Concerns About Parasite Infection After Eating Raw Fish Delivery

Sashimi rice bowl delivered on a hot summer day?

Hello Doctor, due to my internship, I am currently in Shanghai.
On May 17, 2024, during a hot day, I had delivery of chopped sashimi, which included fresh Norwegian salmon, Arctic sweet shrimp, and Arctic surf clams.
In the afternoon, I began experiencing abdominal pain and frequent urges to use the restroom, with my stool being somewhat green (loose).
The next day, I had intermittent cramping in my stomach, no appetite, and sharp pains in my abdomen.
After researching online, I became very worried about a possible parasitic infection, so I went to the emergency room.
The emergency doctor examined my abdomen and lower back but found no significant pain.
They also performed a blood test, ruling out acute gastroenteritis.
The doctor believed the likelihood of a parasitic infection was low and suggested it was more likely a bacterial infection due to the hot weather and potential bacterial growth during the delivery process.

Here are the abnormal parts of my complete blood count report:
- Eosinophils: 0.1
- Absolute eosinophil count: 0.01
All other values were within the normal range, with only these two values being below the reference range.
The doctor considered my condition to be general gastrointestinal discomfort, but I still have some concerns.

Could you please tell me how long the incubation period would be if there were parasites in my body? Would symptoms disappear due to taking gastrointestinal medication? Or could there be a period where symptoms disappear but parasites still remain in the body? Is there anything specific I should pay attention to? The emergency doctor suggested that if I am really worried, I could either monitor my condition or visit an outpatient clinic for further examination, but they were uncertain about the accuracy of the tests.
I have read many claims online that tests may not detect parasites.
I tend to be an anxious person and feel like there are bugs crawling inside me.
If there are indeed parasites in my body, would it be noticeable in my stool? What symptoms would require immediate medical attention?
Thank you, doctor, and I apologize for asking so many questions, but I am really worried.
I appreciate your help.
Best regards.

Xiao Xin, 20~29 year old female. Ask Date: 2024/05/19

Dr. Lin Wufu reply Internal Medicine

Hello, leaving raw food at higher temperatures significantly increases the risk of bacterial growth, which can lead to gastroenteritis.
In contrast, the relationship between parasites and temperature is minimal (if food contains parasites, they do not proliferate within the food).
Common parasites found in sashimi cannot reproduce in the human body, so even if ingested once, the impact is minimal.
It is recommended to seek evaluation from a gastroenterologist or infectious disease specialist only if gastrointestinal symptoms persist for a week or two.

Reply Date: 2024/05/19

More Info

Eating raw fish can indeed raise concerns about potential parasite infections, especially when the fish is not sourced from reputable suppliers or when it is not handled properly. In your case, you consumed raw fish during a hot day, which can increase the risk of bacterial growth rather than parasitic infections. The symptoms you experienced, such as abdominal pain and changes in bowel movements, could be attributed to a variety of factors, including foodborne illnesses caused by bacteria rather than parasites.

Understanding Parasite Infections
Parasites such as Anisakis (a common parasite found in fish) can be a concern when consuming raw or undercooked fish. However, the likelihood of contracting a parasitic infection from a single meal of raw fish is relatively low, especially if the fish was frozen prior to consumption, as freezing can kill many parasites. The symptoms of parasitic infections can vary widely, but they often include gastrointestinal distress, nausea, vomiting, and diarrhea.
The incubation period for parasitic infections can vary depending on the type of parasite. For example, Anisakis typically causes symptoms within hours to a few days after ingestion, while other parasites may take longer to manifest. If you are experiencing symptoms shortly after eating, it is more likely related to bacterial contamination rather than a parasitic infection.

Symptoms and Self-Monitoring
You mentioned experiencing abdominal pain and changes in your bowel habits. It is important to differentiate between mild discomfort and severe symptoms. Mild abdominal pain, especially if it is not persistent or accompanied by fever, vomiting, or severe diarrhea, may not be a cause for alarm. However, if you experience:
- Severe abdominal pain: This could indicate a more serious condition and warrants immediate medical attention.

- Fever: A temperature above 100.4°F (38°C) could suggest an infection.

- Persistent vomiting or diarrhea: If you are unable to keep fluids down or if diarrhea persists for more than a couple of days, seek medical care.

Medical Evaluation and Testing
If you are still concerned about the possibility of a parasitic infection, it is advisable to consult with a healthcare provider. They may recommend stool tests to check for the presence of parasites. However, it is important to note that not all parasites are easily detectable through standard testing, and sometimes multiple tests may be necessary.

Treatment and Recovery
If you do have a parasitic infection, treatment typically involves antiparasitic medications. If your symptoms are due to a bacterial infection, antibiotics may be required. In many cases, gastrointestinal symptoms can improve with supportive care, including hydration and rest.

Conclusion
While your concerns about parasites are understandable, it is crucial to focus on the symptoms you are experiencing and monitor them closely. If your symptoms persist or worsen, do not hesitate to seek medical attention. Remember that food safety practices, such as ensuring that fish is sourced from reputable suppliers and properly handled, can significantly reduce the risk of foodborne illnesses. In the meantime, try to stay calm and observe your symptoms, as anxiety can often exacerbate gastrointestinal discomfort.

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