Trichinosis

Also called trichiniasis and trichinelliasis, trichinosis is a chronic infection that occurs worldwide. It's especially common in populations that eat pork or bear meat.

Trichinosis may produce multiple symptoms; respiratory, central nervous system (CNS), and cardiovascular complications; and, rarely, death. In the United States trichinosis usually is mild.

Causes

People get trichinosis when they eat infected meat — such as bear, walrus, horse or pork — that is undercooked. In nature, carnivores are infected when they feed on other infected animals. Pigs and horses can become infected with trichinosis when they feed on uncooked garbage containing infected meat scraps. Other cases have been linked to eating beef that was mixed with infected pork or ground in a grinder previously used for contaminated pork. Due to increased regulation of pork feed and products, pigs are now a less common source of infection. In recent years, bear meat has become the most common cause of trichinosis in the United

Symptoms and Signs

Symptoms of trichinosis range from very mild to severe and can include:

• Abdominal pain
• Diarrhea or constipation
• Fever
• Chills
• Muscle soreness
• Headaches
• Eye swelling

Diagnostic tests

Infection may be difficult to prove. The patient's history is important to the diagnosis, particularly regarding the ingestion of pork or wild animal meats (and identifying individuals who consumed meat from the same source). Symptoms from a presumptive diagnosis and an increase of parasite-specific antibodies (assayed by bentonite flocculation test) confirm the diagnosis. Skeletal muscle biopsies can show encysted larvae 10 days after ingestion. If a sample of the contaminated meat is available, analysis also shows larvae.

Elevated acute and convalescent antibody titers (determined by flocculation tests 3 to 4 weeks after infection) confirm the diagnosis.

Blood eosinophilia occurs in 90% of symptomatic patients. Other abnormal test results include elevated serum alanine aminotransferase, aspartate aminotransferase, creatine kinase, and lactate dehydrogenase levels and an elevated eosinophil count (up to 15,000/mm³) during the acute stages. A normal or increased lymphocyte level (up to 300/mm³) and increased protein levels in cerebrospinal fluid indicate CNS involvement.

Treatment

Current anthelmintic drugs are ineffective against trichinella larvae in muscle. Mebendazole is active against the enteric stages of the parasite. Glucocorticoids are beneficial in severe myosites and myocarditis. This disease usually is self-limiting, and complete recovery occurs within a few months.

Supportive therapy, such as bed rest, administration of salicylates, and physical therapy to maintain and enhance muscle function, usually proves effective.

If symptoms persist for several years, the patient may need mebendazole therapy. He'll need corticosteroids only if he has a fever, allergic symptoms, leukocytosis, and eosinophilia.

Prevention

• Avoid undercooked pork, walrus, horse, bear or other wild-animal meat.
• Have wild-animal meat frozen or irradiated.
• Know that other processing methods don't kill parasites. Other methods of meat processing or preserving, such as smoking and pickling, don't kill trichinella parasites in infected meat.

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