Trichinosis Treatment & Management

  • Author: Clinton Murray, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 4, 2010
 

Medical Care

In moderate-to-heavy Trichinella infections, the goal is to stop the larval invasion into the host muscle.[8, 9, 10, 11]

  • Within 1 week of ingestion of contaminated meat, administer albendazole (5 mg/kg/d for 1 wk), mebendazole (5 mg/kg/d for 8-14 d), or thiabendazole (25 mg/kg/d for 8-14 d).
    • This drug is effective against worms limited to the intestinal lumen.
    • The goal is to prevent systemic invasion.
    • Thiabendazole does not affect tissue larvae.
  • If tissue invasion occurs, the aim of therapy is to decrease subsequent muscle damage.
    • The most effective treatment modalities include bed rest, analgesics, and antipyretics.
    • Anthelmintic therapy has no proven role at this stage. Albendazole appears to be marginally effective and mebendazole less so. A trial of albendazole is justified in severe or prolonged infections. Avoid thiabendazole at this stage because of its adverse-effect profile.
    • Prednisone at 50 mg/d can be used in severe infections, especially if hemodynamic instability or involvement of the central nervous, cardiac, or pulmonary systems is present.
    • Steroids may decrease inflammation but may also hinder the eradication of the adult worm, resulting in a prolonged production of larvae.
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Surgical Care

A muscle biopsy is necessary only if the diagnosis is unclear after equivocal clinical, laboratory, or serologic testing.

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Consultations

  • Infectious disease specialist
  • Cardiologist, if evidence of cardiac involvement
  • Neurologist, if evidence of neurologic involvement
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Diet

No diet limitations are indicated; however, this is an excellent opportunity to educate patients regarding the avoidance of potentially infected meats and how to properly cook and store foods.

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Activity

For severe infections, bed rest is recommended. This is especially important upon evidence of myocardial involvement because patients may deteriorate clinically during ambulation.

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Contributor Information and Disclosures
Author

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.

Specialty Editor Board

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

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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 and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and 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, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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Trichinosis. Life cycle of Trichinella species parasite. (Image courtesy of the CDC)
Table. Important Characteristics of Trichinella Species
Species Distribution Major Host Reservoir Infectivity Resistance to Freezing
T spiralis (T1)CosmopolitanSwine, wild boar, bear, horse, foxHighNone
Trichinella nativa (T2)ArcticBear, horseHighHigh
Trichinella britovi (T3)TemperateWild boar, horseModerateNone
Trichinella pseudospiralis (T4)CosmopolitanBirds, omnivorous mammalsModerateNone
Trichinella murrelli (T5)Temperate, near arcticBearLowLow
Trichinella nelsoni (T7)TropicalWarthogHighNone
Trichinella papuae (T10)Papua New GuineaWarthogModerateNone
Trichinella zimbabwensis (T11)Central AfricaCrocodilesUnknownNone
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