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==Overview==
==Overview==
If left untreated, patients with trichinosis may progress to develop [[periorbital edema]], [[muscle pain]], and [[fever]].<ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref><ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref> [[Complications]] of trichinosis affect the [[cardiovascular]], [[neurological]], [[ocular]], [[respiratory]] and [[Digestive system|digestive systems]].<ref name="abc">FAO/WHO/OIE Guidelines for the surveillance, management, prevention and control of trichinellosis. FAO (2007). http://www.fao.org/documents/card/en/c/61e00fb1-87e8-5b89-8be1-50481e43eed1/ Accessed on January 28, 2016 </ref> Most people with trichinosis have no [[symptoms]], the [[infection]] goes away by itself. The [[prognosis]] of trichinosis is good with treatment.<ref name="bb">Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016  </ref> The most dangerous case is worms entering the [[central nervous system]]. They cannot survive there, but they may cause enough damage to produce serious [[Neurological disorders|neurological deficits]] (such as [[ataxia]] or respiratory paralysis), and even death. Infestation of the [[heart]] may also lead to death.<ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref>
If left untreated, infected patients develop manifestations within 1-2 days of infection. Infected patients with trichinosis may progress to develop [[periorbital edema]], [[muscle pain]], and [[fever]].<ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref><ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref> Complications of trichinosis affect the [[cardiovascular]], [[neurological]], [[ocular]], [[respiratory|respiratory,]] and [[Digestive system|digestive systems]].<ref name="abc">FAO/WHO/OIE Guidelines for the surveillance, management, prevention and control of trichinellosis. FAO (2007). http://www.fao.org/documents/card/en/c/61e00fb1-87e8-5b89-8be1-50481e43eed1/ Accessed on January 28, 2016 </ref> Most people with trichinosis have no symptoms, the infection is usually self-limited. The prognosis of trichinosis is good with adequate treatment.<ref name="bb">Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016  </ref>  


==Natural History==
==Natural History==
*The [[symptoms]] vary depending on the phase, species of [[Trichinella]], amount of encysted larvae ingested, [[age]], gender, and host immunity.
*Trichinosis is usually self-limited, and the majority of individuals with trichinosis are asymptomatic.
*Patients infected by 10 or less larvae have either minor or no [[symptoms]] and no [[complications]].
*The symptoms vary depending on the phase, species of [[Trichinella|''Trichinella'']], amount of encysted larvae ingested, age, gender, and host immunity.
*''Enteral/Intestinal phase'':
*Patients infected by 10 or less larvae have either minor or no symptoms and no complications.
**From two to seven days after [[infection]].
**The large burden of adult worms in the [[intestines]] promote [[symptoms]] such as [[nausea]], [[heartburn]], [[dyspepsia]], and [[diarrhea]].
*''Parenteral/muscle phase'':
**Seven days after [[infection]].
**The severity of [[symptoms]] caused by larval migration from the [[intestines]] depends on the number of larvae produced.
**As the larvae migrate through [[tissue]] and [[vessels]], the body's inflammatory response results in: [[edema]], [[muscle pain]], [[fever]], and [[Weakness (medical)|weakness]].
**A classic sign of trichinosis is [[periorbital edema]], [[Periorbital edema|swelling around the eyes]], which may be caused by [[vasculitis]].
**[[Splinter hemorrhage]] in the nails is also a common symptom.
**If left untreated, the worms may cause enough damage to produce serious [[Neurological disorders|neurological deficits]] (such as [[ataxia]] or respiratory paralysis) from worms entering the [[central nervous system]] (CNS).
**The [[CNS]] is compromised by trichinosis in 10–24% of reported cases of [[cerebral venous sinus thrombosis]], a very rare form of [[stroke]] (3-4 cases per million annual incidence in adults).
**Trichinosis can be fatal depending on the severity of the [[infection]]; death can occur 4–6 weeks after the [[infection]], and is usually caused by [[myocarditis]], [[encephalitis]], or [[pneumonia]].<ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref><ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref>


