Disease Transmitted from fish to human

ICTHYOZOONOSES

Dr. Kedar Karki

M.V.St. Preventive Medicine/Public Health
Introduction:
Zoonoses are diseases and infections that are naturally transmitted
between vertebrate animals and man. These are of great public
health importance in all developing countries including India. The
subject of zoonoses in taught in all veterinary and medical colleges,
at under graduate and postgraduate levels, and is not included in
the curriculum of fisheries sciences, inspite of several fish borne
diseases communicable to man. There is need for creating
awareness among the fisheries students, fish farmers and general
public about the fish borne diseases communicable to man.

Utilization of natural water resources has increased considerably for the

cultivation of aquatic livestock- particularly fish and shrimps. In addition several
artificial ponds have been dug for the extensive and intensive fish farming in
Nepal. Under these changing situations fish borne zoonoses -Ithyozoonoses are
likely to emerge as problems both for the producer and consumer. The fish
farmer looses money by way of rejection of the produce resulting in economic
loss. The consumer suffers from ill health due to the consumption of food
containing zoonotic agents. Therefore there is an urgent need for familiarizing,
the concerned persons about the Icthyozoonoses. In order to create the
awareness among the fish producers and concerned with aquatic livestock.
Icthyozoonoses as well as the unfamiliar and recently recognized fish borne
maladies.

In view of the ecological conditions prevailing the prevalence of Ichthyo-

zoonosis is expected to be in greater dimension than realized.

PARASITIC ZOONOSES

Several parasites found in fish can infect humans as nontraditional hosts. The
mode of entry into humans is by ingestion of raw or undercooked infected fish.
Proper cooking or freezing prevents transmission of ingested human pathogenic
parasites. Some parasites are found only in tropical regions. The prevalence and
importance of parasitic infections vary markedly depend on local risk factors
and conditions.

1. DIPHYLOBOTHRIOSIS

Diphyllobothrium latum: lives in the small intestine of man and produces gastro-
intestinal disturbances and anemia. The eggs are operculated and are liberated
through feces in water. The eggs develop into a coracidium and are ingested by
cyclops. . In the intestine of the Cyclops the coracidium develops into a
procercoid. Fresh water fish ingests the cyclops possessing procercoid. The
procercoid changes into pleurocercoid. This is also called as sparganum. Man
gets infection by ingestion of insufficiently cooked fish containing
pleurocercoid. Thus the life cycle is completed. Salting, pickling or smoking
does not destroy pleurocercoid and therefore remain infective to man.
Laboratory diagnosis consists of microscopic examination of the patient's stool
to demonstrate characteristic operculted eggs. Fish should not be consumed
with out through cooking.

2. ANISAKIASIS

One of the most important nematode diseases of humans acquired from fish is
anisakiasis or anisakidosis. Anisakis simplex is the most frequently associated
Contracaecum osculatum species. Followed by Pseudoteranova dicipens has
rarely been reported. This disease is caused by the larval stages of worms.
These worms are natural parasites of whales, dolphins, porpoises, seals, sea
lions, herring, cod, mackerel, salmon, squid, halibut, flatfish, etc. Major source
of infection is traditional preparations such as raw herring, lomi lomi salmon,
ceviche, sushi and sashimi. In man symptoms include abdominal pain, fever,
nausea, vomiting, etc. Clinical diagnosis is based on the history of consumption
of raw semi raw smoked inadequately cooked fish eisonophilia and leucocytosis
are also seen on blood examination. Larvae can be demonstrated in the affected
tissues. Serological tests may be of some value in the diagnosis. Endoscopic
removal of the larvae from the stomach of the patients with four to six hours of
ingestion may give relief. Surgical resection of the damaged wall can be
resorted to. Control consists of evisceration of fish immediately after catch
freezing the fish at -20 degrees Celsius. Avoiding consumption raw under cooked
smoked or mildly salted fish will go a long way in the prevention of anisakiasis.

3. DIOCTOPHYMIASIS

Dioctophyma renalae is a very large nematode producing renal colic hematuria,

pyuria, and retention of urine due to the presence of parasite in the urinary
system. Infection occurs by consumption of raw uncooked fresh water fish
crayfish or crustacean containing infective larvae of the nematode. Microscopic
examination of the urine for the presence of eggs of D.renalae confirms the
clinical diagnosis. Surgical removal of the affected kidney is the only treatment.
If both kidneys are infected the prognosis is grave.

Besides health education of fish eating people thorough cooking of the fish
should be ensured.

