy) compared to what was reported in the literature, probably due to migratory stopovers and the ecology of the infested fish species, confirming the role of Contracaecum nematodes as ecological tags of their hosts.
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Affiliation(s)
- Gaetano Cammilleri
- Centro di Referenza Nazionale per le Anisakiasi, Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, Via Gino Marinuzzi 3, 90129 Palermo, Italy
| | - Stefano D’Amelio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Vincenzo Ferrantelli
- Centro di Referenza Nazionale per le Anisakiasi, Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, Via Gino Marinuzzi 3, 90129 Palermo, Italy
| | - Antonella Costa
- Centro di Referenza Nazionale per le Anisakiasi, Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, Via Gino Marinuzzi 3, 90129 Palermo, Italy
| | - Maria Drussilla Buscemi
- Centro di Referenza Nazionale per le Anisakiasi, Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, Via Gino Marinuzzi 3, 90129 Palermo, Italy
| | - Annamaria Castello
- Centro di Referenza Nazionale per le Anisakiasi, Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, Via Gino Marinuzzi 3, 90129 Palermo, Italy
- Correspondence: ; Tel.: +39-0916565258
| | - Emanuela Bacchi
- Centro di Referenza Nazionale per le Anisakiasi, Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, Via Gino Marinuzzi 3, 90129 Palermo, Italy
| | - Elisa Goffredo
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Via Manfredonia 20, 71121 Foggia, Italy
| | - Maria Emanuela Mancini
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Via Manfredonia 20, 71121 Foggia, Italy
| | - Serena Cavallero
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
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Nematode Parasites of the European Pilchard, Sardina pilchardus (Walbaum, 1792): A Genuine Human Hazard? Animals (Basel) 2022; 12:ani12151877. [PMID: 35892527 PMCID: PMC9332007 DOI: 10.3390/ani12151877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The European pilchard is one of the most frequently consumed fish species in Mediterranean countries, especially in Italy and Spain, and has been reported as the cause of at least eight human anisakidosis cases in Spain since 1991, the parasitic disease caused by the ingestion of fish or cephalopods infested by the larval stage of anisakid nematodes. With the aim to shed light on the potential human parasitosis risk posed by these nematode larvae, we helminthologically analyzed a total of 350 sardines (European pilchard) captured in the Atlantic Ocean (175 sardines) and the Mediterranean Sea (175 specimens), acquired in various Spanish nationwide supermarket chains. The statistical analysis of some helminth parameters revealed a higher presence of nematodes belonging to the genus Hysterothylacium (frequency of parasitation of 24.29%; total mean parasite burden of 2.36), usually considered non-parasitic for humans (only three cases reported worldwide), when compared to nematodes of the genus Anisakis (5.71%; 0.16). The human anisakidosis risk after the consumption of raw or undercooked sardines and the role of Hysterothylacium, the most frequent nematode, is discussed, providing information to consumers. To avoid human infection by anisakid larval nematodes, the established preventive measures are confirmed and new ones are proposed. Abstract The European pilchard is one of the most frequently consumed fish species in Mediterranean countries, especially in Italy and Spain, and has been reported as the cause of at least eight human anisakidosis cases in Spain. With the aim to shed light on the potential human parasitosis risk posed by nematode larvae belonging to families Anisakidae or Raphidascarididae, a total of 350 sardines captured in the Atlantic Ocean (175 specimens) and the Mediterranean Sea (175 specimens), acquired in various Spanish nationwide supermarket chains, were helminthologically analyzed. The statistical analysis of some helminth parameters revealed a higher presence of nematodes belonging to the genus Hysterothylacium (prevalence 24.29%; mean abundance of 2.36), usually considered non-parasitic for humans (only three cases reported worldwide), when compared to nematodes of the genus Anisakis (5.71%; 0.16). The human anisakidosis risk after the consumption of raw or undercooked sardines and the role of Hysterothylacium, the most frequent nematode, is discussed, providing information to consumers. To avoid human infection by anisakid larval nematodes, the established preventive measures are confirmed and new ones are proposed, such as the consumption of sardines preferably caught in the Mediterranean and of small-sized specimens available, and the immediate evisceration after fishing.