=== ''Enteral/Intestinal phase:'' ===
*From two to seven days after infection.
*The large burden of adult worms in the intestines promote symptoms such as [[nausea]], [[heartburn]], [[dyspepsia]], and [[diarrhea]].
=== ''Parenteral/muscle phase:'' ===
*The parental phase starts approximately seven days after infection.
*The severity of symptoms caused by larval migration from the intestines depends on the number of larvae produced.
*As the larvae migrate through tissue and [[vessels]], the body's inflammatory response results in [[edema]], [[muscle pain]], [[fever]], and [[Weakness (medical)|weakness]].
*A classic sign of trichinosis is [[periorbital edema]], [[Periorbital edema|swelling around the eyes]], which may be caused by [[vasculitis]].
*If left untreated, the worms may cause enough damage to produce serious [[Neurological disorders|neurological deficits]] (such as [[ataxia]] or respiratory paralysis) from worms entering the [[central nervous system]] (CNS).
*The [[CNS]] is compromised by trichinosis in 10–24% of reported cases of [[cerebral venous sinus thrombosis]], a very rare form of [[stroke]] (3-4 cases per million annual incidence in adults).
*Trichinosis can be fatal depending on the severity of the infection. Death can occur 4–6 weeks after the infection, and is usually caused by [[myocarditis]], [[encephalitis]], or [[pneumonia]].<ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref><ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Trichinosis Classification Based on the Severity of Signs and Larval Density''' <br><SMALL>Adapted from Clin Microbiol Rev. 2009 Jan; 22(1): 127–145.<ref>{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref></SMALL>
! style="width: 180px;background: #4479BA" |{{fontcolor|#FFF| Classification}}
! style="width: 120px;background: #4479BA" |{{fontcolor|#FFF| Fever, Edema, and Myalgia}}
! style="width: 120px;background: #4479BA" |{{fontcolor|#FFF| Recovery Time}}
! style="width: 120px;background: #4479BA" |{{fontcolor|#FFF| Approx. number of larvae/g of muscle}}
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Asymptomatic
| style="background: #F5F5F5; text-align:center" | None
| style="background: #F5F5F5; text-align:center" | N/A
| style="background: #F5F5F5; text-align:center" | <10
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Abortive
| style="background: #F5F5F5; text-align:center" | 1-2 days
| style="background: #F5F5F5; text-align:center" | N/A
| style="background: #F5F5F5; text-align:center" | 10-100
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Mild
| style="background: #F5F5F5; text-align:center" | +
| style="background: #F5F5F5; bold; text-align:center" | 3 weeks
| style="background: #F5F5F5; text-align:center" | 10-100
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Pronounced
| style="background: #F5F5F5; text-align:center" | ++
| style="background: #F5F5F5; bold; text-align:center" | 6 weeks
| style="background: #F5F5F5; text-align:center" | 10-100
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Severe
| style="background: #F5F5F5; text-align:center" | +++
| style="background: #F5F5F5; bold; text-align:center" | >6 months
| style="background: #F5F5F5; text-align:center" | >100
|-
|}
==Complications==
==Complications==
Common [[complications]] of trichinosis include:
Common complications of trichinosis include:<ref name="abc">FAO/WHO/OIE Guidelines for the surveillance, management, prevention and control of trichinellosis. FAO (2007). http://www.fao.org/documents/card/en/c/61e00fb1-87e8-5b89-8be1-50481e43eed1/ Accessed on January 28, 2016  </ref>
*[[Cardiovascular]]:
 
** [[Heart failure]]
=== Cardiovascular: ===
** [[Heart rhythm]] problems ([[arrhythmias]]) from heart inflammation ([[myocarditis]])
* [[Heart failure]]
**[[Thromboembolic disease]]
* [[Heart rhythm]] problems ([[arrhythmias]]) from heart inflammation ([[myocarditis]])
*** [[Deep thrombophlebitis]]
*[[Thromboembolic disease]]
***Intraventricular thrombi
** [[Deep thrombophlebitis]]
***[[Pulmonary embolism]]
**Intraventricular thrombi
**[[Paroxysmal tachycardia]]
**[[Pulmonary embolism]]
**[[Pericardial effusion]]
*[[Paroxysmal tachycardia]]
*[[Neurological|Neurological:]]
*[[Pericardial effusion]]
**[[Encephalomyelitis]]
 
**[[Neuromuscular disorder|Neuromuscular disturbances]]:
=== Neurological: ===
***Decreased [[muscular strength]] and [[Tendon reflex|tendon reflexes]]
*[[Encephalomyelitis]]
***[[Dysphagia]]
*[[Neuromuscular disorder|Neuromuscular disturbances]]:
***[[Trismus]]
**Decreased [[muscular strength]] and [[Tendon reflex|tendon reflexes]]
*[[Ocular]]:
**[[Dysphagia]]
**[[Edema]] and [[Vascular anomaly|vascular lesions]] within the [[conjunctiva]], [[uvea]], [[retina]], and, in some cases, the [[optic nerve]]
**[[Trismus]]
**Pain when moving the eyeballs
 
**[[Muscle]] paralysis
=== Ocular: ===
**[[Diplopia]]
*[[Edema]] and [[Vascular anomaly|vascular lesions]] within the [[conjunctiva]], [[uvea]], [[retina]], and, in some cases, the [[optic nerve]]
**Disturbed [[Accommodation (eye)|accommodation]]
*Pain when moving the eyeballs
*[[Respiratory]]:
*[[Muscle]] paralysis
**[[Dyspnea]]
*[[Diplopia]]
**[[Pneumonia]]
*Disturbed [[Accommodation (eye)|accommodation]]
**Obstructive [[bronchitis]]
**Löffler-type infiltrates or ventilature failures
*[[Digestive]]:
**[[Hypoalbuminemia]]
**Acute [[intestinal]] [[necrosis]]
**Prolonged [[diarrhoea]]<ref name="abc">FAO/WHO/OIE Guidelines for the surveillance, management, prevention and control of trichinellosis. FAO (2007). http://www.fao.org/documents/card/en/c/61e00fb1-87e8-5b89-8be1-50481e43eed1/ Accessed on January 28, 2016  </ref>


