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==Overview== | ==Overview== | ||
'''Trichinosis''', also called '''trichinellosis''', or '''trichiniasis''', is a [[parasitic disease]] caused by eating raw or undercooked pork and wild game products infected with the [[larva]]e of [[Trichinella]] species, commonly called the trichina worm. [[Trichinella spiralis]] was first discovered by [[James Paget]], a English first-year medical student, in 1835.<ref name="a">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref> There have been several [[outbreaks]] of trichinosis, most of them for consuming infected pork, wild boar and bear. Although now uncommon as a result of [[public health]] control measures.<ref>Marva E, Markovics A, Gdalevich M, Asor N, Sadik C, and Leventhal A. Trichinellosis Outbreak. ''Emerg Infect Dis.'' 2005;11(12):1979-1981</ref><ref>Wilson N, Hall R, Montgomery S, Jones F. Trichinellosis Surveillance — United States, 2008–2012. ''MMWR'' 2005;11(12):1979-1981</ref> Based on the severity of [[signs]] and larval density, trichinosis may be classified into [[asymptomatic]], abortive, mild, pronounced, and severe.<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> [[Trichinella|Trichinella spp.]] is usually transmitted to the human host by eating undercooked meat containing [[cysts]] of [[Trichinella|Trichinella spp.]] Following [[ingestion]], exposure to [[gastric acid]] and [[pepsin]] release the larvae from the [[cysts]] and invade the [[small bowel]] mucosa. When a person eats meat from an infected animal, [[Trichinella]] [[cysts]] break open in the [[intestines]] and grow into adult [[roundworms]]. After 1 week, the females release more larvae that migrate through the bloodstream to voluntarily controlled [[muscles]] where they encyst. These organisms tend to invade muscle tissues, including the [[heart]] and [[diaphragm]]. They can also affect the [[lungs]] and [[brain]].<ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref> Characteristic findings on [[microscopic]] [[histopathological]] analysis of the [[muscle]], the nurse cell has a collagen capsule with larvae inside and is surrounded by cellular infiltrates.<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> Trichinosis must be differentiated from [[influenza virus]], [[salmonella]], [[shigella]], eosinophilia-myalgia syndromes, tissular parasitosis, [[glomerulonephritis]], [[serum sickness]], infectious [[meningitis]] and [[encephalitis]], [[leptospirosis]], [[bacterial endocarditis]] and typhus exanthematicus.<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> Worldwide, an estimated 10,000 cases of trichinellosis occur every year.<ref name="a">Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/epi.html. Accessed on January 28, 2016</ref> Common [[risk factors]] in the development of trichinosis [[disease]] are: consuming [[raw]] or undercooked meat, informal meat transportation, [[age]], antimicrobial free/organic [[pork]] and hunting practices.<ref name="a">Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/epi.html. Accessed on January 28, 2016</ref><ref name="pmid22172230">{{cite journal| author=Murrell KD, Pozio E| title=Worldwide occurrence and impact of human trichinellosis, 1986-2009. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 12 | pages= 2194-202 | pmid=22172230 | doi=10.3201/eid1712.110896 | pmc=PMC3311199 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22172230 }} </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><ref name="pmid18407758">{{cite journal| author=Gebreyes WA, Bahnson PB, Funk JA, McKean J, Patchanee P| title=Seroprevalence of Trichinella, Toxoplasma, and Salmonella in antimicrobial-free and conventional swine production systems. | journal=Foodborne Pathog Dis | year= 2008 | volume= 5 | issue= 2 | pages= 199-203 | pmid=18407758 | doi=10.1089/fpd.2007.0071 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18407758 }} </ref><ref name="pmid11716113">{{cite journal| author=Owen IL, Pozio E, Tamburrini A, Danaya RT, Bruschi F, Gomez Morales MA| title=Focus of human trichinellosis in Papua New Guinea. | journal=Am J Trop Med Hyg | year= 2001 | volume= 65 | issue= 5 | pages= 553-7 | pmid=11716113 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11716113 }} </ref> 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> The [[diagnosis]] of trichinosis is based on the European Center for Disease Control [[criteria]], which include a combination of [[clinical]], [[laboratory]] and [[epidemiological]] criteria.<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><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> Common [[physical examination]] findings of trichinosis include [[periorbital edema]] and [[splinter hemorrhage]].<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> The mainstay of [[therapy]] for trichinosis are [[Anthelmintic|anthelmintics drugs]] such as [[albendazole]] or [[mebendazole]].