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A 61-year-old male patient who contracted an acute trichinosis infection 39 years ago presented himself with swellings of the floor of the mouth, the tongue and the cheeks. Histological examination of two surgical specimens showed florid trichinosis. No malignant tumor was detectable. We had no indication of a new infection. Mebendazol (= Vermox), Thiabendazol (= Minzolum) and Prednison were used for management.
We have studied 11 cases of acute human trichinosis; five of these patients were treated with thiabendazole. We have reviewed the laboratory data for these patients and described their course. This study has failed to show any definite effect of thiabendazole on the course of human trichinosis at the doses used. However, thiabendazole may have decreased the infectivity of the larvae which were embedded in the muscles of our patients.
An outbreak of trichinosis in two villages in southern Lebanon affected over 100 patients, aged 3 to 70 years, who celebrated Christmas and New Year's of 1981 by feasting on rare pork. Six were hospitalized in Israel. The diagnosis was made on clinical and histological grounds. The clinical picture included the classical features, but was unusual in that rarely reported pedal or pretibial edema, pruritus and vertigo, were prominent. There was one case with suspected myocarditis. Two women in the first trimester of pregnancy had miscarriages. All patients recovered. With the unstable political situation in Lebanon in recent years, veterinary and sanitary supervision has deteriorated, and most pigpens are infected with trichinosis.
A case of trichinosis involving the cental nervous system is presented. The neurological symptoms developed 20 days after ingestion of the larvae and 3 days after the onset of facial oedema. They consisted of behavioural disorders, tetraparesis, incontinence and oculomotor paralysis. All symptoms progressively regressed. Computed tomography showed transient low-density areas in the white matter. The main manifestations and the physiopathological mechanisms (transport of the parasite through the bloodstream, immuno-allergic reaction) of cerebral trichinosis are discussed.
A. A comparative study of a simplified radioimmunoassay (RIA) technique with the indirect haemagglutination (IHA) test in the diagnosis of 72 patients with hydatid disease indicated the greater sensitivity of the former. Both methods had an equal specificity in 60 control patients. RIA will serve as a useful addition to tests already available in hydatid serology. B. A comparison of the (RIA) technique with fluorescent antibody test (FAT) in the diagnosis of 33 patients with early, active trichinosis and 30 healthy controls indicated an equal sensitivity and specificity of both methods. The adoption of RIA as an easier method is recommended. This study of a simplified radioimmunoassay technique for the diagnosis of hydatid disease and trichinosis in man is presented in two sections.
We report a case of trichinosis presenting with a subacute persistent diarrhea and neurologic complications. Gastrointestinal endoscopic as well as digestive and neurologic radiologic signs were observed. The mainstay of treatment was glucocorticoids associated with thiabendazole. The patient responded well to this regimen. A literature review to explain the gastrointestinal and neurological manifestations of trichinosis as well as their management was done.
A case of human trichinosis is reported. This is the first case of human trichinosis being reported in India.
The investigation of a trichinosis outbreak in Auvergne, France identified 23 cases in 12 households living in two cities-Clermont-Ferrand and Montluçon-between 15 February and 7 March 1991. One patient required intensive care, 15 had major symptoms, and seven had minor or no symptoms. Two case control studies demonstrated a significant (p < 0.01) association between eating horse meat and acute trichinosis. Veterinary services found that three supermarkets where the patients had bought horse meat during the suspected period had been supplied by a single wholesaler. The analysis of the wholesaler's records revealed that the implicated horse meat had been imported from a slaughterhouse in the United States. This outbreak occurred despite a requirement in France for all meat from horses slaughtered in France and in countries exporting meat to France to be examined systematically for trichinella.
