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Trichinosis Follow-up

  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Burke A Cunha, MD  more...
 
Updated: Nov 16, 2015
 

Further Outpatient Care

Patients need continued monitoring because clinical improvement is slow.

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Further Inpatient Care

Inpatient care is rarely needed.

Consider trichinosis in cases of heavy infection with evidence of shock, encephalitis, myocarditis, or pneumonitis.

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Inpatient & Outpatient Medications

See the list below:

  • Analgesics
  • Antipyretics
  • Anthelmintic medication for severe infections
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Transfer

Transfer to another level of care is rarely needed unless the diagnosis is in question or severe sequelae are present.

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Complications

Long-term sequelae of the CNS include decreased mental power, numbness of hands and feet, decreased stress tolerance, loss of initiative, and depression.

Usually, full recovery occurs after cardiac or pulmonary involvement.

Prolonged weakness and myalgias may occur.

Adrenal gland insufficiency may occur.

Obstruction of blood vessels may occur.

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Prognosis

Severe disease develops in only 5%-20% of patients during epidemics.

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Patient Education

Adequate cooking and freezing methods prevent infections.

The most effective measure to eradicate Trichinella species is by adequate cooking to kill the parasite. The current recommendation for heating is 160°F (71°C) for all food-borne disease. Trichinella species can typically be killed by adequate cooking to 140°F (60°C) for 2 minutes or 131°F (55°C) for 6 minutes. If no trace of pink in fluid or flesh is found, these temperatures have been reached.

Freezing is also an effective method for killing most species of Trichinella. For a 6-inch piece of meat, the recommended temperatures to kill larvae are as follows:

  • 5°F (-15°C) for 20 days
  • -10°F (-23°C) for 10 days
  • -20°F (-29°C) for 6 days

Salting, smoking, or drying the meat does not kill cysts.

Excellent patient education resources regarding the esophagus, stomach, and intestine are available at eMedicineHealth's Digestive Disorders Center. Patient education material specific to diarrhea is found in the article Diarrhea. Patient education material specific to vomiting and nausea is found in the article Vomiting and Nausea.

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Contributor Information and Disclosures
Author

Darvin Scott Smith, MD, MSc, DTM&H Adjunct Associate Clinical Professor, Department of Microbiology and Immunology, Stanford University School of Medicine; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Redwood City Hospital

Darvin Scott Smith, MD, MSc, DTM&H is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Lauren E Wedekind Stanford University

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Stephanie A Nevins Research Assistant, Department of Genetics, Snyder Lab, Stanford University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Clinton Murray, MD Program Director, Infectious Disease Fellowship, San Antonio Uniformed Services Health Education Consortium

Clinton Murray, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Association of Military Surgeons of the US, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Trichinellosis is acquired by ingesting meat containing cysts (encysted larvae) of Trichinella. After exposure to gastric acid and pepsin, the larvae are released from the cysts and invade the small bowel mucosa, where they develop into adult worms (females, 2.2 mm in length; males, 1.2 mm; 4-week life span in the small bowel). After 1 week, the females release larvae that migrate to the striated muscles, where they encyst. Trichinella pseudospiralis, however, does not encyst. Encystment is completed in 4-5 weeks, and the encysted larvae may remain viable for several years. Ingestion of the encysted larvae perpetuates the cycle. Rats and rodents are primarily responsible for maintaining the endemicity of this infection. Carnivorous/omnivorous animals, such as pigs or bears, feed on infected rodents or meat from other animals. Different animal hosts are implicated in the life cycle of the different species of Trichinella. Humans are accidentally infected when eating improperly processed meat of these carnivorous animals (or eating food contaminated with such meat). Life cycle image and information courtesy of DPDx.
Cumulative number* of patients with trichinellosis, by sex and age group, in the United States 2002-2007. (*N = 52 years. Age was unknown for one patient, and sex was unknown for another patient.) Courtesy of the US Centers for Disease Control and Prevention (http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5809a1.htm).
Encysted larvae of Trichinella species in muscle tissue, stained with hematoxylin and eosin (H&E). The image was captured at 400X magnification. Courtesy of the US Centers for Disease Control and Prevention (http://www.dpd.cdc.gov/dpdx/HTML/Trichinellosis.htm).
Trichinella larvae, in pressed bear meat, partially digested with pepsin. Courtesy of the US Centers for Disease Control and Prevention ((http://www.dpd.cdc.gov/dpdx/HTML/Trichinellosis.htm).
Larvae of Trichinella from bear meat. Courtesy of the US Centers for Disease Control and Prevention (http://www.dpd.cdc.gov/dpdx/HTML/Trichinellosis.htm).
Table 1. Biologic and Zoogeographic Features of Trichinella Species
SpeciesDistributionMajor HostsReported from Humans
T spiralisCosmopolitanDomestic pigs, wild mammalsYes
T britoviEurasia/AfricaWild mammalsYes
T murrelliNorth AmericaWild mammalsYes
T nativaArctic/subarctic, PalaearcticBears, foxesYes
T nelsoniEquatorial AfricaHyenas, felidsYes
T pseudospiralis *CosmopolitanWild mammals, birdsYes
T papuae *Papua New Guinea, ThailandPigs, crocodilesYes
T zimbabwensis *East and South AfricaCrocodiles, lizards, lionsNo
* Nonencapsulating types   
Table 2. Number of Trichinellosis Cases and Outbreak Cases, by Reporting State -- United States, 2002--2007[4]
State200220032004200520062007Total Outbreak cases
Alaska700300108
California021241102
Florida00011020
Illinois10000010
Maryland00001010
Massachusetts00010010
Michigan00030030
Minnesota00003032
New Hampshire01000010
New Jersey00002130
New York01000342
North Dakota00200020
Ohio00010010
Pennsylvania10130050
Rhode Island00110020
Tennessee02001032
Vermont10000010
Washington00001010
Total1065151355416
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