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Trichinellosis

Trichinosis

Trichinellosis is a term for a parasitic infection caused by Trichinella species, most notably Trichinella spiralis. This condition occurs in humans by ingestion of various meat products (mainly pork) that are contaminated with this parasite. The clinical presentation correlates with the amount of parasite ingested, ranging from asymptomatic and mild constitutional complaints to severe myalgia, urticaria, conjunctival hemorrhage, fever, hypoalbuminemia, and the development of life-threatening complications. The diagnosis is made through serological testing and a thorough patient history that identifies recent consumption of "suspicious" meat products.


Presentation

Trichinellosis denotes an infection by the tissue nematode Trichinella, with many discovered species [1] [2] [3]. The vast majority of human cases, however, are caused by Trichinella spiralis, which is found in many parts of the world [1] [2] [3] [4]. The pathogenesis of this zoonotic disease starts by the consumption of the parasite through contaminated or undercooked meat products and animals that have been confirmed as the source of T. spiralis - pigs, horses, wild boars, and even dogs in certain geographic areas [1] [2] [4] [5]. The clinical course strongly depends on the quantity of parasite introduced into the organism, with an average incubation period around 1-3 weeks [1] [2]. In milder cases, the presentation may be asymptomatic or consist of few constitutional symptoms - myalgia, low-grade fever, and gastrointestinal discomfort. When a substantial parasitic load has occurred, symptoms in the form of diarrhea, nausea, vomiting, headache, and severe myalgia characterize trichinellosis and appear within days [1] [2] [6]. As the parasite attempts to migrate from the gastrointestinal tract into other tissues several weeks after the initial infection, a prominent immunological reaction develops, inducing a more prominent clinical response - high-grade fever accompanied by chills, swelling, periorbital edema, urticarial rash, conjunctival hemorrhage, and myalgia as a constitutive feature [2] [6]. Furthermore, various complications have been reported, including myocarditis, encephalitis, and thromboembolic disease, which may be life-threatening in the absence of proper therapy [1] [2] [4] [5] [6].