Seven outbreaks of trichinosis occurred in Zhengzhou (central China) from 1992 to 1996, 250 patients were diagnosed. Trichinella larvae were found in 3 of 4 portions of the pork examined and in 5 of 7 cases by muscle biopsy. There was a higher occurrence of outbreaks in winter. Young and middle-aged workers, cadres and merchants were the majority of patients, (higher in males than in females). The most important clinical manifestations were fever, eyelid edema, tiredness and eosinophilia without any gastrointestinal symptoms, rash and with less myalgia. Anti-Trichinella antibodies were detected by IF in 62.6% individuals with the history of infection. The specific antibodies were only observed in 78% patients one week after onset of disease, while the antibody positive rate was increased to 92.5%, 97.6% and 100% two, three, four and five weeks after the onset and evidently increased from 89.6% before therapy to 100% one week after therapy, and decreased to 74.6% and 23.7% one and four months after therapy respectively, which suggested that IF was a useful tool for immunodiagnosis and checking up therapeutic effect of trichinosis.
This study included 90 patients with trichinosis treated at the Clinic for Infectious and Dermatovenereology Diseases in Novi Sad for a year. In patients with mild clinical picture the lowest values of eosinophils was 0.08% (Xmin = 0.08), the highest 0.80% (Xmax = 0.80) and mean value 0.37% (x = 0.37). In patients with mild to severe clinical picture the lowest number of eosinophils was 0.02% (Xmin -0.02), the highest value 0.81% (Xmax = 0.81) and mean value 0.36% (x = 0.36). In severe cases of trichinosis eosinophilia was evident in 0.14% (Xmin = 0.14), the highest value 0.70% (Xmax = 0.70), while the mean value was 0.39% (x = 0.39). Most patients (46.14% with mild clinical picture, 32.82% with mild to severe clinical picture and 40% with severe clinical picture) had values of eosinophilia between 0.26% and 0.40%. By the follow-up of total number of eosinophils it has been established that most patients (71.80% with mild 75% with mild to severe and 60% with severe clinical picture), had values between 0.50 x 10(9)/l and 6.00 x 10(9)/l. In ten patients values of eosinophils were extremely high-10.00 x 10(9)/l. Extremely high eosinophilia-29.16 x 10(9)/l was recorded in a patient with a mild to severe clinical picture. It has been established that on the basis of percentile eosinophilia or total number of peripheral blood eosinophils severity of clinical picture cannot be assessed (x2 = 0.852 and x2 = 2.452).
The prevalence of trichinosis was analyzed among human beings and animals in Moscow Province over 50 years (1946-1996). A total of 7022 domestic, synanthropic, and wild carnivorous animals were incompletely helminthologically dissected. Enzyme immunoassay revealed diagnostic Trichinella antigen antibody titers in 45.4% of 544 examinees during outbreaks and at their intervals, as well as in 0.58% of domestic pigs of different property forms. Trichinella larvae were found in domestic pigs (0.13%), dogs (12.3%), cats (12.9%), hunting and fur-bearing (wild boars (2.0%), wolves (38.8%), red foxes (32.0%), raccoon-like dogs (20.0%)) animals and rats (2.4%). Criteria were developed and epidemiological and epizootic division of the districts near Moscow was made. Three unfavourable (hyperendemic, mesoendemic, hypoendemic) and one favourable areas were identified. A trichinosis control programme was worked out.
The established serological tests for trichinosis are often negative during the period when laboratory investigation is most likely to be useful.Another serological test, the immunofluorescence test, appears to be more promising in this respect. The results were based on studies involving experimental animals and human patients. In two rabbits orally infected with Trichinella spiralis larvae, antibodies were demonstrable by immunofluorescence on the fourth day after infection, by complement fixation on the eighth and tenth days, and by the precipitin test on the thirteenth and twenty-eighth days, respectively. In three human cases the immunofluorescence antibody test was positive two weeks (the earliest blood samples available) after onset, while precipitin and complement fixation tests did not become positive until the end of the fourth week. The immunofluorescence test thus becomes positive at least two weeks earlier than the other two, a factor which undoubtedly increases its value in diagnosis.
