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A rare presentation of Trichinella spiralis with squamous cell carcinoma of the tongue is reported. The possible carcinogenic potential of trichinosis and its management are discussed.
An early rise in serum IgE levels was observed in five of seven patients with acute primary trichinosis. Parallel increases in the total IgG, IgM, and Iga levels, as well as specific IgG and IgM antibody titres to Trichinella spiralis larval antigen, were detected in two. The elevated levels persisted long after the clinical recovery of the patients.
After ingestion of wild boar meat 58 patients developed typical clinical signs and symptoms of trichinosis. All patients had marked blood eosinophilia. In 45% of the patients GOT and GPT and in 62% HBDH were moderately increased, while in 76% LDH and in 86% creatine-kinase showed abnormally high values. CK-MB was increased in three patients. 92% of muscle biopsies showed typical morphological changes in skeletal muscles. Latexagglutination, complement-fixation and agar-gel diffusion tests were not reliable. In most of the examined cases clinical symptoms and histological results correlated well with the indirect haemagglutination test, the microprecipitation test with living larvae of Trichinella spiralis and evidence of specific antibodies (IgG, IgM, IgE) by indirect immunofluorescence and the ELISA technique. 25 patients were treated with thiabendazole (Minzolum), 19 of them successfully.
In 1982, an epidemic of acute trichinosis occurred in Bitburg with 402 cases. The acute stage was observed and documented in 193 patients. The first signs of the disease appeared on average 17 days after eating trichina-containing meat. Muscle pain was reported by 85% of patients, lid and/or facial edema by 83%, gastrointestinal complaints by 62%, fever by 60%, flu-like symptoms by 56%, headache by 26%, eye complaints by 19%. Eosinophils were present in the blood of 92%. Trichinella antibodies were demonstrated in 98% of patients examined for them. Interstitial myositis was found in 90% of muscle biopsies (from 162 patients). Serious complications--thrombosis, myocarditis, pneumonia, hepatitis or meningism--occurred in 26 (13.5%) of the 193 patients. Even six months after onset of the disease 43% of patients were still not free of symptoms.
A large outbreak of trichinosis acquired from walrus in Salluit in 1987 provided the immunologic and epidemiologic data from which two distinct clinical syndromes were identified. The first syndrome is the classic myopathic form with edema, fever, myalgia, and rash. The second is a persistent diarrheal illness with little edema or myalgia. The clinical presentations are paralleled by distinct differences in type and development of antibody response. The clinical and serologic profiles of the two syndromes support the hypothesis that the myopathic form represents a primary infection of Trichinella nativa, while the second represents a secondary infection in previously sensitized individuals.
Black bears (Ursus americanus) from 10 states were examined for Trichinella spiralis during the 1970-1975 period. Trichinae were found in 14 (3.1%) of 454 bears examined. Infected bears were found from California, seven (13.2%) of 54; Idaho, one (2.3%) of 44; and Wisconsin, six (3.8%) of 163. Trichina counts per gram of tissue obtained by the artificial digestion-Baermann method ranged from 1390 to 0.02. Six California bears and one from Wisconsin contained more than one trichina per gram, a level considered capable of inducing clinical trichinosis in man.
A severe case of trichinosis occurred following the ingestion of raw meat from a common black bear, Ursus americanus, that was shot in Butte County, California. Examination of steaks cut from the bear revealed heavy infection with T. spiralis. A good clinical response was obtained following treatment with prednisone (1 mg/kg body weight per day) and thiabendazole (50 mg/kg body weight per day); no toxic effects were observed. In comparison with the pre-treatment biopsy, a more intense inflammatory response was seen following the administration of thiabendazole. Nevertheless, a muscle biopsy taken several months after discharge still showed well-encapsulated, morphologically intact larvae. In addition to the expected immunological responses to T spiralis, a marked rise in titer of antibodies to Toxoplasms gondii was observed by the fluorescent antibody and Sabin-Feldman dye test methods. Since toxoplasma infection of muscle is widespread in man, it is possible that an unrelated disease of muscle could result in stimulation of anti-toxoplasma antibodies similar to the findings in polymyositis and dermatomyositis. Alternatively, the possibility that a dual infection was acquired from the bear meat cannot be excluded.
Four patients had trichinosis after consuming raw home-butchered pork. The patients had fever, myalgias, periorbital edema, and conjunctivitis. All of the patients had nausea, vomiting, or diarrhea (corresponding to the intestinal phase of the infection) seven to ten days before the onset of fever and myalgias. Laboratory findings included eosinophilia, elevated serum CPK and aldolase values, and seroconversion of Trichinella serology one month after onset of myalgias. The patients were treated with mebendazole and prednisone and recovered uneventfully.