Fever
  • Physicians must be aware of trichinosis and should include it in their differential diagnosis when examining patients with fever and myositis with or without eosinophilia.[ncbi.nlm.nih.gov]
  • In milder cases, the presentation may be asymptomatic or consist of few constitutional symptoms - myalgia, low-grade fever, and gastrointestinal discomfort.[symptoma.com]
  • Signs and symptoms include abdominal discomfort, nausea, vomiting, fever, diarrhea, headache, coughing, myalgias, arthralgias, and eye swelling. An infection with trichinella.[icd9data.com]
Hunting
  • The wild boar is an important source of trichinellosis for people in European countries as a large number of hunted animals escape veterinary control.[ncbi.nlm.nih.gov]
Chills
  • We report the case of a 42-year-old woman who was admitted to the hospital for fever, chills, nausea, vomiting, fatigue, myalgia, and general muscle weakness.[ncbi.nlm.nih.gov]
  • […] the parasite attempts to migrate from the gastrointestinal tract into other tissues several weeks after the initial infection, a prominent immunological reaction develops, inducing a more prominent clinical response - high-grade fever accompanied by chills[symptoma.com]
  • Headaches, fevers, chills, cough, eye swelling, aching joints and muscle pains, itchy skin, diarrhea, or constipation follow the first symptoms.[gov.mb.ca]
  • Symptoms may include: Nausea and vomiting Diarrhea Abdominal pain Fatigue Fever Headaches Fever Chills Cough Swelling in the face and eyes Muscle and joint pains Itchy skin Constipation Difficulty moving Breathing or heart problems Death, in severe cases[gethealthycarsoncity.org]
Fatigue
  • We report the case of a 42-year-old woman who was admitted to the hospital for fever, chills, nausea, vomiting, fatigue, myalgia, and general muscle weakness.[ncbi.nlm.nih.gov]
  • The first symptoms of trichinellosis occur suddenly, and they include nausea, diarrhea, vomiting, fatigue, fever, and stomach ache.[gov.mb.ca]
  • Nausea, diarrhea, vomiting, fatigue, fever, and abdominal discomfort are the first symptoms of trichinellosis.[web.archive.org]
  • Symptoms may include: Nausea and vomiting Diarrhea Abdominal pain Fatigue Fever Headaches Fever Chills Cough Swelling in the face and eyes Muscle and joint pains Itchy skin Constipation Difficulty moving Breathing or heart problems Death, in severe cases[gethealthycarsoncity.org]
Rigor
  • The evidence that the disease can be monitored and to some extent controlled with a rigorous reporting and testing system in place should be motivation to expand appropriate programs worldwide.[ncbi.nlm.nih.gov]
Hoarseness
  • Myalgia and asthenia lasted more than four months in the Thailand outbreak caused by T pseudospiralis. 35 Gastrointestinal symptoms such as diarrhoea may also extend into this parenteral phase. 36 Dyspnoea (even ventilatory failure), 44 coughing, and hoarseness[doi.org]
Diarrhea
  • Signs and symptoms include abdominal discomfort, nausea, vomiting, fever, diarrhea, headache, coughing, myalgias, arthralgias, and eye swelling. An infection with trichinella.[icd9data.com]
  • » Diarrhea - Explains diarrhea (loose stool or frequent bowel movements) and includes causes, dehydration prevention and treatment.[web.archive.org]
  • The first symptoms of trichinellosis occur suddenly, and they include nausea, diarrhea, vomiting, fatigue, fever, and stomach ache.[gov.mb.ca]
Vomiting
  • Source:MedicineNet Nausea and Vomiting - Nausea and vomiting symptoms of many conditions including motion sickness, pregnancy, emotional stress, gallbladder disease, and more.[web.archive.org]
  • The symptoms of the disease vary widely depending on the infection load, stage of infection and host immunity and include nausea, vomiting, abdominal pain, fever, facial edema and muscle pain.[ncbi.nlm.nih.gov]
  • Signs and symptoms include abdominal discomfort, nausea, vomiting, fever, diarrhea, headache, coughing, myalgias, arthralgias, and eye swelling. An infection with trichinella.[icd9data.com]
Nausea
  • Source:MedicineNet Nausea and Vomiting - Nausea and vomiting symptoms of many conditions including motion sickness, pregnancy, emotional stress, gallbladder disease, and more.[web.archive.org]
  • The symptoms of the disease vary widely depending on the infection load, stage of infection and host immunity and include nausea, vomiting, abdominal pain, fever, facial edema and muscle pain.[ncbi.nlm.nih.gov]
  • Signs and symptoms include abdominal discomfort, nausea, vomiting, fever, diarrhea, headache, coughing, myalgias, arthralgias, and eye swelling. An infection with trichinella.[icd9data.com]
Abdominal Pain
  • Clinically the epidemic has shown a typical, uncomplicated febrile course in most patients, but two patients showed signs of cardiac damage and one intense abdominal pain, suggesting an acute abdomen.[ncbi.nlm.nih.gov]
Urticaria
  • The clinical presentation correlates with the amount of parasite ingested, ranging from asymptomatic and mild constitutional complaints to severe myalgia, urticaria, conjunctival hemorrhage, fever, hypoalbuminemia, and the development of life-threatening[symptoma.com]
  • Urticaria (most common) Petechiae Splinter hemorrhages Palmar rash - Peripheral palmar and volar digital edema and erythema; desquamation occurs (10% in one study [Walsh, 2001]) Physical: Fever (71%) Palpebral edema (50-60%) - Usually considered one of[web.archive.org]
  • The trichinellotic syndrome is characterised by facial oedema, muscle pain and swelling, weakness, and frequently fever; anorexia, headache, conjunctivitis, and urticaria occur less frequently. 36, 40 Fever, usually remittent, generally begins at two[doi.org]
Periorbital Edema
  • We hereby discuss an atypical case of trichinellosis, which presented with myositis of the thigh muscles but had no eosinophilia and no facial or periorbital edema and was associated with osteomyelitis of the femur.[ncbi.nlm.nih.gov]
  • edema, urticarial rash, conjunctival hemorrhage, and myalgia as a constitutive feature.[symptoma.com]
Retinal Hemorrhage
  • Vitreous cells and retinal hemorrhage were observed in both eyes. In both cases, inflammation and retinal hemorrhage disappeared one month after first visit. Conclusion:Trichinellosis is one of the causes of uveitis and palpebral edema.[webview.isho.jp]
Diplopia
  • An intense invasion of muscles of the ocular bulb provokes pain when moving the eyeballs, muscle paralysis, diplopia, or a disturbed accommodation ( 29, 36 ). Chronic-stage trichinellosis.[doi.org]
Myalgia
  • In milder cases, the presentation may be asymptomatic or consist of few constitutional symptoms - myalgia, low-grade fever, and gastrointestinal discomfort.[symptoma.com]
  • These included fever with chills and myalgia (100%), periorbital oedema (67%), dyspnoea (9%), and dysphagia (3%).[ncbi.nlm.nih.gov]
  • Signs and symptoms include abdominal discomfort, nausea, vomiting, fever, diarrhea, headache, coughing, myalgias, arthralgias, and eye swelling. An infection with trichinella.[icd9data.com]
Arthralgia
  • Signs and symptoms include abdominal discomfort, nausea, vomiting, fever, diarrhea, headache, coughing, myalgias, arthralgias, and eye swelling. An infection with trichinella.[icd9data.com]
  • The most commonly observed signs and symptoms were myalgia (89.2%), arthralgia (69.9%) and eyelid (67%) and facial oedema (65.8%).[ncbi.nlm.nih.gov]
  • 40-60%) - Usually only in the acute intestinal proliferative and penetration phases of helminth infestation Facial edema (40-50%) - Usually considered one of the hallmark features, particularly when localized to the eyelids Headache (50-60%) Fatigue Arthralgia[web.archive.org]
Muscle Weakness
  • We report the case of a 42-year-old woman who was admitted to the hospital for fever, chills, nausea, vomiting, fatigue, myalgia, and general muscle weakness.[ncbi.nlm.nih.gov]
  • Symptoms of trichinosis include: Abdominal discomfort, cramping Diarrhea Facial swelling around the eyes Fever Muscle pain (especially muscle pain with breathing, chewing, or using large muscles) Muscle weakness Medicines, such as albendazole, can be[nlm.nih.gov]
  • weakness and tenderness - Usually not true neurologic weakness but pain related Neurologic findings consistent with encephalopathy or focal deficits Cardiac findings of myocarditis, pericarditis, or ischemia Causes: Trichinosis is a completely preventable[web.archive.org]
Muscle Swelling
  • swelling and pain, weakness, and in some cases, skin rash and peripheral edema.[orpha.net]
Facial Edema
  • The symptoms of the disease vary widely depending on the infection load, stage of infection and host immunity and include nausea, vomiting, abdominal pain, fever, facial edema and muscle pain.[ncbi.nlm.nih.gov]
  • Larval migration into muscle tissues (one week after infection) can cause periorbital and facial edema, conjunctivitis, fever, myalgias, splinter hemorrhages, rashes, and peripheral eosinophilia.[web.archive.org]
Facial Swelling
  • Symptoms of trichinosis include: Abdominal discomfort, cramping Diarrhea Facial swelling around the eyes Fever Muscle pain (especially muscle pain with breathing, chewing, or using large muscles) Muscle weakness Medicines, such as albendazole, can be[nlm.nih.gov]

