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, 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]
Complications
Common complications of trichinosis include:
Cardiovascular:
- Heart failure
- Heart rhythm problems (arrhythmias) from heart inflammation (myocarditis)
- Thromboembolic disease
- Deep thrombophlebitis
- Intraventricular thrombi
- Pulmonary embolism
- Paroxysmal tachycardia
- Pericardial effusion
Neurological:
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[3]
Prognosis
- The prognosis of trichinosis is good with adequate treatment.
- Most people with trichinosis have no symptoms, the infection is usually self-limited.
- The mortality rate of trichinosis is approximately 0.2% worldwide.
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
- ↑ Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016