===Prognosis===
=== Respiratory: ===
*Most people with trichinosis have no [[symptoms]] and the [[infection]] goes away by itself. More severe [[infections]] may be more difficult to treat, especially if the [[lungs]], the [[heart]], or the [[brain]] is involved.<ref name="bb">Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016  </ref>
*[[Dyspnea]]
*[[Pneumonia]]
*Obstructive [[bronchitis]]
*Löffler-type infiltrates or ventilature failures
 
=== Digestive: ===
*[[Hypoalbuminemia]]
*Acute [[intestinal]] [[necrosis]]  
*Prolonged [[diarrhoea]]
 
==Prognosis==
*The prognosis of trichinosis is good with adequate treatment.
*Most people with trichinosis have no symptoms, the infection is usually self-limited.<ref name="bb">Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016  </ref>
*The mortality rate of trichinosis is approximately 0.2% worldwide.<ref name="pmid17689195">{{cite journal| author=Pozio E| title=World distribution of Trichinella spp. infections in animals and humans. | journal=Vet Parasitol | year= 2007 | volume= 149 | issue= 1-2 | pages= 3-21 | pmid=17689195 | doi=10.1016/j.vetpar.2007.07.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17689195  }} </ref>
*Prompt treatment with antiparasitic drugs can help prevent the progression of trichinosis by killing the adult worms and so preventing further release of larvae.
*Once the [[''Trichinella'']] larvae have become established in skeletal muscle cells, usually by 3 to 4 weeks post infection, treatment may not completely eliminate the infection and associated symptoms.
*If trichinosis treatment is not initiated within the first several days of infection, more prolonged or repeated courses of treatment may be necessary.<ref name="d">Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Conditions diagnosed by stool test]]
[[Category:Infectious disease]]
[[pl:Włośnica (choroba)]]
{{WH}}
{{WS}}

Latest revision as of 19:01, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac

Overview

If left untreated, infected patients develop manifestations within 1-2 days of infection. Infected patients with trichinosis may progress to develop periorbital edema, muscle pain, and fever.[1][2] Complications of trichinosis affect the cardiovascular, neurological, ocular, respiratory, and digestive systems.[3] Most people with trichinosis have no symptoms, the infection is usually self-limited. The prognosis of trichinosis is good with adequate treatment.[4]

Natural History

  • Trichinosis is usually self-limited, and the majority of individuals with trichinosis are asymptomatic.
  • The symptoms vary depending on the phase, species of Trichinella, amount of encysted larvae ingested, age, gender, and host immunity.
  • Patients infected by 10 or less larvae have either minor or no symptoms and no complications.

Enteral/Intestinal phase:

Parenteral/muscle phase:

Trichinosis Classification Based on the Severity of Signs and Larval Density
Adapted from Clin Microbiol Rev. 2009 Jan; 22(1): 127–145.[5]
Classification Fever, Edema, and Myalgia Recovery Time Approx. number of larvae/g of muscle
Asymptomatic None N/A <10
Abortive 1-2 days N/A 10-100
Mild + 3 weeks 10-100
Pronounced ++ 6 weeks 10-100
Severe +++ >6 months >100

Complications

Common complications of trichinosis include:[3]

Cardiovascular:

Neurological:

Ocular:

Respiratory:

Digestive:

Prognosis

  • The prognosis of trichinosis is good with adequate treatment.
  • Most people with trichinosis have no symptoms, the infection is usually self-limited.[4]
  • The mortality rate of trichinosis is approximately 0.2% worldwide.[6]
  • Prompt treatment with antiparasitic drugs can help prevent the progression of trichinosis by killing the adult worms and so preventing further release of larvae.
  • Once the ''Trichinella'' larvae have become established in skeletal muscle cells, usually by 3 to 4 weeks post infection, treatment may not completely eliminate the infection and associated symptoms.
  • If trichinosis treatment is not initiated within the first several days of infection, more prolonged or repeated courses of treatment may be necessary.[7]

References

  1. ↑ 1.0 1.1 Gottstein B, Pozio E, Nöckler K (2009). "Epidemiology, diagnosis, treatment, and control of trichinellosis". Clin Microbiol Rev. 22 (1): 127–45, Table of Contents. doi:10.1128/CMR.00026-08. PMC 2620635. PMID 19136437.
  2. ↑ 2.0 2.1 Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016
  3. ↑ 3.0 3.1 FAO/WHO/OIE Guidelines for the surveillance, management, prevention and control of trichinellosis. FAO (2007). http://www.fao.org/documents/card/en/c/61e00fb1-87e8-5b89-8be1-50481e43eed1/ Accessed on January 28, 2016
  4. ↑ 4.0 4.1 Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016
  5. ↑ Gottstein B, Pozio E, Nöckler K (2009). "Epidemiology, diagnosis, treatment, and control of trichinellosis". Clin Microbiol Rev. 22 (1): 127–45, Table of Contents. doi:10.1128/CMR.00026-08. PMC 2620635. PMID 19136437.
  6. ↑ Pozio E (2007). "World distribution of Trichinella spp. infections in animals and humans". Vet Parasitol. 149 (1–2): 3–21. doi:10.1016/j.vetpar.2007.07.002. PMID 17689195.
  7. ↑ Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016
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