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Trichinosis patients may develop peri-orbital oedema, conjunctival haemorrhages, splinter haemorrhages of the fingernails, and nonspecific skin rashes. Here, we describe an unusual hand rash noted in several patients enrolled in a treatment study for trichinosis.
Three patients fell ill with diarrhoea 14 to 15 days after eating smoked ham. All had an increased white cell count (up to 16,200 microliters), eosinophilia (14 to 38%) and increased creatinkinase activity (357 up to 1905 U/l). Patient 1 (a 21-year-old woman) also had fever of around 40 degrees C; patient 2 (32-year-old woman) had a fever up to 39 degrees C, with muscle pains and swellings in the face. Patient 3 (38-year-old man) had no other symptoms. Because of eosinophilia and as five other family members in former Yugoslavia whence the ham had been imported, also had had fevers, trichinosis was soon considered as the cause. Serology in patients 1 and 2 was positive on admission, in patient 3 after one week. Mebendazole was administered, initially 50 mg/kg in three doses for 2 days. Drug blood levels were determined 1 and 4 hours after start of treatment and the dosage was then increased to 80-100 mg/kg daily. Duration of treatment ranged from 11 to 14 days. All patients were discharged symptom-free and there have been no sequelae. In Germany trichinosis typically occurs in small outbreaks. It is assuming increasing importance as an imported disease.
The opportunity offered by a recent outbreak of trichinosis in Lebannon was utilized to evaluate the applicability of an indirect fluorescent antibody (IFA) test for early diagnosis. Freeze-dried T. spiralis sonicated larval antigen fragments were used, together with human test serum and monospecific anti-human IgG, IgM and IgA fluorescein conjugates. Diagnostic IgG levels of 1/100 and above were observed in serum obtained some time during the acute phase of illness from nine out of ten patients. Diagnosis was made in seven cases within 30 days after the onset of symptoms. IgM antibodies were demonstrated in occasional samples. No IgA antibodies were detected. IgG levels of 1/100 were present in only four out of ten samples obtained 150 days after the clinical onset. These observations suggest that freeze-dried larval antigens make the IFA test an easy and useful procedure in the diagnosis of acute trichinosis. In chronic cases the efficacy of the method appears to be poor.
An outbreak of trichinosis occurred in the city of Zhengzhou, central China, between December 1995 and February 1996, affecting 85 of the administrative units into which the city is split. Of 297 subjects from eight of the affected units, 54% were seropositive for Trichinella and 41% had symptoms consistent with acute trichinosis. Of the 490 subjects who had eaten at one particular dumpling restaurant 1-5 weeks before the outbreak and who were traced, 291 (59%) were seropositive and 212 (43%) had been or were ill. MOst of the infections were in manual workers, cadres and merchants aged 20-49 years. Most of those who had been infected failed to develop gastro-intestinal symptoms or a cutaneous rash. Eyelid oedema was only seen in the early stages of the infection, the main clinical manifestations being fever of long duration of tiredness. Surprisingly, six cases had no marked symptoms after repeated infection. Eosinophilia (eosinophils > 7% of leucocytes) was noted in 71 (55%) of the 130 cases in which blood cells were counted. When 212 sera were tested for antibodies to Trichinella, seropositivities were found to increase from 89.1% (IFAT) of 87.7% (microprecipitation test) at presentation to 100% (both tests) 1 week after treatment with albendazole. All those treated were cured. The outbreak was one of the most extensive, single-source outbreaks ever recorded in China, probably with > 600 infections and > 300 clinical cases. The entire episode was attributed to the ingestion of undercooked pork dumplings at one restaurant.
There is no consensus on the benefits of treatment with any specific anthelminthic compound on muscle-stage trichinosis. A double-blind, placebo-controlled comparison was done of 3 antiparasitic drugs during an outbreak of trichinosis in Chiangrai Province, northern Thailand. Forty-six adults were randomized to receive 10 days of oral treatment with mebendazole (200 mg twice a day), thiabendazole (25 mg/kg twice a day), fluconazole (400 mg initially, then 200 mg daily), or placebo. All patients received treatment to eradicate adult intestinal worms. Trichinella spiralis infection was proved parasitologically in 19 (41%) of 46 patient and by serodiagnosis in all cases. Significantly more patients improved after treatment with mebendazole (12/12) and thiabendazole (7/7) than after treatment with placebo (6/12; P<.05) or fluconazole (6/12). Muscle tenderness resolved in more patients treated with thiabendazole and mebendazole than in those treated with placebo (P<.05). However, 30% of volunteers could not tolerate the side effects of thiabendazole. In summary, Trichinella myositis responds to thiabendazole and to mebendazole.