Workup

Due to the nonspecific clinical presentation of trichinellosis, the diagnosis might be difficult to attain [1] [2] [4] [5] [6]. For this reason, a thorough patient history is often the crucial component of the workup. Physicians must ask the patients if they consumed undercooked or "suspicious" game meat, pork, or other meat products and determine if the timetable matches the clinical course [2]. A detailed physical examination should not be overlooked, as it may provide further clues toward trichinellosis as the cause of symptoms. But in order to make a definite diagnosis, both laboratory and specific microbiological studies need to be performed. A complete blood count (CBC) will almost always show marked eosinophilia, which is typical for a parasitic infection, whereas very high levels of serum creatine phosphokinase (CBK or CK) are highly indicative of trichinellosis in the presence of myalgia and eosinophilia [1] [2] [6]. Conversely, specific serology testing for the detection of T. spiralis antigens and respective antibodies through enzyme-linked immunosorbent assay (ELISA) is a reliable method that can confirm the presence of this parasite [1]. However, the test may be false-negative in the initial stages of the ailment, as antibodies are not yet formed against the pathogen [1] [3]. Although being highly invasive is not always recommended, a muscle biopsy can sometimes be carried out in order to obtain a viable sample of parasitological testing [1] [6].

Trichinella Spiralis
  • Trichinella spiralis may exist subclinically in a variety of human tissues including neck muscles.[ncbi.nlm.nih.gov]
  • From Wikidata Jump to navigation Jump to search parasitic disease due to invasion by Trichinella spp. trichiniasis Trichinella spp. invasion Trichinella spp. infection trichinellosis Trichinella spiralis infection Triquina edit English trichinosis parasitic[wikidata.org]
Tissue Nematode
  • Trichinellosis denotes an infection by the tissue nematode Trichinella, with many discovered species. The vast majority of human cases, however, are caused by Trichinella spiralis, which is found in many parts of the world.[symptoma.com]
  • Tissue nematodes (trichinellosis, dracunculiasis, filariasis, loiasis, and onchocerciasis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed.[nlm.nih.gov]
  • Tissue nematodes Trichinella spiralis. In Principles and Practices of Pediatrics 2nd edition. Philadelphia, PA: JB Lippincott; 1994. 1413-14. Moorhead A, Grunenwald PE, Dietz VJ, Schantz PM.[emedicine.medscape.com]
  • Trichinosis is a disease caused by parasitic roundworms (nematodes) that can infect and damage body tissues. Nematodes are a major division of the helminth family of parasitic worms (for example, Trichinella spiralis ).[medicinenet.com]

