Medication Summary

Anthelminthic therapy is generally considered only effective during the intestinal phase of infection. Because of the limited number of cases in any one outbreak, comparative trials at various stages of infection are lacking, leading to controversy regarding appropriate dosing and effectiveness in the muscle phase of the disease.^[71]One trial during an outbreak in Italy assessed the effectiveness of mebendazole in patients several weeks following infection.^[72]All patients became better in terms of decreased myalgias and other symptoms while under treatment, but between 3 and 45% had recurrence of various symptoms following a 10-day mebendazole course. In another study in Thailand, groups treated with mebendazole or thiabendazole had 100% resolution of myalgias reported at 4 months.^[28]A review of experience in Romania revealed a better response among children with albendazole than in adults and a better result in both children and adults with albendazole than mebendazole.^{[73, 74]}

Corticosteroid treatment usually is instituted to reduce the immunologic response to the larvae. Jarisch-Herxheimer–like reactions have been described in patients with heavy larval loads following the administration of anthelmintic medications. This reaction is clinically manifested by a worsening of symptoms and is thought to be caused by a response to liberation of immunologically active components of the dying larvae. If the larval load is extremely high or in critical locations, this reaction may result in significant clinical deterioration resembling septic shock.

In the study in Romania, patients treated with corticosteroids and albendazole experienced longer hospitalizations than those treated with albendazole alone. The study does not specify what clinical parameters were used to determine timing of hospital discharge because it was a retrospective population study. A different study of an outbreak in Turkey due to T britovi reported more rapid improvement in symptoms and laboratory values in patients given prednisolone along with either mebendazole or albendazole.^[75]

Increasing resistance to helminths has led to investigation of potential new treatments. Investigators have demonstrated activity of different Artemisia species, effective against malaria, on Trichinella in animal models.^[76]

Class Summary

These agents are frequently used to decrease myalgia and to limit eosinophilia when neurologic or myocardial involvement is present, although their efficacy and safety has been questioned.^[4]

Prednisone (Deltasone, Orasone)

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Useful in treating inflammatory reactions. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Hydrocortisone (Solu-Cortef, Westcort)

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May be used in place of prednisone in patients too ill to take PO medications. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing the increased capillary permeability.

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Mebendazole (Vermox)

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Causes worm death by selectively and irreversibly blocking cell division and intestinal glucose uptake and in the adult.

Albendazole (Albenza)

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Decreases ATP production in the worm, causing worms' energy depletion, immobilization, and death.

Follow-up

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Media Gallery

Life cycle of Trichinella species parasite. Image courtesy of the Centers for Disease Control and Prevention.
Photomicrograph depicting numbers of Trichinella spiralis cysts seen embedded in a muscle tissue specimen, in a case of trichinellosis. Image courtesy of the Centers for Disease Control and Prevention.

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Author

L Kristian Arnold, MD, MPH Chief Medical Officer, ArLac Global Health Services, Lexington, MA; Medical Director, Boston Police Department; Assistant Professor (Retired), Emergency Medicine, Boston University School of Medicine

L Kristian Arnold, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, American College of Occupational and Environmental Medicine

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.

Mark L Plaster, MD, JD Executive Editor, Emergency Physicians Monthly

Mark L Plaster, MD, JD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Received ownership interest from M L Plaster Publishing Co LLC for management position.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, Society for Academic Emergency Medicine, Council of Residency Directors in Emergency Medicine, Clerkship Directors in Emergency Medicine, Alliance for Clinical Education

Disclosure: Nothing to disclose.

Acknowledgements

I would like to thank the many primary level researchers from around the globe who helped me improve my understanding through email communications, sharing pdf and hard copies of publications to which I did not have direct access and encouraging me for the value of this "offbeat" Emergency Medicine topic. Thank you, Domo Arigato, Merci Beaucoup, Molto Gracie.

Sections Trichinellosis/Trichinosis
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References

Trichinellosis/Trichinosis Medication

Medication Summary

Glucocorticoids