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Anisakicidal Effects of R (+) Limonene: An Alternative to Freezing Treatment in the Industrial Anchovy Marinating Process. Foods 2022; 11:foods11081121. [PMID: 35454708 PMCID: PMC9028723 DOI: 10.3390/foods11081121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 02/01/2023] Open
Abstract
Anisakiasis is a fish-borne zoonotic disease caused by the ingestion of raw/undercooked fishes or cephalopods parasitized by members of the genus Anisakis. Freezing ensures the inactivation of viable Anisakis larvae; however, since it affects the organoleptic properties of food, essential oils and their compounds were proposed as an alternative. In this study, fresh anchovy fillets were experimentally parasitized with L3 Anisakis larvae to test the anisakicidal efficacy of R (+) limonene (LMN) in marinated fishery products. The anisakicidal effectiveness and organoleptic influence of several LMN concentrations (0.5%, 1%, and 5%) were tested during the marinating process (MS) and storage in sunflower seed oil (SO) of marinated anchovy fillets. Double treatment (DT) with 1% LMN was also performed both during marination and subsequent storage in oil. MS treatment resulted only in a reduction in larvae viability after 48 h, while a complete inactivation was observed in SO after 8, 10, and 20 days of treatment with 5%, 1%, and 0.5% LMN, respectively. DT was the most effective with complete larval inactivation after 7 days. Only 5% LMN influenced the sensory characteristics of the fillets, resulting, however, in a pleasant lemon-like odor and taste. Considering the results obtained, LMN might be a suitable natural alternative to manage Anisakis risk in the fishery industry.
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Marinated Anchovies (Engraulis encrasicolus) Prepared with Flavored Olive Oils (Chétoui cv.): Anisakicidal Effect, Microbiological, and Sensory Evaluation. SUSTAINABILITY 2021. [DOI: 10.3390/su13095310] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To meet the food demand of future generations, more sustainable food production is needed. Flavored olive oils (FOOs) have been proposed as natural additives to ensure food safety and quality through a more sustainable approach. The chemical composition and antioxidant potential of two different olive oils flavored, respectively, with cumin (Cm) and with a mixture of parsley, garlic, and lemon (Mix) were investigated. Cm-FOO and Mix-FOO were tested against Anisakis both in vitro and ex vivo through an exposure test of anchovy fillets experimentally parasitized with Anisakis larvae. Microbiological and sensory analysis were carried out on marinated anchovy fillets exposed to both FOOs to evaluate their effects on the shelf life and their sensory influence. The addition of herbs and spices did not affect the chemical composition of the olive oil (free acidity, UV absorbance, and fatty acid composition). Only Mix showed antioxidant activity, while Cm had no effect in this regard. Cm-FOO and Mix-FOO devitalized the Anisakis larvae both in vitro within 24 h and ex vivo after 8 and 10 days of exposure, respectively. The results of microbiological analyses showed that FOOs inhibited the growth of typical spoilage flora in the marinated anchovies without negatively affecting their sensory characteristics, as observed from the sensory analysis.
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Prevalence and identification of Anisakis nematodes in fish consumed in Marrakesh, Morocco. Mol Biol Rep 2021; 48:3417-3422. [PMID: 33864586 DOI: 10.1007/s11033-021-06323-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
Morocco is considered as an important producer of fish with more than one million tons of small pelagic fish caught per year, along more than 3400 km of coastline. Otherwise, few studies have investigated the zoonotic parasites of fish. The purpose of this study is to determine the prevalence of Anisakis nematodes larvae in two fish species, namely sardines Sardina pilchardus and mackerel Scomber scombrus. These two species are widely consumed in Marrakesh due to their availability and their affordable prices. A total of 948 fish, including 546 sardines and 402 mackerel, were purchased from the wholesale market of Marrakesh, from January 2016 to December 2018. Sampling was performed on the days of fish arrival from the fishing areas (Dakhla, Essaouira, Safi and Sidi Ifni). The samples were examined visually for the presence of Anisakis larvae. We obtained a prevalence of 8.4% in mackerel with different rates depending on their origins (Safi: 13.23%; Essaouira: 11.66%; Sidi Ifni: 2.5%; Dakhla: 0%) and the seasons. However, no larvae were detected in the sardines after meticulous visual inspection. The detected larvae were morphologically and genetically identified. We identified the larvae by the PCR-RFLP technique using the primers LSU5-F (TAGGTCGACCCGCTGAAYTTAAGCA) and IR16-R (ATTCACACCCATTGACTCGCG) from the 28S rDNA region. The analysis showed that all larvae belong to Anisakis simplex sensu-stricto (s.s.). According to our results mackerel presents a higher risk of contamination than sardine, while statistical studies show that there is no impact of season and fishing origin on the prevalence.