<ref name="d">Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016</ref> The best way to [[Prevention (medical)|prevent]] trichinellosis is to cook meat to safe temperatures. Using food thermometers can make sure the temperature inside the meat is high enough to kill the [[parasites]].<ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref> | '''Trichinosis''', also called '''trichinellosis''', or '''trichiniasis''', is a [[parasitic disease]] caused by eating raw or undercooked pork and wild game products infected with the [[larva]]e of [[Trichinella]] species, commonly called the trichina worm. [[Trichinella spiralis]] was first discovered by [[James Paget]], a English first-year medical student, in 1835.<ref name="a">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref> There have been several [[outbreaks]] of trichinosis, most of them for consuming infected pork, wild boar and bear. Although now uncommon as a result of [[public health]] control measures.<ref>Marva E, Markovics A, Gdalevich M, Asor N, Sadik C, and Leventhal A. Trichinellosis Outbreak. ''Emerg Infect Dis.'' 2005;11(12):1979-1981</ref><ref>Wilson N, Hall R, Montgomery S, Jones F. Trichinellosis Surveillance — United States, 2008–2012. ''MMWR'' 2005;11(12):1979-1981</ref> Based on the severity of [[signs]] and larval density, trichinosis may be classified into [[asymptomatic]], abortive, mild, pronounced, and severe.<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> [[Trichinella|Trichinella spp.]] is usually transmitted to the human host by eating undercooked meat containing [[cysts]] of [[Trichinella|Trichinella spp.]] Following [[ingestion]], exposure to [[gastric acid]] and [[pepsin]] release the larvae from the [[cysts]] and invade the [[small bowel]] mucosa. When a person eats meat from an infected animal, [[Trichinella]] [[cysts]] break open in the [[intestines]] and grow into adult [[roundworms]]. After 1 week, the females release more larvae that migrate through the [[bloodstream]] to voluntarily controlled [[muscles]] where they encyst. These organisms tend to invade muscle tissues, including the [[heart]] and [[diaphragm]]. They can also affect the [[lungs]] and [[brain]].<ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref> Characteristic findings on [[microscopic]] [[histopathological]] analysis of the [[muscle]], the nurse cell has a collagen capsule with larvae inside and is surrounded by cellular infiltrates.<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> Trichinosis must be differentiated from [[influenza virus]], [[salmonella]], [[shigella]], eosinophilia-myalgia syndromes, tissular parasitosis, [[glomerulonephritis]], [[serum sickness]], infectious [[meningitis]] and [[encephalitis]], [[leptospirosis]], [[bacterial endocarditis]] and typhus exanthematicus.<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> Worldwide, an estimated 10,000 cases of trichinellosis occur every year.<ref name="a">Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/epi.html. Accessed on January 28, 2016</ref> Common [[risk factors]] in the development of trichinosis [[disease]] are: consuming [[raw]] or undercooked meat, informal meat transportation, [[age]], antimicrobial free/organic [[pork]] and hunting practices.<ref name="a">Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/epi.html. Accessed on January 28, 2016</ref><ref name="pmid22172230">{{cite journal| author=Murrell KD, Pozio E| title=Worldwide occurrence and impact of human trichinellosis, 1986-2009. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 12 | pages= 2194-202 | pmid=22172230 | doi=10.3201/eid1712.110896 | pmc=PMC3311199 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22172230 }} </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><ref name="pmid18407758">{{cite journal| author=Gebreyes WA, Bahnson PB, Funk JA, McKean J, Patchanee P| title=Seroprevalence of Trichinella, Toxoplasma, and Salmonella in antimicrobial-free and conventional swine production systems. | journal=Foodborne Pathog Dis | year= 2008 | volume= 5 | issue= 2 | pages= 199-203 | pmid=18407758 | doi=10.1089/fpd.2007.0071 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18407758 }} </ref><ref name="pmid11716113">{{cite journal| author=Owen IL, Pozio E, Tamburrini A, Danaya RT, Bruschi F, Gomez Morales MA| title=Focus of human trichinellosis in Papua New Guinea. | journal=Am J Trop Med Hyg | year= 2001 | volume= 65 | issue= 5 | pages= 553-7 | pmid=11716113 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11716113 }} </ref> 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> The [[diagnosis]] of trichinosis is based on the European Center for Disease Control [[criteria]], which include a combination of [[clinical]], [[laboratory]] and [[epidemiological]] criteria.<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><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> Common [[physical examination]] findings of trichinosis include [[periorbital edema]] and [[splinter hemorrhage]].<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> The mainstay of [[therapy]] for trichinosis are [[Anthelmintic|anthelmintics drugs]] such as [[albendazole]] or [[mebendazole]].<ref name="d">Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016</ref> The best way to [[Prevention (medical)|prevent]] trichinellosis is to cook meat to safe temperatures. Using food thermometers can make sure the temperature inside the meat is high enough to kill the [[parasites]].<ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref> | ||
