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Pediatric Trichinosis Clinical Presentation

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
 
Updated: Feb 24, 2015
 

History

Most cases of trichinosis with T.spiralis are subclinical. Symptoms appear only in heavily infected individuals. Predominant symptoms (ie, GI or systemic) vary and depend on the Trichinella species ingested. The incubation period can range from a few days to 2 months. Shorter incubation periods occur when the host’s larvae load is greater.

Patients with T. nativa infection experience symptoms related only to the enteral phase; onset is delayed when compared to infection with T. spiralis, although T. nativa infections may be fatal.[13] T. nelsoni and T. britovi both have low pathogenicity in their enteral and parenteral phases.

Early (enteral/intestinal) phase for T.spiralis

Within the first week post-ingestion, gastrointestinal (GI) symptoms such as diarrhea (most common), nausea, emesis and abdominal discomfort develop. These symptoms are non-specific and mimic clinical signs of many other illnesses such as food poisoning or a viral gastroenteritis illness. These symptoms are absent in patients with mild infections, who ingest only a few viable larvae.

Acute (parenteral) phase for T. spiralis

The parenteral phase occurs when the larvae are moving their way throughout the host organism, migrating to tissues with indiscriminate invasion of different cells. This stage starts 10-14 days post-ingestion and can last about 2 months.

Hallmarks of this phase are fever (in 90% of patients), myalgias (in 90% of patients), and periorbital edema (in 80% of patients). Myalgias are common in the masseters, diaphragm, and intercostal muscles. Pain usually occurs during physical exertion. Pain at rest typically occurs in those patients with severe disease. Less common symptoms during the parenteral phase of tissue invasion include headache (in 50% of patients) and urticarial skin rash (in 20% of patients), and conjunctival and subungual hemorrhages.

Concerning symptoms will occur during this phase, as the larvae are invading the cardiac and central nervous systems. Myocarditis can occur and is typically mild and transient in nature as the larvae leave the myocardium shortly after penetrating this tissue. Involvement of the central nervous system (CNS) is more problematic as larvae migration can cause CNS granulomas and petechial hemorrhages, leading to encephalopathy.[3]

Late phase for T. spiralis

The late stage begins 5-7 weeks after the initial infection and is characterized by the disappearance of most early signs and symptoms. However, myalgias and fatigue frequently persist. In one prospective study, these symptoms persisted in 98% of patients at 2 years and in 25% of patients after 10 years.[14]

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Physical

Temperature curves illustrating a fever history exhibit variable intensity and duration; lasting for a few days in mild infection and up to 3-6 weeks in severe infections. General malaise and myalgias are also characteristic.

If periorbital or facial edema is present, it is symmetrical and produces a characteristic appearance, making patients unrecognizable. For this reason, trichinosis is often called the “disease of big heads”. Involvement of extraocular muscles can cause diplopia and blurred vision.[3]

Symptoms due to vasculitis or thromboembolic disease include subconjunctival and subungual (splinter) hemorrhages. If the cardiac, pulmonary, or nervous systems are involved, findings can indicate pericarditis, myocarditis, pneumonitis, or encephalopathy.

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Causes

Most human infections are due to T. spiralis, the Trichinella species that commonly infects pigs, wild boars and rats. T. murrelli is found in black bears, raccoons, red foxes, cougars and bobcats and is the predominant species infecting wild mammals of temperate North America[7] T. britovi is found in carnivores of Europe and western Asia (eg, wild boars, horses, foxes). T. nativa infects arctic and subarctic mammals such as bears, wolves, seals and walrus; T. nelsoni is common in African predators and scavengers (eg, hyenas, lions, panthers). All of these species encyst.