4. TREMATODE INFECTIONS

Thirty-three species of digenetic trematodes have been listed as transmissible

to man through consumption of fish, crustacea or molluscs. Among these
members of Heterophydiae family are significant. There are very small
trematodes that inhabit the intestine of birds and mammals. The infective stage
(metacercaria) can be found in a wide variety of fish. These parasites acquired
by eating raw marinated or improperly cooked fish are frequently reported from
human infections. Accumulation of large numbers of these parasites in the small
intestine may cause inflammation, ulceration and necrosis. These trematodes
are represented by the following species Heterophyes heterophyes, Paragonimus
werstermonia, Metagonimus yokogawai, Clonorchis sinensis, Opisthorchis
sps.,etc. The pathology caused by these parasites is similar and the risk
cholangio- carcinoma (gall bladder cancer) may be high in chronic cases.

Nanophyetes salmoncola is a trematode parasite in the intestine of dogs and

many wide piscivorous mammals. The disease however does not arise directly
from the trematode but instead is due to a rickettsial hyperparasite
"Neorickettsia helmonthoeca" which is pathogenic for dogs. Humans infected
with this fluke do not develop salmon poisoning. The presence of large number
of parasites can cause gastroenteritis popularly called as salmon poisoning.

Acanthocephalans or spiny-headed worms have been reported from humans. The

adults of Chorinosoma stromosum are found in the stomach of pinnepids
(sealions). The tiny crustacean intermediate hosts and fish, which eat the fish,
are sources of infections.

BACTERIAL ZOONOSES

1. SALMONELLOSIS:

Salmonellosis is a disease caused by any of the 2000 serotypes present in the

man, animals, birds and fishes. The symptoms may be septicemia as in typhoid
or bowel disturbances as in the case of infection due to Salmonella species.
Sudden on set of abdominal pain, diarrhea, nausea, vomiting, fever, anorexia
may be conspicuous. The disease is normally diagnosed in man and animals by
bacterial examination of the blood, stool, urine etc. Fish grown in dirty waters
may be a source of infection. Quinolins and other antibiotics along with
supportive treatment are necessary to treat the affected patient. Hygienic
production of fish in the processing plants is necessary to prevent human
epidemics.

2. ERYSIPELOSIS

Erysipelothrix insidiosa (rheusiopathiae)is a slender rod shaped, non sporing, non

motile, pleomorphic gram positive bacteria. Infection with this bacteria causes,
itching, tingling and burning sensation at the site of inoculation /penetration of
the organism in the thumb, forefinger and wrist. Erythyma, edema, artharlgia,
lymphangitis, septicemia, endocarditis, anemia, and meningitis may be seen.
This is an occupational hazard of the fishermen, anglers and workers in the fish
processing plants. This bacterium is also amenable to antibiotic treatment if
initiated early. Isolating the organism from the wound or other appropriate
specimen makes diagnosis.

3. LISTERIOSIS

Listeria monocytogenes is a non capsulated, non sporing, pleomorphic, gram

positive, rod shaped bacteria may also live a saprophyte in soil also and also
infects wide range of animals and fishes and produces diseases in man. After an
incubation period of 4 to 21 days the infected persons exhibits symptoms. It
occurs in different forms. Septicemia, abortion, meningitis, glandular
granulomatosis, conjunctivitis, papuler exanthema, pneumonia, urethritis
endocarditis, hydrocephalus the usual manifestations. Tetracyclins, Ampicillins
are the drugs of choice for the treatment of the affected patient.

4.TULARAEMIA

Francisella tularensis is a small gram-negative non-sporulating, non-capsulated

non-motile aerobic, rod shaped organism producing chills and fever with sudden
onset. Erythymatous papulae, pustule, ulcer, regional lymphangitis, malaise,
anorexia, head ache, nausea, gastro enteritis and broncho-pneumonia re also
common. Laboratory diagnosis is based isolation and identification of the
organism. Skin test gives positive result during the first week of the disease.
Immunization of the high-risk groups and providing protective wears to the
occupationally exposed persons constitute the control measures.

TOXINS IN FISH AND SHELLFISH

1. Scombroid (Histamine) Poisioning

A laboratory in Canada first confirmed histamine poisoning in 75. Most in

subsequently mahi-mahi or dolphin [Coryphaena hippurus] and marlin [Makaira
spp.] are also implicated. Histamine levels of between 28 mg and 710 mg / 100
g were demonstrated. Symptoms of Scombroid poisoning are gastro-intestinal
and neurological in nature. Histamine production is maximum at or near 30
degrees Celsius. Cooking has no impact on the toxin.