==Historical Perspective== | ==Historical Perspective== | ||
Revision as of 13:58, 1 February 2016
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Trichinosis Microchapters |
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Trichinosis overview On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
Overview
Trichinosis, also called trichinellosis, or trichiniasis, is a parasitic disease caused by eating raw or undercooked pork and wild game products infected with the larvae of Trichinella species, commonly called the trichina worm. Trichinella spiralis was first discovered by James Paget, a English first-year medical student, in 1835.[1] There have been several outbreaks of trichinosis, most of them for consuming infected pork, wild boar and bear. Although now uncommon as a result of public health control measures.[2][3] Based on the severity of signs and larval density, trichinosis may be classified into asymptomatic, abortive, mild, pronounced, and severe.[4] Trichinella spp. is usually transmitted to the human host by eating undercooked meat containing cysts of Trichinella spp. Following ingestion, exposure to gastric acid and pepsin release the larvae from the cysts and invade the small bowel mucosa. When a person eats meat from an infected animal, Trichinella cysts break open in the intestines and grow into adult roundworms. After 1 week, the females release more larvae that migrate through the bloodstream to voluntarily controlled muscles where they encyst. These organisms tend to invade muscle tissues, including the heart and diaphragm. They can also affect the lungs and brain.[5] Characteristic findings on microscopic histopathological analysis of the muscle, the nurse cell has a collagen capsule with larvae inside and is surrounded by cellular infiltrates.[4] Trichinosis must be differentiated from influenza virus, salmonella, shigella, eosinophilia-myalgia syndromes, tissular parasitosis, glomerulonephritis, serum sickness, infectious meningitis and encephalitis, leptospirosis, bacterial endocarditis and typhus exanthematicus.[6] Worldwide, an estimated 10,000 cases of trichinellosis occur every year.[1] Common risk factors in the development of trichinosis disease are: consuming raw or undercooked meat, informal meat transportation, age, antimicrobial free/organic pork and hunting practices.[1][7][4][8][9] If left untreated, patients with trichinosis may progress to develop periorbital edema, muscle pain, and fever.[5][4] Complications of trichinosis affect the cardiovascular, neurological, ocular, respiratory and digestive systems.[6] Most people with trichinosis have no symptoms, the infection goes away by itself. The prognosis of trichinosis is good with treatment.[10] 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 deficits (such as ataxia or respiratory paralysis), and even death. Infestation of the heart may also lead to death.[5] The diagnosis of trichinosis is based on the European Center for Disease Control criteria, which include a combination of clinical, laboratory and epidemiological criteria.[6][4] Common physical examination findings of trichinosis include periorbital edema and splinter hemorrhage.[5][4] The mainstay of therapy for trichinosis are anthelmintics drugs such as albendazole or mebendazole.[11] The best way to prevent trichinellosis is to cook meat to safe temperatures. Using food thermometers can make sure the temperature inside the meat is high enough to kill the parasites.[5]
Historical Perspective
Trichinella spiralis was first discovered by James Paget, a English first-year medical student, in 1835.[1] In 1846, Joseph Leidy, an American paleontologist, was the first to discover the association between undercooked meat and development of trichinosis.[12] There have been several outbreaks of trichinosis, most of them for consuming infected pork, wild boar and bear. Although now uncommon as a result of public health control measures.[13][14]
Classification
Based on the severity of signs and larval density, trichinosis may be classified into asymptomatic, abortive, mild, pronounced, and severe. [4]
Pathophysiology
Trichinella spp. is usually transmitted to the human host by eating undercooked meat containing cysts of Trichinella spp. Following ingestion, exposure to gastric acid and pepsin release the larvae from the cysts and invade the small bowel mucosa. When a person eats meat from an infected animal, Trichinella cysts break open in the intestines and grow into adult roundworms. Females are 2.2 mm in length; males 1.2 mm. The life span in the small intestine is about four weeks. After 1 week, the females release more larvae that migrate through the bloodstream to voluntarily controlled muscles where they encyst. These organisms tend to invade muscle tissues, including the heart and diaphragm. They can also affect the lungs and brain.[5] Characteristic findings on microscopic histopathological analysis of the muscle, the nurse cell has a collagen capsule with larvae inside and is surrounded by cellular infiltrates.[4]
