Pediatric Trichinosis Workup

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

Laboratory Studies

The following studies are indicated in trichinosis:

CBC count

Eosinophilia is almost universal and is among the earliest laboratory findings. Eosinophilia begins approximately 10 days after ingestion and may reach a peak of 5000/µL by 3-4 weeks after ingestion.

Counts remain elevated during the acute stage of infection, regress slowly, and may remain elevated at lower levels for 3 months postinfection.

An extremely severe course of trichinosis is accompanied by eosinopenia, a manifestation of immunosuppression.

Leukocytosis is also typical and appears early in infection. The condition subsides before eosinophil counts return to the reference range.

Serologic studies [13]

The anterior half of the larva presents stichosomes with discoid cells (ie, stichocytes), which are secretory, and their product is highly antigenic. Antigen preparations may be crude homogenates of T spiralis muscle larvae or excretory-secretory products produced by cultured larvae. The T spiralis larvae group 1 of larval secretory antigens are common in all Trichinella species and can be used to detect infection with any species.[14]

These test results are not positive until at least 2 weeks after ingestion. Larger numbers of infecting larvae cause faster antibody response in patients.

Immunoglobulin E (IgE)–class antibodies appear first and are typical for the acute stage of the disease, but they are seldom detected during the acute stage because their half-life in serum is relatively short.

Tests based on immunoglobulin G (IgG)–specific antibodies are most sensitive (100% 50 d after ingestion). However, IgG antibodies can persist for years after infection, even if the disease has been benign or asymptomatic; therefore, a rising titer is needed to establish the diagnosis of acute infection.

Antibodies can be detected using enzyme immunoassay (EIA) or the bentonite flocculation (BF) test. An EIA detects antibodies earlier than the BF test, and results also remain positive for longer periods than the BF test. However, EIA results are less specific than those of the BF test.

EIA is used for routine screening. Test all EIA-positive specimens using the BF test for confirmation. A positive result by both tests indicates a Trichinella infection within the last several years.

Muscle enzymes

Muscle enzyme, creatine kinase (CK), and lactate dehydrogenase (LDH) levels are elevated in approximately 75-90% of cases.

CK levels may increase as much as 10-fold, whereas the rise in LDH levels is less. Neither serum level correlates with the severity of clinical disease.

Serum albumin

Hypoalbuminemia is a marker for severe trichinosis.

Next

Imaging Studies

  • Plain radiography may show calcified densities in soft tissues, indicating old infection, but is not useful in diagnosing acute infection.
  • In patients with CNS involvement, brain CT scanning using ring enhancement following intravenous contrast reveals multiple small hypodense lesions in the hemispheric white matter.
Previous
Next

Other Tests

  • Stool examination: Charcot-Leyden crystals from eosinophils may be found in stools. Ova are not found in stools; larvae are rarely found in stools.
  • Antigen detection: Circulating antigens can be detected by EIA or immunoradiometric assay and by monoclonal antibodies specific for antigens obtained from T spiralis muscle larvae, although these tests are not typically used for diagnosis.
  • Polymerase chain reaction: In cases in which the diagnosis is questionable (eg, atypical presentations or patients who are immunosuppressed) or in early stages of infection when other test results are negative (eg, serologic studies), polymerase chain reaction testing used to detect Trichinella- specific DNA in muscle biopsy and blood specimens is valuable.
Previous
Next

Procedures

  • Muscle biopsy is usually unnecessary. However, in cases in which the diagnosis is in question, a sample obtained from a tender swollen muscle may confirm the diagnosis using parasitologic or histologic studies.
  • Electromyography reveals changes of the myopathic type during the acute stage, but these changes are not pathognomonic for trichinosis. In most patients, bioelectric disturbances correspond in severity to the clinical course.
Previous
Next

Histologic Findings

  • Basophilic transformation of muscle fibers occurs within 4-5 days after larval penetration and is a valuable diagnostic criterion, even in cases in which no larvae can be demonstrated.
  • Basophilic transformation affects only a portion of the affected muscle fiber, which becomes the so-called nurse cell.
  • Myofibrils disappear, the sarcoplasm becomes basophilic, and the cell nucleus is displaced to the center of the cell.
  • The larva can be observed within the affected nurse cell.
  • Attempting diagnosis before larvae begin to coil (ie, < 2 wk after larvae enter the muscle cell) creates a risk of confusing the worm with fragments of muscle tissue.
  • Encapsulation begins approximately 2 weeks after ingestion. The capsule contains the larva and fragments of basophilically transformed sarcoplasm that directly surround the larva.
  • Infiltration by eosinophils and mononuclear cells also occurs.
  • The absence of a capsule and the presence of a straight larva in the complex indicate ongoing infection.
Previous
Proceed to Treatment & Management
 
 
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].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.