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Palomba M, Santoro M, Alburqueque RA, Cipriani P, Mattiucci S. First molecular detection of the parasites Molicola uncinatus and Hepatoxylon trichiuri (Cestoda: Trypanorhyncha) infecting the silver scabbardfish Lepidopus caudatus from the Central Mediterranean Sea: Implications for the seafood quality and safety. Food Control 2021. [DOI: 10.1016/j.foodcont.2020.107807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Genera and Species of the Anisakidae Family and Their Geographical Distribution. Animals (Basel) 2020; 10:ani10122374. [PMID: 33322260 PMCID: PMC7763134 DOI: 10.3390/ani10122374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/11/2023] Open
Abstract
Simple Summary The parasites of the Anisakidae family infest mainly marine mammals; however, they have the ability to infest paratenic hosts such as mollusks, small crustaceans and fish. The consumption of meat from animals of aquatic origin favors the acquisition of the disease known as Anisakiasis or Anisakidosis, depending on the species of the infecting parasite. Currently, the identification of the members of this family is carried out through the use of molecular tests, which brings about the generation of new information. The purpose of this review was to identify the genus and species of the Anisakidae family by reviewing scientific papers that used molecular tests to confirm the genus and species. The adaptability of the Anisakidae family to multiple hosts and environmental conditions allows it to have a worldwide distribution. As it is a zoonotic agent and causes non-specific clinical symptoms, it is important to know about the different members of the Anisakidae family, as well as the hosts where they have been collected. Abstract Nematodes of the Anisakidae family have the ability to infest a wide variety of aquatic hosts during the development of their larval stages, mainly marine mammals, aquatic birds, such as pelicans, and freshwater fish, such crucian carp, these being the hosts where the life cycle is completed. The participation of intermediate hosts such as cephalopods, shrimp, crustaceans and marine fish, is an important part of this cycle. Due to morphological changes and updates to the genetic information of the different members of the family, the purpose of this review was to carry out a bibliographic search of the genus and species of the Anisakidae family identified by molecular tests, as well as the geographical area in which they were collected. The Anisakidae family is made up of eight different parasitic genera and 46 different species. Those of clinical importance to human health are highlighted: Anisakis pegreffi, A. simplexsensu stricto, Contracaecumosculatum, Pseudoterranova azarazi, P. cattani, P. decipiens and P. krabbei. The geographical distribution of these genera and species is located mainly in the European continent, Asia and South America, as well as in North and Central America and Australia. Based on the information collected from the Anisakidae family, it was determined that the geographical distribution is affected by different environmental factors, the host and the ability of the parasite itself to adapt. Its ability to adapt to the human organism has led to it being considered as a zoonotic agent. The disease in humans manifests nonspecifically, however the consumption of raw or semi-raw seafood is crucial information to link the presentation of the parasite with the disease. The use of morphological and molecular tests is of utmost importance for the correct diagnosis of the genus and species of the Anisakidae family.
