How can I prevent and treat infections from eating sushi?

Preventing and Treating Infections from Sushi

To prevent infections from eating sushi, avoid consuming raw or undercooked seafood, particularly if you are immunocompromised, and choose commercially frozen sushi from reputable establishments, as it has better microbiological quality than fresh sushi from sushi bars. 1, 2

Risk Factors for Sushi-Related Infections

• Raw fish in sushi can harbor various pathogens including bacteria (Salmonella, Listeria monocytogenes, E. coli) and parasites
• Immunocompromised individuals (particularly those with HIV and CD4+ counts <200 cells/μL) are at higher risk of serious foodborne illness 1
• Fresh sushi from sushi bars typically has higher bacterial counts (mean 6.3 log CFU/g) compared to commercially frozen sushi from supermarkets (mean 2.7 log CFU/g) 2

Prevention Strategies

Safe Selection and Consumption

• Choose sushi from reputable establishments with proper food handling practices 3
• Commercially processed (frozen) sushi generally has better microbiological quality than freshly prepared sushi 2
• If immunocompromised:
  • Avoid raw or undercooked seafood entirely 1
  • Choose fully cooked seafood options when eating at Japanese restaurants
  • Consider vegetarian sushi options as alternatives

Food Handling Precautions

• Wash hands thoroughly before eating and after handling raw fish 1
• Ensure proper refrigeration of sushi (below 41°F/5°C) if not consuming immediately 4
• Consume sushi within a couple of days of purchasing 5
• Avoid cross-contamination between raw seafood and other foods 1

High-Risk Populations

For individuals with compromised immune systems, the CDC and Infectious Diseases Society of America recommend:

• Completely avoid raw or undercooked seafood, including sushi and sashimi 1
• Choose low-mercury seafood options (e.g., salmon, shrimp) over higher mercury varieties (e.g., fresh tuna) whether raw or cooked 5
• Cook seafood to an internal temperature of 165°F (74°C), using a food thermometer to verify 4

Treatment of Sushi-Related Infections

If you suspect a foodborne illness after consuming sushi:

1. Seek medical attention promptly if experiencing:

   • Severe abdominal pain
   • Persistent vomiting
   • Bloody diarrhea
   • Fever above 101.5°F (38.6°C)
   • Signs of dehydration (excessive thirst, dry mouth, little or no urination)

2. Diagnostic approach:

   • Stool cultures to identify specific pathogens
   • Blood cultures if systemic infection is suspected

3. Treatment options:

   • Supportive care with fluid and electrolyte replacement for most cases
   • Specific antimicrobial therapy based on identified pathogens
   • Antiparasitic medications for parasitic infections 6

Special Considerations

• Pregnant women were previously advised to avoid sushi, but improved standards and surveillance have reduced contamination risks. However, caution is still recommended 5
• Long-term consumption of raw fish may lead to accumulation of chemical contaminants that can affect health 7
• The safest approach for preventing seafood-related infections is adequate cooking, which inactivates most pathogens 5, 6

Remember that while sushi can be enjoyed safely by many people, those with compromised immune systems should exercise greater caution and consider fully cooked alternatives.