Pediatric Trichinosis Follow-up

Updated: Aug 14, 2018
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Follow-up

Further Outpatient Care

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  • 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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Further Inpatient Care

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  • Hospitalize all patients with trichinosis who have severe and moderately severe disease. All pregnant women, regardless of disease severity, should be hospitalized for monitoring and treatment of complications. There is an increased risk of fetal loss with maternal infection.

  • Hospitalization is also indicated for fluid and electrolyte management and for pain control.

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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

The best way to prevent trichinosis is to adequately cook meat to a safe temperature before consuming. Meat should not be sampled until it is cooked. A food thermometer should be used to measure the internal temperature of cooked meat.

The United States Department of Agriculture (USDA) recommends the following guidelines for proper meat preparation.

  • For Whole Cuts of Meat (excluding poultry and wild game). Cook to at least 145° F (63°C), as measured by a food thermometer placed into the thickest part of the meat; then allow the meat to rest for 3 minutes before carving or consuming.

  • For Ground Meat (including wild game, excluding poultry): Cook to at least 160° F (71°C).

  • For All Wild Game (whole cuts and ground): Cook to at least 160° F (71°C).

  • Curing (salting), drying, or smoking meat alone does not consistently kill infective worms. Based on reports to the CDC, consuming homemade jerky and sausage have caused many cases of trichinosis.

  • Cooking meats in microwave ovens does not effectively prevent infection because microwave cooking does not sufficiently heat all parts of the meat. [26]

Alternatively, freezing pork less than 6 inches thick for 7 days at -22°F (-30°C) or at 20 days at 5°F (-15°C) will kill any larvae/worms. Freezing wild game meats, unlike freezing pork products, may not effectively kill all larvae because some Trichinella species that infect wild game animals (eg, bear, seal, walrus) are freeze-resistant. These species possess an antifreeze molecule that protects the larvae from the harming and killing effects of extreme cold temperatures.

Additional points:

  • Thoroughly wash hands with warm water and soap after handling raw meat.

  • Properly clean meat grinders after each use.

  • To help prevent Trichinella infection in animal populations, do not allow pigs or wild animals to eat uncooked meat, scraps, or carcasses of any animals, including rats, which may be infected with Trichinella. [26]

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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 patient management and prognosis:

  • Asymptomatic infection - A history of exposure associated with eosinophilia but without signs and symptoms

  • Abortive disease - Signs and symptoms that appear individually and not as a syndrome

  • Benign disease - Full syndrome of low-intensity signs and symptoms and no complications

  • Moderately severe disease - Full syndrome of significant intensity, rarely with complications

  • Severe disease - Full syndrome of highly pronounced systemic signs and symptoms with metabolic disturbances (eg, hypoalbuminemia) and circulatory or neurologic complications

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 medical and pharmaceutical 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 due to their transitory stay in the heart. Cardiac muscle 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 pericardial effusions without impairment of systolic function.

  • Pulmonary: Patients with lung involvement can present with pneumonitis or bronchitis.

  • Central neurologic: 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. [27]

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Prognosis

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  • 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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