Causes
Common cause of trichinosis include Trichinella spiralis. Less common causes of trichinosis include T. britovi, T. nativa, T. pseudospiralis, T. papuae, T. nelsoni, T. murrelli, and T. zimbabwensis.[1]
Differential Diagnosis
Trichinosis must be differentiated from influenza virus, salmonella, shigella, eosinophilia-myalgia syndromes, tissular parasitosis, glomerulonephritis, serum sickness, infectious meningitis and encephalitis, leptospirosis, bacterial endocarditis and typhus exanthematicus.[6]
Epidemiology and Demographics
Worldwide, an estimated 10,000 cases of trichinellosis occur every year.[1]
Risk Factors
Common risk factors in the development of trichinosis disease are: consuming raw or undercooked meat, informal meat transportation, age, antimicrobial free/organic pork and hunting practices.[1][7][4][8][9]
Natural History, Complications and Prognosis
If left untreated, patients with trichinosis may progress to develop periorbital edema, muscle pain, and fever.[5][4] Complications of trichinosis affect the cardiovascular, neurological, ocular, respiratory and digestive systems.[6] Most people with trichinosis have no symptoms, the infection goes away by itself. The prognosis of trichinosis is good with treatment.[10] 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 deficits (such as ataxia or respiratory paralysis), and even death. Infestation of the heart may also lead to death.[5]
Diagnostic Criteria
The diagnosis of trichinosis is based on the European Center for Disease Control criteria, which include a combination of clinical, laboratory and epidemiological criteria.[6][4]
History and Symptoms
Trichinosis initially involves the intestines. Within 1-2 days of contagion, manifestations such as nausea, heartburn, dyspepsia, and diarrhea; the severity of symptoms depends on the number of worms ingested. Later on, as the worms encyst in different parts of the human body, other manifestations may occur, such as headache, fever, chills, cough, eye swelling, joint pain and muscle pain, and itching. A positive history of gastroenteritis symptoms, muscle pain and fever and recent ingestion of undercooked meat such as pork, wild boar or bear is suggestive of trichinosis.[5][1][4]
Physical Examination
Common physical examination findings of trichinosis include periorbital edema and splinter hemorrhage.[5][4]
Laboratory Findings
A blood test indicating eosinophilia, elevated muscle enzymes and anti trichinella IgG or muscle biopsy can identify trichinosis.[4][5]
Medical Therapy
The mainstay of therapy for trichinosis are anthelmintics drugs such as albendazole or mebendazole.The mainstay of therapy for trichinosis are anthelmintics drugs such as albendazole or mebendazole.[11]
Primary Prevention
The best way to prevent trichinellosis is to cook meat to safe temperatures. Using food thermometers can make sure the temperature inside the meat is high enough to kill the parasites.[5]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016
- ↑ Marva E, Markovics A, Gdalevich M, Asor N, Sadik C, and Leventhal A. Trichinellosis Outbreak. Emerg Infect Dis. 2005;11(12):1979-1981
- ↑ Wilson N, Hall R, Montgomery S, Jones F. Trichinellosis Surveillance — United States, 2008–2012. MMWR 2005;11(12):1979-1981
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 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.
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 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
- ↑ 7.0 7.1 Murrell KD, Pozio E (2011). "Worldwide occurrence and impact of human trichinellosis, 1986-2009". Emerg Infect Dis. 17 (12): 2194–202. doi:10.3201/eid1712.110896. PMC 3311199. PMID 22172230.
- ↑ 8.0 8.1 Gebreyes WA, Bahnson PB, Funk JA, McKean J, Patchanee P (2008). "Seroprevalence of Trichinella, Toxoplasma, and Salmonella in antimicrobial-free and conventional swine production systems". Foodborne Pathog Dis. 5 (2): 199–203. doi:10.1089/fpd.2007.0071. PMID 18407758.
- ↑ 9.0 9.1 Owen IL, Pozio E, Tamburrini A, Danaya RT, Bruschi F, Gomez Morales MA (2001). "Focus of human trichinellosis in Papua New Guinea". Am J Trop Med Hyg. 65 (5): 553–7. PMID 11716113.
- ↑ 10.0 10.1 Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016
- ↑ 11.0 11.1 Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016
- ↑ Joseph Leidy. Wikipedia. https://en.wikipedia.org/wiki/Joseph_Leidy. Accessed on January 22, 2016
- ↑ Marva E, Markovics A, Gdalevich M, Asor N, Sadik C, and Leventhal A. Trichinellosis Outbreak. Emerg Infect Dis. 2005;11(12):1979-1981
- ↑ Wilson N, Hall R, Montgomery S, Jones F. Trichinellosis Surveillance — United States, 2008–2012. MMWR 2005;11(12):1979-1981