T. pseudospiralis, T. papuae and T. zimbabwensis are species that do not encyst. T.pseudospiralis infects birds and marsupials. T. papuae and T. zimbabwensis infect saurians, crocodilians andnonavian archosaurs . T. papuae has been linked to consumption of raw soft-shelled turtles[15] and in trichinosis epidemics in Thailand.[16, 17]

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Contributor Information and Disclosures
Author

Germaine L Defendi, MD, MS, FAAP Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Ashir Kumar, MD, MBBS FAAP, Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS is a member of the following medical societies: Infectious Diseases Society of America, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Acknowledgements

Basim Asmar, MD Director, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan; Professor, Department of Pediatrics, Wayne State University School of Medicine

Basim Asmar, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Swati Garekar, MBBS Staff Physician, Department of Pediatrics, Children's Hospital of Michigan

Swati Garekar, MBBS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

References
  1. Markell EK, Voge M, John DT. Medical Parasitology, 6th ed. Philadelphia, PA: WB Saunders Company; 1986. 270-74.

  2. Knopp S, Steinmann P, Keiser J, Utzinger J. Nematode infections: soil-transmitted helminths and trichinella. Infect Dis Clin North Am. 2012 Jun. 26(2):341-58. [Medline].

  3. Oski FA, et al. Tissue nematodes Trichinella spiralis. In Principles and Practices of Pediatrics 2nd edition. Philadelphia, PA: JB Lippincott; 1994. 1413-14.

  4. Moorhead A, Grunenwald PE, Dietz VJ, Schantz PM. Trichinellosis in the United States, 1991-1996: declining but not gone. Am J Trop Med Hyg. 1999 Jan. 60(1):66-9. [Medline]. [Full Text].

  5. Kennedy ED, Hall RL, Montgomery SP, Pyburn DG, Jones JL. Trichinellosis surveillance - United States, 2002-2007. MMWR Surveill Summ. 2009 Dec 4. 58(9):1-7. [Medline].

  6. American Academy of Pediatrics. Trichinellosis (Trichinella spiralis). Red Book: 2009 Report of the Committee on Infectious Diseases. 28th. Elk Grove Village, IL: American Academy of Pediatrics; 2009. 673-4.

  7. Hall RL, Lindsay A, Hammond C, Montgomery SP, Wilkins PP, da Silva AJ, et al. Outbreak of human trichinellosis in Northern California caused by Trichinella murrelli. Am J Trop Med Hyg. 2012 Aug. 87(2):297-302. [Medline]. [Full Text].

  8. Murrell KD, Pozio E. Worldwide occurrence and impact of human trichinellosis, 1986-2009. Emerg Infect Dis. 2011 Dec. 17(12):2194-202. [Medline].

  9. Cui J, Wang ZQ, Xu BL. The epidemiology of human trichinellosis in China during 2004-2009. Acta Trop. 2011 Apr. 118(1):1-5. [Medline].

  10. Pannwitz G, Mayer-Scholl A, Balicka-Ramisz A, Nockler K. Increased Prevalence of Trichinella spp., Northeastern Germany, 2008. Emerg Infect Dis. 2010 Jun. 16(6):936-42. [Medline].

  11. Neghina R, Neghina AM, Marincu I, Iacobiciu I. Trichinellosis in children and adults: a 10-year comparative study in Western Romania. Pediatr Infect Dis J. 2011 May. 30(5):392-5. [Medline].

  12. Moller LN, Koch A, Petersen E, et al. Trichinella infection in a hunting community in East Greenland. Epidemiol Infect. 2010 Sep. 138(9):1252-6. [Medline].

  13. Capo V, Despommier DD. Clinical aspects of infection with Trichinella spp. Clin Microbiol Rev. 1996 Jan. 9(1):47-54. [Medline]. [Full Text].

  14. Cabie A, Bouchaud O, Houze S, et al. Albendazole versus thiabendazole as therapy for trichinosis: a retrospective study. Clin Infect Dis. 1996 Jun. 22(6):1033-5. [Medline].

  15. Lo YC, Hung CC, Lai CS, Wu Z, Nagano I, Maeda T. Human trichinosis after consumption of soft-shelled turtles, taiwan. Emerg Infect Dis. 2009 Dec. 15(12):2056-8. [Medline].

