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FDA's Bad Bug Book

Nanophyetus salmincola or N. schikhobalowi are the names, respectively, of the North American and Russian troglotrematoid trematodes (or flukes). These are parasitic flatworms. Knowledge of nanophyetiasis is limited. The first reported cases are characterized by an increase of bowel movements or diarrhea, usually accompanied by increased numbers of circulating eosinophils, abdominal discomfort and nausea. A few patients reported weight loss and fatigue, and some were asymptomatic.

There have been no reported outbreaks of nanophyetiasis in North America; the only scientific reports are of 20 individual cases referred to in one Oregon clinic. A report in the popular press indicates that the frequency is significantly higher. It is significant that two cases occurred in New Orleans well outside the endemic area. In Russia's endemic area the infection rate is reported to be greater than 90% and the size of the endemic area is growing.

Nanophyetiasis is transmitted by the larval stage (metacercaria) of a worm that encysts in the flesh of freshwater fishes. In anadromous fish, the parasite's cysts can survive the period spent at sea. Although the metacercaria encysts in many species of fish, North American cases were all associated with salmonids. Raw, underprocessed, and smoked salmon and steelhead were implicated in the cases to date.