Pediatric Trichinosis Follow-up

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 10, 2012
 

Further Inpatient Care

  • Hospitalize all patients with trichinosis who have severe and moderately severe disease and all pregnant women, regardless of disease severity, for monitoring and treatment of complications.
  • Hospitalization is also indicated for fluid and electrolyte management and for analgesia.
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Further Outpatient Care

  • Symptoms such as myalgias and headaches may persist long after the acute stage of disease has ended. Treatment with anthelminthic therapy during the acute stage has affected these late-stage symptoms.
  • Treatment is entirely symptomatic.
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Deterrence/Prevention

Controlling infection in swine

Many countries have regulations that prohibit feeding raw abattoir scraps to domesticated pigs and that require inspection of commercial meat for Trichinella species.

Infection in pigs also results from scavenging on infected rodent populations. Controlling rodent populations decreases the prevalence of infection in pigs.

Meat preparation

Proper cooking of meat is the most effective method to prevent infection. Larvae are destroyed by cooking meat until no trace of pink fluid or flesh remains; this occurs at about 60°C for 10 minutes. To allow a margin of error, the recommended internal temperature of meat should be raised uniformly to about 70°C. Cooking in microwave ovens does not effectively prevent infection because it does not sufficiently heat all parts of the meat.

Larvae in pork products are also destroyed by freezing at -30°C for 1 week or at -15°C for 3 weeks. Note, however, that the meat of some wild animals (eg, bear, fox) possesses an antifreeze molecule that protects the larvae from the killing effects of extreme cold temperatures.

Smoked or salted meat may contain viable parasites.

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Complications

Clinical disease due to Trichinella species is classified based on the severity and likelihood of complications. The following classification also helps in management and prognosis:

  • Severe disease - Full syndrome of highly pronounced systemic signs and symptoms with metabolic disturbances (eg, hypoalbuminemia) and circulatory or neurologic complications
  • Moderately severe disease - Full syndrome of significant intensity, rarely with complications
  • Benign disease - Full syndrome of low-intensity signs and symptoms and no complications
  • Abortive disease - Signs and symptoms that appear individually and not as a syndrome
  • Asymptomatic infection - A history of exposure associated with eosinophilia but without signs and symptoms

Complications occur in the early or acute stages of severe or, occasionally, in moderately severe trichinosis and can usually be prevented if patients receive adequate treatment during early stages of the disease.

  • Cardiac: Although T spiralis larvae do not become encapsulated in heart muscle tissue, focal cellular infiltrates, consisting mainly of eosinophils and mononuclear cells, are observed because of their transitory stay in the heart. The changes are more extensive 4-8 weeks after ingestion. Arrhythmias and heart failure may occur in exceptionally heavy infection. A prospective study showed cardiac involvement in 13% of patients, almost all of which consisted of nonspecific ST-T changes and minimal effusions without impairment of systolic function.
  • Pulmonary: Patients with lung involvement can present with pneumonitis or bronchitis.
  • CNS: In cases of very severe infection, migrating larvae may penetrate cerebral tissues from blood vessels. Patients may present with obtundation or excessive excitement. Some present with signs of meningitis.[16]
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Prognosis

  • Trichinosis is usually a self-limited illness, but death sometimes occurs if the number of infective larvae ingested is large.
  • Early treatment helps prevent complications during the acute stage.
  • Despite adequate treatment in the acute stage, infection may have long-lasting sequelae (eg, muscle aches, headaches, eye disturbances), especially in severe cases.
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Patient Education

The key to preventing trichinosis is public education about the potential danger of eating any raw meat product, especially the meat of wild game animals.

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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Coauthor(s)

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.

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.

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

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.

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.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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, and Southern Medical Association

Disclosure: Nothing to disclose.

References

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

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

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

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

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

  6. 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. May 2011;30(5):392-5. [Medline].

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

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

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

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

  11. 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. Jun 2010;104(6):433-7. [Medline].

  12. 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. Jun 2011;84(6):994-7. [Medline]. [Full Text].

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

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

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

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

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

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

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

  20. 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. Jan 2008;78(1):40-4. [Medline].

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

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

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

  24. 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].

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

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

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

  28. 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. Mar 2004;11(1):3-13. [Medline].

  29. 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. Jul 2007;12(7):E070719.2. [Medline].

  30. 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. Nov 2008;15(11):1723-9. [Medline].

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

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

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

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

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

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

  37. 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. Jul 1999;107(1):18-23. [Medline].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  55. 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. Aug 27 2009;[Medline].

  56. 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. Aug 2009;81(2):313-6. [Medline].

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

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

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

 
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