  16. Kusolsuk T, Kamonrattanakun S, Wesanonthawech A, et al. The second outbreak of trichinellosis caused by Trichinella papuae in Thailand. Trans R Soc Trop Med Hyg. 2010 Jun. 104(6):433-7. [Medline].

  17. Intapan PM, Chotmongkol V, Tantrawatpan C, Sanpool O, Morakote N, Maleewong W. Molecular identification of Trichinella papuae from a Thai patient with imported trichinellosis. Am J Trop Med Hyg. 2011 Jun. 84(6):994-7. [Medline]. [Full Text].

  18. Rosenblatt JE. Laboratory diagnosis of infections due to blood and tissue parasites. Clin Infect Dis. 2009 Oct 1. 49(7):1103-8. [Medline].

  19. Centers for Disease Control and Prevention. Laboratory Identification of Parasitic Diseases of Public Health Concern. CDC. Available at http://www.cdc.gov/dpdx/trichinellosis/dx.html. Accessed: November 29, 2013.

  20. Escalante M, Romaris F, Rodriguez M, et al. Evaluation of Trichinella spiralis larva group 1 antigens for serodiagnosis of human trichinellosis. J Clin Microbiol. 2004 Sep. 42(9):4060-6. [Medline]. [Full Text].

  21. Morakote N, Sukhavat K, Khamboonruang C, Siriprasert V, Suphawitayanukul S, Thamasonthi W. Persistence of IgG, IgM, and IgE antibodies in human trichinosis. Trop Med Parasitol. 1992 Sep. 43(3):167-9. [Medline].

  22. Watt G, Saisorn S, Jongsakul K, et al. Blinded, placebo-controlled trial of antiparasitic drugs for trichinosis myositis. J Infect Dis. 2000 Jul. 182(1):371-4. [Medline].

  23. Centers for Disease Control and Prevention. Parasites – Trichinellosis (also known as Trichinosis), Prevention and Control. CDC. Available at http://www.cdc.gov/parasites/trichinellosis/prevent.html. Accessed: December 13, 2013.

  24. Neghina R, Iacobiciu I, Neghina AM, Marincu I. Trichinellosis, another helminthiasis affecting the central nervous system. Parasitol Int. 2011 Jun. 60(2):230. [Medline].

  25. Aronson SM. A tale of an inconsequential worm. Med Health R I. 1999 Oct. 82(10):347. [Medline].

  26. Astudillo LM, Arlet PM. Images in clinical medicine. The chemosis of trichinosis. N Engl J Med. 2004 Jul 29. 351(5):487. [Medline].

  27. Barennes H, Sayasone S, Odermatt P, De Bruyne A, Hongsakhone S, Newton PN, et al. A major trichinellosis outbreak suggesting a high endemicity of Trichinella infection in northern Laos. Am J Trop Med Hyg. 2008 Jan. 78(1):40-4. [Medline].

  28. Bruschi F. Trichinellosis in developing countries: is it neglected?. J Infect Dev Ctries. 2012 Mar 12. 6(3):216-22. [Medline].

  29. Bruschi F, Chiumiento L. Trichinella inflammatory myopathy: host or parasite strategy?. Parasit Vectors. 2011 Mar 23. 4:42. [Medline]. [Full Text].

  30. Bruschi F, Korenaga M, Watanabe N. Eosinophils and Trichinella infection: toxic for the parasite and the host?. Trends Parasitol. 2008 Oct. 24(10):462-7. [Medline].

  31. CDC. Trichinellosis associated with bear meat--New York and Tennessee, 2003. MMWR Morb Mortal Wkly Rep. 2004 Jul 16. 53(27):606-10. [Medline].

  32. De Bruyne A, Ancelle T, Vallee I, Boireau P, Dupouy-Camet J. Human trichinellosis acquired from wild boar meat: a continuing parasitic risk in France. Euro Surveill. 2006. 11(9):E060914.5. [Medline].

  33. Dubey ML, Khurana S, Singhal L, Dogra S, Singh S. Atypical trichinellosis without eosinophilia associated with osteomyelitis. Trop Doct. 2011 Oct. 41(4):244-6. [Medline].

