Clinical Background
Trichinosis is a zoonotic disease that is transmitted by uncooked meat products, mainly pork.
Epidemiology
- Incidence - very low in U.S.
- Transmission - raw or undercooked infected meat
- Domestic pigs
- Wild boar
- Walrus
- Black bear
- Dog
- Horse
Organism
- Pork worm or Trichinella spiralis, Trichinella species is among the smallest of the parasitic nematodes
- Transmission occurs when infected meat is eaten without proper cooking
- Cyst dissolves, parasite matures and deposits larvae in deep mucosa
- Larvae enter lymphatics and are carried to all parts of body and again encyst
Clinical Presentation
- Symptoms from larval migration appear the second week after infection
- Periorbital and facial edema
- Hemorrhages in retina, nail beds, subconjunctival
- Inflammatory muscle changes
- Myocarditis, encephalitis and pneumonia account for most deaths
Treatment
- Treatment unsuccessful in most patients
- Glucocorticoids are used for severe myositis and myocarditis
- Infected patients usually recover with bedrest
Prevention
- Fully cooking pork or freezing at -15°C for 3 weeks
See Also
Diagnosis
Diagnosis
- Indications for testing - clinical presentation and risk factor of improper meat preparation, mainly pork
- Laboratory testing
- Trichinella antibody testing by ELISA or IFA
- May crossreact with other parasites
- May not be positive in early disease
- Histology - muscle biopsy with staining
Differential Diagnosis
- Myopathy
- Connective tissue disease
- Myositis
- Gastroenteritis
Tests generally appear in the order most useful for common clinical situations
| Test name: Trichinella Antibody by ELISA
|
| ARUP #: 0050787 |
| Methodology: Enzyme-Linked Immunosorbent Assay
|
| Use: Detect presence of serum Trichinella antibodies when there is a clinical suspicion of Trichinella infection |
| Limitations: |
| Follow-up:
|
References
Guidelines
Gamble HR, Pozio E, Bruschi F, Nockler K, Kapel CM, Gajadhar AA. International Commission on Trichinellosis: recommendations on the use of serological tests for the detection of Trichinella infection in animals and man. Parasite.
2004;
11(
1):
3-13.
General References
Bruschi F, Murrell KD. New aspects of human trichinellosis: the impact of new Trichinella species. Postgrad Med J.
2002;
78(
915):
15-22.
Cancrini G. Human infections due to nematode helminths nowadays: epidemiology and diagnostic tools. Parassitologia.
2006;
48(
1-2):
53-56.
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.
Jones JL, Schulkin J, Maguire JH. Therapy for common parasitic diseases in pregnancy in the United States: a review and a survey of obstetrician/gynecologists' level of knowledge about these diseases. Obstet Gynecol Surv.
2005;
60(
6):
386-393.
Kociecka W. Trichinellosis: human disease, diagnosis and treatment. Vet Parasitol.
2000;
93(
3-4):
365-383.
Mitreva M, Jasmer DP. Biology and genome of Trichinella spiralis. WormBook.
2006;
:
1-21.
Pozio E, Darwin Murrell K. Systematics and epidemiology of trichinella. Adv Parasitol.
2006;
63:
367-439.
Pozio E, Gomez Morales MA, Dupouy-Camet J. Clinical aspects, diagnosis and treatment of trichinellosis. Expert Rev Anti Infect Ther.
2003;
1(
3):
471-482.
Medical Reviewers
Litwin, Christine, M.D. Medical Director, Immunology at ARUP Laboratories; Professor, Clinical Pathology, University of Utah
Comprehensive Review: September 2008
Last Update: September 2008