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Kochanowski M, Różycki M, Dąbrowska J, Karamon J, Sroka J, Antolak E, Bełcik A, Cencek T. Development and Application of Novel Chemiluminescence Immunoassays for Highly Sensitive Detection of Anisakis simplex Proteins in Thermally Processed Seafood. Pathogens 2020; 9:pathogens9100777. [PMID: 32977528 PMCID: PMC7598195 DOI: 10.3390/pathogens9100777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023] Open
Abstract
The third-stage larvae (L3) of Anisakis simplex are the most important source of hidden allergens in seafood products. However, there exist no commercial methods for detecting Anisakis proteins in food. Furthermore, only a few methods have been validated for the detection of A. simplex in thermally processed food. The aims of our study are (i) the development and validation of high-sensitivity chemiluminescent (CL) immunoassays for the detection of A. simplex proteins in processed seafood, (ii) and A. simplex antigen detection in common seafood products from Polish markets. We developed and validated CL sandwich ELISA (S-ELISA) and CL competitive ELISA (C-ELISA) methods for A. simplex proteins detection in food, with respective detection limits of 0.5 and 5 ng/mL. The usefulness of the assays for detecting A. simplex proteins in highly processed food was evaluated by examination of autoclaved canned fish spiked with A. simplex larvae (1–8 larvae/200 g). Commercial real-time PCR was unable to detect A. simplex in autoclaved samples at all levels of enrichment with Anisakis larvae. CL-S-ELISA was used to test various types of seafood products from Polish markets. Among all tested products (n = 259), 28% were positive. A. simplex antigens were found mostly (n = 39) in smoked fish products: mackerel, herring, cod, and hake. Other positive samples were found in marinated herrings, canned cod livers, canned mackerels, and surimi sticks. In tuna, Atlantic argentine, anchovy, sardine, sprat, and squid products, A. simplex antigens were not detected. This study provides novel effective tools for the detection of A. simplex proteins in processed food and highlights the potential allergic hazards for Anisakis-sensitized Polish consumers of seafood.
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Cammilleri G, Ferrantelli V, Pulvirenti A, Drago C, Stampone G, Del Rocio Quintero Macias G, Drago S, Arcoleo G, Costa A, Geraci F, Di Bella C. Validation of a Commercial Loop-Mediated Isothermal Amplification (LAMP) Assay for the Rapid Detection of Anisakis spp. DNA in Processed Fish Products. Foods 2020; 9:E92. [PMID: 31963107 PMCID: PMC7022600 DOI: 10.3390/foods9010092] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
Parasites belonging to the Anisakis genera are organisms of interest for human health because they are responsible for the Anisakiasis zoonosis, caused by the ingestion of raw or undercooked fish. Furthermore, several authors have reported this parasite to be a relevant inducer of acute or chronic allergic diseases. In this work, a rapid commercial system based on Loop-Mediated Isothermal Amplification (LAMP) was optimised and validated for the sensitive and rapid detection of Anisakis spp. DNA in processed fish products. The specificity and sensitivity of the LAMP assay for processed fish samples experimentally infected with Anisakis spp. larvae and DNA were determined. The LAMP system proposed in this study was able to give positive amplification for all the processed fish samples artificially contaminated with Anisakis spp., giving sensitivity values equal to 100%. Specificity tests provided no amplification for the Contracaecum, Pseudoterranova, or Hysterothylacium genera and uninfected samples. The limit of detection (LOD) of the LAMP assay proposed was 102 times lower than the real-time PCR method compared. To the best of our knowledge, this is the first report regarding the application of the LAMP assay for the detection of Anisakis spp. in processed fish products. The results obtained indicate that the LAMP assay validated in this work could be a reliable, easy-to-use, and convenient tool for the rapid detection of Anisakis DNA in fish product inspection.
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Affiliation(s)
- Gaetano Cammilleri
- Istituto Zooprofilattico Sperimentale della Sicilia, via Gino Marinuzzi 3, 90129 Palermo, Italy; (V.F.); (A.C.); (F.G.); (C.D.B.)