  34. Dupouy-Camet J, Lecam S, Talabani H, Ancelle T. Trichinellosis acquired in Senegal from warthog ham, March 2009. Euro Surveill. 2009 May 28. 14(21):[Medline].

  35. Feigin RD, Cherry JD. Parasitic myocarditis. Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders Co; 2004. 407-9.

  36. Gamble HR, Pozio E, Bruschi F, et al. International Commission on Trichinellosis: recommendations on the use of serological tests for the detection of Trichinella infection in animals and man. Parasite. 2004 Mar. 11(1):3-13. [Medline].

  37. Golab E, Szulc M, Wnukowska N, Rozej W, Fell G, Sadkowska-Todys M. Outbreak of trichinellosis in North-Western Poland--update and exported cases, June-July 2007. Euro Surveill. 2007 Jul. 12(7):E070719.2. [Medline].

  38. Gomez-Morales MA, Ludovisi A, Amati M, Cherchi S, Pezzotti P, Pozio E. Validation of an enzyme-linked immunosorbent assay for diagnosis of human trichinellosis. Clin Vaccine Immunol. 2008 Nov. 15(11):1723-9. [Medline].

  39. Gotistein B, Piarroux R. Current trends in tissue-affecting helminths. Parasite. 2008 Sep. 15(3):291-8. [Medline].

  40. Gottstein B, Pozio E, Nöckler K. Epidemiology, diagnosis, treatment, and control of trichinellosis. Clin Microbiol Rev. 2009 Jan. 22(1):127-45, Table of Contents. [Medline]. [Full Text].

  41. Hall RL, Lindsay A, Hammond C, Montgomery SP, Wilkins PP, da Silva AJ. Outbreak of human trichinellosis in Northern California caused by Trichinella murrelli. Am J Trop Med Hyg. 2012 Aug. 87(2):297-302. [Medline].

  42. Hidron A, Vogenthaler N, Santos-Preciado JI, Rodriguez-Morales AJ, Franco-Paredes C, Rassi A Jr. Cardiac involvement with parasitic infections. Clin Microbiol Rev. 2010 Apr. 23(2):324-49. [Medline].

  43. Ilic N, Gruden-Movsesijan A, Sofronic-Milosavljevic L. Trichinella spiralis: shaping the immune response. Immunol Res. 2012 Apr. 52(1-2):111-9. [Medline].

  44. Jansen A, Schoneberg I, Stark K, Nockler K. Epidemiology of trichinellosis in Germany, 1996-2006. Vector Borne Zoonotic Dis. 2008 Apr. 8(2):189-96. [Medline].

  45. Kaewpitoon N, Kaewpitoon SJ, Philasri C, et al. Trichinosis: epidemiology in Thailand. World J Gastroenterol. 2006 Oct 28. 12(40):6440-5. [Medline].

  46. Kociecka W. Trichinellosis: human disease, diagnosis and treatment. Vet Parasitol. 2000 Dec 1. 93(3-4):365-83. [Medline].

  47. Lazarevic AM, Neskovic AN, Goronja M, et al. Low incidence of cardiac abnormalities in treated trichinosis: a prospective study of 62 patients from a single-source outbreak. Am J Med. 1999 Jul. 107(1):18-23. [Medline].

  48. Lindh J, Ljungstrom I. Trichinella spp. Akuffo H, Linder E, Ljungstrom I, Wahlgren M. Parasites of the Colder Climates. London and New York: Taylor & Francis; 2003. 195-204.

  49. Long SS, Pickering LK, Prober CG. Trichinella spiralis. Pediatric Infectious Diseases. 2003. 1344-46.

  50. Madariaga MG, Cachay ER, Zarlenga DS. A probable case of human neurotrichinellosis in the United States. Am J Trop Med Hyg. 2007 Aug. 77(2):347-9. [Medline].

  51. Mandell GL, Bennett JE, Dolin RD. Tissue nematodes, including trichinosis, dracunculiasis, and the filariases. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Philadelphia, Pa: Churchill Livingstone; 2005. 3267-76.

