Trichinosis natural history, complications, and prognosis: Difference between revisions
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*The parental phase starts approximately seven days after infection. | *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. | *The severity of symptoms caused by larval migration from the intestines depends on the number of larvae produced. | ||
*As the larvae migrate through | *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]]. | *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). | *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). | *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> | *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: === | === Cardiovascular: === | ||
* [[Heart failure]] | |||
* [[Heart rhythm]] problems ([[arrhythmias]]) from heart inflammation ([[myocarditis]]) | |||
*[[Thromboembolic disease]] | |||
** [[Deep thrombophlebitis]] | |||
**Intraventricular thrombi | |||
**[[Pulmonary embolism]] | |||
*[[Paroxysmal tachycardia]] | |||
*[[Pericardial effusion]] | |||
=== Neurological: === | === Neurological: === | ||
*[[Encephalomyelitis]] | |||
*[[Neuromuscular disorder|Neuromuscular disturbances]]: | |||
**Decreased [[muscular strength]] and [[Tendon reflex|tendon reflexes]] | |||
**[[Dysphagia]] | |||
**[[Trismus]] | |||
=== Ocular: === | === Ocular: === | ||
*[[Edema]] and [[Vascular anomaly|vascular lesions]] within the [[conjunctiva]], [[uvea]], [[retina]], and, in some cases, the [[optic nerve]] | |||
*Pain when moving the eyeballs | |||
*[[Muscle]] paralysis | |||
*[[Diplopia]] | |||
*Disturbed [[Accommodation (eye)|accommodation]] | |||
=== Respiratory: === | === Respiratory: === | ||
*[[Dyspnea]] | |||
*[[Pneumonia]] | |||
*Obstructive [[bronchitis]] | |||
*Löffler-type infiltrates or ventilature failures | |||
=== Digestive: === | === Digestive: === | ||
*[[Hypoalbuminemia]] | |||
*Acute [[intestinal]] [[necrosis]] | |||
*Prolonged [[diarrhoea]] | |||
==Prognosis== | ==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}} | ||
Latest revision as of 19:01, 18 September 2017
Trichinosis Microchapters |
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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:
- 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.
- A classic sign of trichinosis is 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 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.[1][2]
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:
- Heart failure
- Heart rhythm problems (arrhythmias) from heart inflammation (myocarditis)
- Thromboembolic disease
- Deep thrombophlebitis
- Intraventricular thrombi
- Pulmonary embolism
- Paroxysmal tachycardia
- Pericardial effusion
Neurological:
- Encephalomyelitis
- Neuromuscular disturbances:
- Decreased muscular strength and tendon reflexes
- Dysphagia
- Trismus
Ocular:
- Edema and vascular lesions within the conjunctiva, uvea, retina, and, in some cases, the optic nerve
- Pain when moving the eyeballs
- Muscle paralysis
- Diplopia
- Disturbed accommodation
Respiratory:
- 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.[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
- ↑ 1.0 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.
- ↑ 2.0 2.1 Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016
- ↑ 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
- ↑ 4.0 4.1 Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016
- ↑ 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.
- ↑ 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.
- ↑ Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016