- Dipartimento di Scienze della Vita, Università degli studi di Modena e Reggio Emilia, Via Università 4, 41121 Modena, Italy;
| | - Vincenzo Ferrantelli
- Istituto Zooprofilattico Sperimentale della Sicilia, via Gino Marinuzzi 3, 90129 Palermo, Italy; (V.F.); (A.C.); (F.G.); (C.D.B.)
| | - Andrea Pulvirenti
- Dipartimento di Scienze della Vita, Università degli studi di Modena e Reggio Emilia, Via Università 4, 41121 Modena, Italy;
| | - Chiara Drago
- Enbiotech s.r.l. Via Aquileia 34, 90144 Palermo, Italy; (C.D.); (G.S.); (G.D.R.Q.M.); (S.D.); (G.A.)
| | - Giuseppe Stampone
- Enbiotech s.r.l. Via Aquileia 34, 90144 Palermo, Italy; (C.D.); (G.S.); (G.D.R.Q.M.); (S.D.); (G.A.)
| | | | - Sandro Drago
- Enbiotech s.r.l. Via Aquileia 34, 90144 Palermo, Italy; (C.D.); (G.S.); (G.D.R.Q.M.); (S.D.); (G.A.)
| | - Giuseppe Arcoleo
- Enbiotech s.r.l. Via Aquileia 34, 90144 Palermo, Italy; (C.D.); (G.S.); (G.D.R.Q.M.); (S.D.); (G.A.)
| | - Antonella Costa
- Istituto Zooprofilattico Sperimentale della Sicilia, via Gino Marinuzzi 3, 90129 Palermo, Italy; (V.F.); (A.C.); (F.G.); (C.D.B.)
| | - Francesco Geraci
- Istituto Zooprofilattico Sperimentale della Sicilia, via Gino Marinuzzi 3, 90129 Palermo, Italy; (V.F.); (A.C.); (F.G.); (C.D.B.)
| | - Calogero Di Bella
- Istituto Zooprofilattico Sperimentale della Sicilia, via Gino Marinuzzi 3, 90129 Palermo, Italy; (V.F.); (A.C.); (F.G.); (C.D.B.)
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Cavallero S, El Sherif RA, Pizzarelli A, El Fituri A, El Showhdi M, Benmosa F, D’Amelio S. Occurrence of Anisakis and Hysterothylacium Nematodes in Atlantic Chub Mackerels from Libyan Coasts. Helminthologia 2019; 56:347-352. [PMID: 31708677 PMCID: PMC6818631 DOI: 10.2478/helm-2019-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/11/2019] [Indexed: 11/21/2022] Open
Abstract
The occurrence of zoonotic parasitic nematodes in Atlantic chub mackerels (Scomber colias syn. Scomber japonicus) from Libyan waters was investigated, using epizootiological estimations and molecular specific characterization of larvae. Nematodes belonging to Anisakis spp., the main etiological agent of anisakiasis in Mediterranean waters, and to Hysterothylacium spp. so far considered not pathogenic to humans, were detected. Prevalence values were generally high in visceral cavities (over 40 % for both parasites) while were low for Anisakis (around 1 %) and null for Hysterothylacium in muscles. Moreover, the level of infections was associated with seasons, a feature potentially useful to plan fishing captures and to elaborate risk mitigation strategies for anisakiasis. Species molecular identification performed on a subsample described the presence of Hysterothylacium aduncum as the predominant species, along with Anisakis pegreffii and the hybrids (A. pegreffii and A. simplex sensu stricto), thus posing a concrete zoonotic risk following the consumption of such fish species as a raw preparation.
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Affiliation(s)
- S. Cavallero
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - R. A. El Sherif
- Department of Quality Control and Diseases of Marine Organisms, Marine Biology Research Center, Tripoli, Libya
| | - A. Pizzarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - A.A. El Fituri
- Department of Quality Control and Diseases of Marine Organisms, Marine Biology Research Center, Tripoli, Libya
| | - M. El Showhdi
- Department of Quality Control and Diseases of Marine Organisms, Marine Biology Research Center, Tripoli, Libya
| | - F. Benmosa
- Department of Quality Control and Diseases of Marine Organisms, Marine Biology Research Center, Tripoli, Libya
| | - S. D’Amelio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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