Treatment

  • If treatment is not initiated within the first several days of infection, more prolonged or repeated courses of treatment may be necessary.[web.archive.org]
  • The patient was subsequently evaluated by an infectious disease specialist and required no further treatment for his parasitic infection.[ncbi.nlm.nih.gov]

Prognosis

  • What is the prognosis for patients with trichinosis? For those who have minor or no symptoms, the prognosis is excellent with no complications.[web.archive.org]
  • Prognosis [ 1 ] Patients with mild infection are usually asymptomatic. Those with mild symptoms improve in 2-3 weeks. Symptoms associated with heavy infections may persist for 2-3 months.[patient.info]
  • , the prognosis is usually good with the exceptions of the rare, heavily infected cases.[doi.org]

Etiology

  • All members of the trichinella genus can infect human in addition to trichinella spiralis, the traditional etiological agent.[icd9data.com]
  • Among their children, one died in utero at 26 weeks gestation due to maternal hepatitis of unknown etiology and a second child had Trichinella-specific IgG antibodies but was clinically normal.[ncbi.nlm.nih.gov]
  • […] of diseases in human communities. 2. the field of medicine concerned with the determination of the specific causes of localized outbreaks of infection, such as hepatitis, of toxic disorders, such as lead poisoning, or any other disease of recognized etiology[vdh.virginia.gov]
  • Predominant age: 20 to 49 years, although cases were reported from all age groups Predominant sex: male female Etiology and Pathophysiology Eating undercooked meat contaminated with viable Trichinella cysts.[unboundmedicine.com]

Epidemiology

  • PURPOSE OF THE STUDY: The purpose of the study was assessment of the epidemiological situation of trichinellosis in Poland in 2011.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Predominant age: 20 to 49 years, although cases were reported from all age groups Predominant sex: male female Etiology and Pathophysiology Eating undercooked meat contaminated with viable Trichinella cysts.[unboundmedicine.com]
  • Pathophysiology: Infection is initiated by ingestion of viable larvae in raw or undercooked meat. Gastric action liberates the larvae, which are enclosed in intramuscular cysts.[web.archive.org]
  • Its mission is to exchange information on the epidemiology, biology, pathophysiology, immunology, and clinical aspects of trichinosis in humans and animals. Prevention is a primary goal.[en.wikipedia.org]
  • Humans are incidental hosts. [2] Pathophysiology For T.spiralis, larvae enter the human host when raw or undercooked meat is eaten with viable encysted larvae. In the stomach, larvae ex-cyst through acid-pepsin digestion.[emedicine.medscape.com]
  • Pathophysiology of the gastrointestinal phase. In: Campbell WC, ed. Trichinella and trichinosis. New York: Plenum Press, 1983: 209–39. Ferraccioli GF, Mercadanti M, Salaffi F, et al.[doi.org]

Prevention

  • Courtesy of Centers for Disease Control and Prevention (CDC) ().[emedicine.medscape.com]
  • Treatment Information Prompt treatment with antiparasitic drugs can help prevent the progression of trichinellosis by killing the adult worms and so preventing further release of larvae.[web.archive.org]
  • In response to these events, stakeholders set up the community-based Nunavik Trichinellosis Prevention Program (NTPP).[ncbi.nlm.nih.gov]
  • […] yes no Further reading and references Parasites A-Z ; Centers for Disease Control and Prevention Murray C ; Trichinosis, eMedicine, Jan 2010 Trichinellosis, DPDx, Centers for Disease Control & Prevention Gottstein B, Pozio E, Nockler K ; Epidemiology,[patient.info]

References

Article

  1. Gottstein B, Pozio E, Nöckler K. Epidemiology, Diagnosis, Treatment, and Control of Trichinellosis. Clin Microbiol Rev. 2009;22(1):127-145.
  2. McIntyre L, Pollock SL, Fyfe M, et al. Trichinellosis from consumption of wild game meat. CMAJ. 2007;176(4):449-451.
  3. Wang Z-Q, Shi Y-L, Liu R-D, et al. New insights on serodiagnosis of trichinellosis during window period: early diagnostic antigens from Trichinella spiralis intestinal worms. Infect Dis Poverty. 2017;6:41.
  4. Ortega-Pierres MG, Arriaga C, Yépez-Mulia L. Epidemiology of trichinellosis in Mexico, Central and South America. Vet Parasitol. 2000;93(3-4):201-225.
  5. Holzbauer SM, Agger WA, Hall RL, et al. Outbreak of Trichinella spiralis infections associated with a wild boar hunted at a game farm in Iowa. Clin Infect Dis. 2014;59(12):1750-1756.
  6. Dupouy-Camet J, Kociecka W, Bruschi F, Bolas-Fernandez F, Pozio E. Opinion on the diagnosis and treatment of human trichinellosis. Expert Opin Pharmacother. 2002;3(8):1117-1130.

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Last updated: 2019-06-28 12:29