Trichinosis natural history, complications, and prognosis

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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, 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 goes away by itself. The prognosis of trichinosis is good with treatment.^[4] 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.^[1]

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.

- 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.

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]

Common complications of trichinosis include:

↑ ^1.0 ^1.1 ^1.2 Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016
↑ ^2.0 ^2.1 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.
↑ ^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
↑ Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016