Trichinosis

Anan Srikiatkhachorn MD (Dr. Srikiatkhachorn of King Mongkut’s Institute of Technology Ladkrabang has no relevant financial relationships to disclose.)
Wannakorn Rattanawong MD (Dr. Rattanawong of Chulalongkorn University in Bangkok, Thailand, has no relevant financial relationships to disclose.)
John E Greenlee MD, editor. (Dr. Greenlee of the University of Utah School of Medicine received an honorarium from Merck for authorship.)
Originally released June 30, 1999; last updated May 16, 2016; expires May 16, 2019

This article includes discussion of trichinosis, trichinellosis, and neurotrichinosis. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Improvement in control of the meat industry has significantly reduced the incidence of human trichinosis; however, the proportion of outbreaks associated with noncommercial or game meat has increased. In this article, the authors review the basic and clinical aspects of this food-borne condition.

Key points

 

• Trichinosis is an infectious disease caused by consumption of raw meat contaminated with larvae of nematode in the genus Trichinella.

 

• Clinical syndrome of Trichinella infection is caused by larvae migration and invasion of target tissues, primarily muscles causing muscle pain and swelling.

 

• Systemic symptoms include headache, maculopapular rash, focal edema, local inflammation, leukocytosis, and eosinophilia.

 

• A definitive diagnosis is established by demonstration of larvae in muscle, blood, or cerebrospinal fluid.

 

• Although benzimidazoles are recommended in the treatment of trichinosis, symptomatic and supportive treatments are the mainstays in the management of this condition.

Historical note and terminology

In 1835, James Paget (later, Sir James) discovered the roundworm Trichinella spiralis while dissecting a cadaver as a first-year medical student at St. Bartholomew's hospital. However, Richard Owen (later, Sir Richard), his mentor, was the first to publish the findings, and he received acclaim for the discovery (Campbell 1983). In 1859, Rudolf Virchow described the maturation of T spiralis in the gut and the subsequent lymphatic and hematogenous dissemination of larvae to muscles. The first recognized acute case of human trichinosis was reported by Friedrich von Zenker in 1860 (Zenker 1860). He was also the first to elucidate the mode of dissemination of the parasites in the host by implicating the consumption of raw, contaminated pork as the vehicle of transmission. In 1906, Frothingham provided direct evidence of the central nervous system involvement by demonstrating the larva in the brain of a patient who had died from acute trichinosis (Frothingham 1906). Subsequent observations revealed that the parasite could be detected in cerebrospinal fluid. This parasitic disease was once a major health problem in the United States and North America. The prevalence has considerably decreased since the strict regulation of the meat industry in the 1940s.

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