2. Ciguatera Poisioning:

Ciguatera is a clinical syndrome characterized by the gastro-intestinal and

neurological disorders. Ciguatera usually results from consumption of tropical
reef fish or higher carnivores. Several benthic dinoflagellates are associated
with a range of ciguatoxins. The epiphytic Gambierdiscus toxicus may be the
main source of toxins other dinoflagellates thought to be responsible for
ciguatera include Amphidinum carteri, A.klebsi, Coolia monotis, Ostropcis ovata,
O.siamensis, Prorocentrum concavum, P.lima and P.rhathymum. The principle
toxins produced are ciguatoxin, scaritoxin, maiotoxin and palitoxin. Ciguatera
related toxins are bio-accumulated. Higher carnivores consume herbivorous fish
that feed on toxin benthic algae. The level of toxins in fish increases further up
in the food chain. It is believed that disturbances to reeves during hurricanes
and human recreations will result in the development of endemic (niche) for
toxic algae.

3. Paralytic shellfish poisoning

Paralytic shellfish poisoning (PSP) is a serious illness which leads to neurological

symptoms including paralysis terminating some times in fatality.

Dinoflagellates produce 20 derivatives of saxitoxin and accumulated in shellfish

especially mussels, cockles, clams, and scallops. Saxitoxins are potent algal
toxins. Alexandrium tamarensis and A.catinela have been implicated in PSP. The
Cynobacterium Anabaena circinalis isloated from freshwater mussels produces 2
type to Saxitoxins, C-toxins, and gonyautoxins. Generally PSP is heat stable and
outbreaks have occurred from consumption of cooked shellfish.

4. Puffer fish poisoning

Pufferfish poisoning (PFP) results in similar symptoms like PSP. Illness results
from consumption of fish from Tetradontidae family including Pufferfish. The
source is not considered to be diatoms or dinoflagellates. Bacteria implicated
thus far include Listonella pelagia, Alteromonas sps. and Shewanella sps.

5. Neurotoxic shellfish poisoning:

Neurotoxic shellfish poisoning (NSP) causes symptoms of numbness, gastro-

intestinal disturbances, and muscular aches in man. NSP is caused by a
concentration of a red tide dinoflagellate Gymnodium breve and its toxin
(Brevitoxin) in shellfish.

6. Diarrhetic shellfish poisoning:

Diarrhetic shellfish poisoning (DSP) causes gastrointestinal disturbances with

abdominal cramps. DSP is the result of vocadic acid production by
dinoflagellates concentrated in mussel, oyster, and scallop tissues. The algal sps
associated are Dinophysis fortii and D.accuminita, Prorocentrum sps is another
potential DSP dinoflagellate.

7. Amnestic shellfish poisoning:

Amnestic shellfish poisoning (ASP) results in gastro-intestinal and neurological

symptoms, particularly memory loss. Symptoms often occur in elderly and
resemble Alzheimer's disease. Nitzshia pungens was identified as producer of
domoic acid that is responsible for an outbreak of ASP. Pseudonitzchia sps. also
produce domoic acid.

8. Tetramine poisoning:
Tetramine poisoning caused blurred vision, light-headedness, staggering,
flushing, and weakness. Tetramine in 1.3 mg/g of whelk soft tissue Neptunea
decemcostata whelks are large and are usually collecting during scallop
-trawling. N.despecta tornata, Buccianium sps, Fusitriton sps are known to have
caused severe headaches dizziness and abdominal cramps as a result of the
presence of Tetramine (tetramethyl ammonium ion). In the salivary glands and a
lesser concentration in other organs.

Boiling whelks for 1 hour will not destroy but removal of salivary glands is
supposed to render the whelks edible.

9. Undetermined seafood toxin illness:

Several illnesses have also been documented from other undetermined seafood
toxins. Normally the symptoms are mild gastro-enteritis and sometimes burning
peppery sensation in the mouth. Certain amines or other spoilage compounds
are thought to be responsible for the fish-poisoning episodes.

PREVENTION AND CONTROL

Susceptible populations are those with underlying disease, diabetics, with

impaired liver function, convalescents, cancer patients, HIV sero reactors.
Indicator bacteria are inadequate to predict the prevalence of these infections
and illnesses in the environment. Small round viruses [SRVS] are an emerging
concern. Attention is now devoted to aquaculture product safety through
Government programs, industry initiatives and new international standards such
as "code of hygienic practice for the products of aquaculture". Hazard analyses
and critical control point [HACCP] and good management practices [GMP} are
very important. Aquatic foods are not only perishable but also act as ideal
substrates for pathogens. Production and processing profiles have to be very
strictly followed. Greater awareness among the public health personal about
these rare diseases, by conducting periodical seminars, training programs and
other communication methods. Creation of laboratory facilities for the rapid
identification of these illnesses. Development of machinery for the monitoring,
investigation and control of the episodes. Educating the population at risk,
about the prevalence of these maladies in the area will go a long way in
preventing the Ithyo-zoonoses.