Anisakiasis outbreak by Anisakis simplex larvae associated to Peruvian food in Spain.

I have read the interesting article published in the journal that you direct, about massive infections by Anisakis simplex larvae, in two adult people with the only important epidemiological antecedent of having consumed a typical plate of Peru prepared with raw fish (1). Due to the characteristics of the cases , I want to comment some aspects with the purpose to enrich the description and thus contribute to a better epidemiological knowledge of the anisakiasis or anisakidosis behavior. It is a foodborne disease (FBD), caused by larvae L 3-in the majority of the cases – of Anisakis simplex or Pseudoterranova decipi-ens usually that cause gastrointestinal symptoms (2); however, it also may be associated with mild or severe allergic-type, reactions (3). The two cases described (1) correspond to an outbreak because they were associated in time, space and person to a common source. Until today, the only one outbreak described of this marine zoonosis occurred in France in 6 people with the antecedent of having consumed inadequately treated fresh herring (4). Also, an outbreak by Pseudoterranova larvae was reported in 3 of 4 people that consumed " cebiche " prepared with raw hake in a restaurant in Cartagena, Chile (5). Outbreaks from allergic forms have been reported associated to consumption , principally, of Merluccius merluccius " Hake " and En-graulis encrasicholus " Anchoy " in Spain (3). In the summer of 2002, in Lima, Peru, 5 members of a family were reported for presenting acute diarrheal disease (ADD). They had the epidemiologic antecedent of having consumed " cebiche " prepared with raw " perico " Coryphaena hippurus and the clinical sign and symptoms they presented (abdominal pain, nausea and diarrhea) were compatible with acute gastric anisakiasis. It is possible that it was an outbreak of anisakiasis in family members by A. physeteris larvae (unpublished data), unfortunately the cases were lost in follow up and it was not possible to verify the outbreak. The " perico " was one of the fish species intensely parasitized by A. physe-teris larvae along the Peruvian coast during " El Niño " phenomenon in 1997-1998, which could cause the anisakiasis emergence (6). In a FBD outbreak it is indispensable to identify the source of contamination, the mechanisms of transmission, the source and exposure place, and the etiologic agent, which is key information to search for other related cases and to implement control and prevention measures. It …