A 35-year-old woman contracted severe trichinosis which was atypical in that it lacked a gastrointestinal prodrome and periorbital edema, and in that eosinophilia developed only late in the course of the illness. The patient developed an incapacitating myositis as well as complications of encephalopathy, myocarditis, and retinal hemorrhages, resulting in severe debilitation of more than two and one-half months' duration. Muscle histochemistry illustrated previously unreported features.
Clinical and morphologic observations are described in a 46 year old woman with fatal trichinosis. Attention is called to the occurrence of extensive ventricular endocardial damage with superimposed thrombosis; Evidence is presented to indicate that the most likely cause of the endocardial damage is the associated eosinophilia. The mechanism by which eosinophils damage endocardium, however, remains obscure.
The enzyme-linked immunosorbent assay (ELISA) was successfully applied to detect IgE antibodies against parasitic antigens by using an additional antibody layer to attain an amplification effect. The sera of 18 Gurkha patients with clinical manifestations of acute trichinosis and 35 Chinese with other parasitic infections were tested for antibodies to Trichinella spiralis by IgE-, IgM- and IgG-ELISA, IgG-radioimmunoassay (RIA) and indirect haemagglutination test (IHA). ELISAs for detection of IgE and IgM antibodies provided a 100% specific and sensitive diagnosis. Although IHA, IgG-RIA and IgG-ELISA detected antibodies in 94% of patients, non-specific reactions were also observed in the two last named methods. Muscle biopsies were positive in only 56% of patients.
The first documented report of human trichinosis in Hong Kong is described comprising an outbreak amongst 20 Gurkha soldiers following a barbecue. The cardinal clinical features were fever, myalgia and facial oedema and the most useful laboratory tests were eosinophilia and elevated levels of creatinine phosphokinase. Gastrointestinal symptoms were uncommon. Seven patients who developed electrocardiographic abnormalities are the subject of an ongoing study. Four patients had psychiatric manifestations. Splinter haemorrhages, hypocalcaemia and evidence of renal dysfunction were absent. The parasite was recovered from 13 of patients and the diagnosis confirmed serologically in all. The value of the enzyme-linked immunosorbent assay (ELISA) for IgM and IgE antibodies is emphasized in that it is 100% specific and sensitive. Thiabendazole alone was used in treatment and all patients recovered.
A competitive enzyme-linked immunosorbent assay (ELISA) for the detection of swine trichinosis has been developed using a biotinylated monoclonal antibody and an avidin-enzyme conjugate. The assay is based on competitive binding between swine serum antibodies and a monoclonal antibody specific for an antigenic determinant present on proteins from Trichinella spiralis excretory-secretory products with molecular weights of 45,000, 49,000, and 53,000. The competitive ELISA reliably detected pigs infected experimentally with T. spiralis and eliminated false-positive reactions in pigs infected with other swine nematodes, particularly Trichurus suis. When the competitive ELISA and an indirect ELISA using affinity-isolated antigen were compared using serum from pigs with naturally-acquired infections of T. spiralis, both tests were highly effective in detecting infected animals.
An excretory--secretory (ES) antigen was used in a serodiagnostic enzyme-linke immunosorbent assay (ELISA) for swine trichinosis. ELISA procedures included a double-antibody test, using either an anti-swine IgG or a protein A enzyme conjugate, and a triple-antibody test using a pig IgG heavy-chain specific second antibody with a conjugated third antibody. The ES antigen was effective in eliminating all false-positive reactivity in sera from farm-raised hogs. The triple-antibody procedure was more sensitive and demonstrated a greater efficiency in detecting positive animals and early seroconversions. Naturally-infected pigs with worm burdens as low as 0.01 larvae per gram (LPG) of diaphragm were seropositive using these procedures. Seroconversion in experimentally-infected animals receiving low doses of muscle larvae (500) occurred considerably later than in animals receiving high doses (10000). This might account for false-negative reactions in naturally-infected animals with very low (less than 0.1 LPG) worm burdens.