An outbreak of trichinosis caused by ingestion of horse meat occurred in December 1993 in France; more than 500 people were affected. We compared the immediate and midterm efficacy and tolerability of thiabendazole and albendazole as therapy for the 46 patients seen in our department. Forty-four patients (96%) were treated. The first 26 patients received thiabendazole therapy; the next 18 received albendazole therapy. All the patients were tested with prednisone. Eight relapses occurred (seven in the thiabendazole group and one in the albendazole group [not significant]). Side effects of treatment were reported by seven patients, all of whom were treated with thiabendazole (P = .01). Six months after treatment, 16 of the 31 patients who responded to a questionnaire still had symptoms, the most frequent of which were myalgias (81%) and fatigue (69%). No significant difference was observed between the two treatment groups. The immediate efficacy of thiabendazole and albendazole as therapy for trichinosis was comparable, but albendazole was better tolerated.
The arctic form of Trichinella spiralis that infects terrestrial and marine mammals is of importance in public health because persons living in arctic regions still depend on wild animals for economic subsistence. In 1975, an extended common-source epidemic of trichinosis attributed to consumption of walrus meat involved 29 persons in Barrow, Alaska. Of those persons eating this meat, 64% became ill, and the rate of infection of persons eating meat prepared with little or no cooking was four times as great as that of persons eating cooked meat. One year later a second outbreak occurred when a family ate partially cooked meat from an infected walrus. Clinical illness differed little from the disease acquired in temperature climates; however, only 70% had a positive bentonite flocculation titer, whereas 96% had eosinophilia. These epidemics of trichinosis are the first reported in Alaska to be associated with the consumption of walrus meat.
Trichinosis is a serious but understudied medical problem in the Arctic. Forty-nine consecutive cases in the Inuit population of northeastern Canada are described. Most developed the disease after eating raw walrus, and the clinical presentation of most of these cases differed from previously reported descriptions of classic trichinosis due to Trichinella spiralis. Unlike the classic syndrome of a brief period of diarrhea followed by fever, myalgia, muscle weakness, and edema, the most common presentation in these cases was a prolonged diarrhea without fever and with brief muscle symptoms. High peripheral eosinophilia, high Trichinella antibody serotiters, and little direct or indirect evidence of muscle invasion in many of those with the chronic diarrheal presentation suggest a new clinical syndrome due to a different species of Trichinella seen in the Arctic or to reinfection with Trichinella.
Two outbreaks of trichinosis occurred in France in August and October of 1985 and 1,073 cases in all were identified. In the first outbreak, two localities were involved: the town of Melun and the 14th district of Paris. To determine the origin of the contamination, three case-control studies were carried out: among patients' families, among the populations of these two areas, and among the inmates in the prison of Melun. In the second outbreak, cases again occurred in Paris but in a different district (the 12th), in the city's suburbs, and in other towns scattered throughout France. Although no parasites were found in any of the meat examined in either outbreak, results of the study indicate that infection was due to horsemeat consumption and led to the incrimination of two carcasses, one imported from a slaughterhouse in the United States and the other from West Germany. These findings led the French Ministry of Agriculture to order the inspection for trichinosis of all meat from horses slaughtered both in France and in countries exporting horsemeat to France.
Myocarditis and neurological disorders are the most serious complication of human infestation by Trichinella spiralis. On occasion, the unawareness of clinical manifestations, the form of presentation and the association of uncustomary neurological symptoms impedes the diagnosis of trichinosis. We report a case of trichinosis with peripheral facial diplegia, meningeal disorder and EKG alteration, with no prior intestinal symptomology. Treatment with thiabendazole and steroids resulted in a very favorable clinical evolution.
Trichinosis is a worldwide zoonotic disease closely related to cultural and dietary habits caused by a nematode Trichinella spp. Human infection is acquired through ingestion of undercooked meat containing infective encysted larvae. There are two cycles of transmission, one domestic and the other wild. A complete life cycle develops in a single host harboring adult worms in the small intestine, from which newborn larvae migrate and finally encyst in striated muscle. Traumatic and immunological alterations are responsible for the main clinical features, including diarrhea, febrile syndrome, myalgias, oculopalpebral signs and eosinophilia. Cardiovascular, lung and CNS involvement characterize severe trichinosis. CNS inflammatory infiltration and damage may result from larval migration and vascular obstruction, or from the effect of toxic parasite antigens, or eosinophil infiltration. Humoral and cellular immune host response are relevant both to protect against re-infection and for immunodiagnosis. DNA probes and PCR technology may help to identify Trichinella spp. Muscle biopsy may disclose T spiralis larvae coiled within a muscle fibre host nurse cell surrounded by a capsule. Inflammatory infiltration includes monocytes, plasma cells, eosinophils and T lymphocytes mainly of the suppressor/cytotoxic phenotype. Histological appearance and histochemical profile of the host nurse cell differ from that of striated muscle fibre and are partly indicative of regeneration. Our own histological and histochemical findings in experimental studies of infected mouse muscle support the concept that changes induced by the larva encysting within a single host skeletal muscle fibre which becomes a nurse cell are unique of Trichinella infection. Interestingly, no dystrophin could be detected within the host nurse cell-capsule interface. It has been advanced that larva-induced host muscle fibre changes may be regulated at muscle gene transcription level whilst host regulatory pathways governed by cell cycle phase may also contribute to larval development.