  52. Marva E, Markovics A, Gdalevich M, et al. Trichinellosis outbreak. Emerg Infect Dis. 2005 Dec. 11(12):1979-81. [Medline].

  53. McIntyre L, Pollock SL, Fyfe M, Gajadhar A, Isaac-Renton J, Fung J. Trichinellosis from consumption of wild game meat. CMAJ. 2007 Feb 13. 176(4):449-51. [Medline].

  54. Mitreva M, Jasmer DP. Biology and genome of Trichinella spiralis. WormBook. 2006 Nov 23. 1-21. [Medline].

  55. Murrell KD, Bruschi F. Clinical trichinellosis. Prog Clin Parasitol. 1994. 4:117-50. [Medline].

  56. Neghina R, Moldovan R, Marincu I, Calma CL, Neghina AM. The roots of evil: the amazing history of trichinellosis and Trichinella parasites. Parasitol Res. 2011 Oct 8. [Medline].

  57. Neghina R, Neghina AM. Reviews on trichinellosis (IV): hepatic involvement. Foodborne Pathog Dis. 2011 Sep. 8(9):943-8. [Medline].

  58. Outbreak of trichinellosis in French hunters who ate Canadian black bear meat. Can Commun Dis Rep. 2006 May 1. 32(9):109-12. [Medline].

  59. Ozdemir D, Ozkan H, Akkoc N, et al. Acute trichinellosis in children compared with adults. Pediatr Infect Dis J. 2005 Oct. 24(10):897-900. [Medline].

  60. Papatsiros VG, Boutsini S, Ntousi D, Stougiou D, Mintza D, Bisias A. Detection and zoonotic potential of Trichinella spp. from free-range pig farming in Greece. Foodborne Pathog Dis. 2012 Jun. 9(6):536-40. [Medline].

  61. PDR. Physician's Desk Reference. Montvale, NJ: Thomson Healthcare; 2000.

  62. Pozio E, Darwin Murrell K. Systematics and epidemiology of trichinella. Adv Parasitol. 2006. 63:367-439. [Medline].

  63. Pozio E, Gomez Morales MA, Dupouy-Camet J. Clinical aspects, diagnosis and treatment of trichinellosis. Expert Rev Anti Infect Ther. 2003 Oct. 1(3):471-82. [Medline].

  64. Pozio E, Hoberg E, La Rosa G, Zarlenga DS. Molecular taxonomy, phylogeny and biogeography of nematodes belonging to the Trichinella genus. Infect Genet Evol. 2009 Jul. 9(4):606-16. [Medline].

  65. Taratuto AL, Venturiello SM. Trichinosis. Brain Pathol. 1997 Jan. 7(1):663-72. [Medline].

  66. Taylor WR, Tran GV, Nguyen TQ, Dang DV, Nguyen VK, Nguyen CT, et al. Acute Febrile Myalgia in Vietnam due to Trichinellosis following the Consumption of Raw Pork. Clin Infect Dis. 2009 Aug 27. [Medline].

  67. Tint D, Cocuz ME, Ortan OF, Niculescu MD, Radoi M. Cardiac involvement in trichinellosis: a case of left ventricular thrombosis. Am J Trop Med Hyg. 2009 Aug. 81(2):313-6. [Medline].

  68. Turk M, Kaptan F, Turker N, et al. Clinical and laboratory aspects of a trichinellosis outbreak in Izmir, Turkey. Parasite. 2006 Mar. 13(1):65-70. [Medline].

  69. Watt G, Silachamroon U. Areas of uncertainty in the management of human trichinellosis: a clinical perspective. Expert Rev Anti Infect Ther. 2004 Aug. 2(4):649-52. [Medline].

  70. Youn H. Review of zoonotic parasites in medical and veterinary fields in the Republic of Korea. Korean J Parasitol. 2009 Oct. 47 Suppl:S133-41. [Medline]. [Full Text].

 
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