Immune responses to unrelated antigens were studied during the course of Trichinella spiralis infection in mice. A transitory depression of the IgM response to the thymus dependent antigen, sheep erythrocytes, was seen three weeks after infection and this effect was more pronounced after challenge. A depression of the IgG response also was observed, however, not until 6 weeks after infection. The humoral response to the thymus independent antigen, polyvinyl pyrrolidone showed a slight increase which was most evident in challenged mice. The nonspecific cellular immune response, as measured by the split heart allograft technique, showed a profound and longlasting depression. This effect was mot pronounced one week after inoculation, when the parasite resides mainly in the intestine. The time at which the nonspecific cellular immunity was most depressed coincides with the period of strong specific cell mediated immunity. It is also shown that experimental trichinosis in CBA mice is accompanied by profound but transient changes in the thymus reflected mainly as a depletion of cortical thymocytes. These changes were not due to corticosteroids or malnutrition. There is reason to believe that thymic depletion is of significance for the depressed antibody response, but not for the prolonged survival of allografts. These findings indicate that T. spiralis affects the nonspecific immunity at different levels.
The therapeutic efficacy of ketoconazole and mebendazole was studied in ICR/CD-1 mice infected with Trichinella spiralis for 17 to 20 weeks. Efficacy of both drugs was over 70% when compared with results in control mice. This study indicates that both ketoconazole and mebendazole should be considered in the treatment of trichinosis in humans.
Since the large outbreak of trichinosis in Liverpool in 1953 there have been three outbreaks in Ireland, two occurring recently in Cork and Kerry, where a total of 76 cases was confirmed. In the outbreak of 50 cases in Kerry the latex trichina slide agglutination test was found to be valuable diagnostically and epidemiologically, while the efficacy of thiabendazole treatment was not established. This infection may be maintained as a reservoir in wild carnivores, occasionally spreading to pigs and perpetuated in them by a failure to boil pig swill.
Trichinosis is a worldwide disease contained by good husbandry and culinary practice, presenting unexpectedly in individual cases or mini-epidemics. The disease varies greatly in its manifestation and severity although when marked can be recognized by fever with myositis and periorbital oedema. Antibody tests are specific but the appearance on computed tomography of the brain are sufficiently characteristic to allow a confident diagnosis. Two cases where such appearances led to the diagnosis are reported.
Monkeys infected with 2.0 larvae/g body weight died 31-41 days post-infection (PI): two of three monkeys infected with 1.0 larva/g body weight became moribund and were sacrificed at 50 days, but six of six monkeys infected with 1.0 larva/g body weight were healthy 225 days PI. Periorbital and facial edema and eosinophilia were observed in all groups during the second week PI, and myalgia and stiffening of joints was observed during the third week. High numbers of encyse, biceps brachii and deltoideus. Adult worms were recovered from the intestine 49 days PI. The morphological changes were essentially similar to those seen in humans and a generalized lymphoid hyperplasia was not observed. Thus, rhesus monkeys develop trichinosis which show similarities clinically, pathologically and morphologically to human disease.
A case of clinically severe trichinosis following ingestion of commercially prepared pickled pigs' feet is reported. An unusual finding on muscle biopsy was a larval count of 4,046 per gram of muscle, the second highest density of muscle invasion recorded to date. Survival has not been reported previously in patients with greater than 1,000 trichinae per gram of muscle. Complete symptomatic recovery followed combined corticosteroid and thiabendazole administration.
During a small outbreak of trichinosis, two of four symptomatic patients developed moderate to large pericardial effusions. In neither was there ventricular dilatation nor impairment of systolic function. These observations suggest that pericardial effusion is more common than previously appreciated and that it may have a role in the genesis of the symptoms and signs mimicking congestive heart failure which occasionally complicate the course of this illness.
The first South American case of human trichinosis, resulting from the consumption of roast wild boar (Sus scrofa) is reported in Chile. The patient presented fever, diarrhea, myalgias, facial edema, sub-conjunctival reddening, photophobia, eosinophilia, and elevated glutamic oxalacetic transaminase. The diagnosis was confirmed by two immunoenzymatic tests (ELISA) using somatic and excretion-secretion antigens.
Between 1975 and 1984, the incidence of trichinosis in the United States (per million person years at risk) was 25 times greater for the Southeast Asian refugee population than for the general United States population. Cases in the southeast Asian refugees differed from those reported previously in the general population in geographic distribution and source of infected meat. Cambodians and Laotians accounted for over 90 per cent of the cases in the Southeast Asian refugees, but comprised less than 50 per cent of that total population.
Sera from 58 cases of confirmed human trichinosis were examined over an 11-month period. The enzyme-linked immunosorbent assay (ELISA) was used for the detection of class-specific serum antibodies (IgG, IgM, IgA, IgE) and for total serum IgE. The indirect immunofluorescent test served as reference technique. The ELISA proved to be more sensitive. Specific IgG antibodies were detected by ELISA in 100% of the clinical cases. Both IgG and IgM were demonstrable throughout the observation period of 11 months. Specific serum IgA was seen in 62% of the patients during the first 3 months, presumably the result of stimulation of the immune system by the adult worms in the intestine. Specific serum IgE was seen in a few cases only at the onset of the disease. Total serum IgE levels were elevated in 32% of the patients in the first month of the disease and in 17% after 11 months, compared to 10% of healthy individuals.