A localised outbreak of trichinosis occurred in January 1976 in the southern suburbs of Paris. A total fo 125 cases was recorded including 30 children. The prominent symptoms were oedema of the face or eyelids, fever, and myalgia; diarrhoea was unusual and constipation common. An increased blood eosinophil count and raised serum concentrations of muscular enzymes strongly indicated trichinosis. This diagnosis was confirmed later immunologically. The parasite was found in only three out of 32 muscle biopsy specimens but this investigation was made relatively early in the disease. No deaths occurred. In all cases clinical recovery was fast and serum antibody titres were maximum during the first month and decreased slowly. The disease was milder and the recovery faster in children than adults. Epidemiological study suggested that horse meat was responsible for the infection, though no meat could be examined.
Acute trichinosis can be followed by a chronic stage. Myalgia is the main clinical symptom in the chronic course of the disease. From 19 patients with a history of acute trichinosis 2-42 years ago, 15 patients suffered from chronic myalgia. Other typical complaints of our patients in the chronic stage were opthalmodynia, burning of the eyes, headache and early fatigability.
Changes in enzyme activity in human trichinosis have been studied. The activities of 19 enzymes and some isoenzymes were investigated in 12 patients from the 3rd to the 20th week. The activities of muscle-specific enzymes (CK, ALD and MK) were greatly increased with peaks during the 4th week; activities returned to normal ranges during the 7th and 8th weeks. Liver-specific enzymes (GTP, OCT, guanase, GLDH, SDH and MDH) and AP, ChE, cerulosplasmin remained within normal limits in all patients with the exception of a child who died. An explanation of the origin of hyperenzymemia is proposed on the basis of these investigations. The data obtained support the proposition that hyperenzymemia is of muscular origin and that the liver is seldom affected in case of trichinosis.
A case of wildlife trichinosis was found in a red fox (Vulpes vulpes japonica) captured at Rokkasho, Aomori Prefecture on November 27, 1998. Trichinella larvae were obtained from almost all of the muscle tissues except for the masseter. The highest number of larvae per gram of tissue was found in the muscles of the gluteal region and throat. The lowest number was found in the diaphragm and tongue. Trichina cysts within the muscle fibers had groups of fatty cells at the poles, and minimal tissue reaction was observed around the cyst. No calcification was found in the cyst. These morphological findings suggested that the considerable time had elapsed since the invasion. This is the first case of trichinosis in a red fox in Japan.
Twenty-three of 50 members of an extended Dutch-German family and their close friends who ate raw homemade summer sausage became ill with trichinosis; 12 patients were hospitalized for an average of 10 days each. The sausage had been made in three different batches according to an old family recipe. One of the batches made from USDA-inspected pork was found to contain Trichinella spiralis larvae by two Illinois State laboratories. The other two batches were negative. Seventeen of the 23 patients submitted information on medical expenses incurred and wages lost because of the outbreak. These costs totaled almost $20,000. There is need for a nationwide program for controlling trichinosis in swine.
In 1974, at least 13 persons acquired trichinosis aboard a luxury liner en route to Alaska. Epidemiologic investigation implicated ground beef served on the ship as the vehicle of transmission. The beef is thought to have been contaminated by pork which had previously been frozen, though presumably not under trichinacidal conditions. To our knowledge, this is the first report of trichinosis acquired at sea.
A recent trichinosis epidemy involved around hundred patients in southern Paris suburbs; most frequent and marked clinical features were: facial and palpebral oedema, fever, bowel troubles (mostly constipation; diarrhea was seldom) and muscular tenderness. Most of the time eosinophiles cells and muscular enzymes were markedly raised. Trichinosis was proved by serological changes, with some delay. One muscular biopsy was found positive. Therapy consisted either in Thiabendazole (manufacturer's name: Mintezol) sometimes associated with prednisolone, or fluoromebendazole. There was no lethality.