Trichinellosis: human disease, diagnosis and treatment

doi:10.1016/S0304-4017(00)00352-6

Veterinary Parasitology

Volume 93, Issues 3–4, 1 December 2000, Pages 365-383

https://doi.org/10.1016/S0304-4017(00)00352-6 Get rights and content

Abstract

In this review, the pathological mechanisms of human trichinellosis are presented, including a discussion on organ pathology, with particular attention paid to intestinal and muscular invasion. The clinical pattern in the acute stage of trichinellosis is presented, together with a classification of trichinellosis relative to severity of the disease. In turn, complications and diagnostic criteria are discussed. Drugs employed in the contemporary treatment of trichinellosis are presented (mainly those of the benzimidazole group and glucocorticosteroids) as well as indications for administering them, as related to severity of the disease.

Introduction

Trichinellosis is a parasitic infection of worldwide distribution. In humans, it is manifested as a syndrome with specific clinical signs and symptoms of variable intensity, depending upon the extent of invasion, the species of Trichinella involved and the immune response of the host. Knowledge of clinical pathology is indispensable since it allows the physician to rationally diagnose the disease and to properly treat patients.

Section snippets

Pathological mechanisms of lesions in trichinellosis

The pathological mechanisms of lesions observed in trichinellosis are complex and related to both the development of two generations of Trichinella sp. in the host and immunopathological events initiated by antigens released by the parasite. Development of the lesions is strictly linked to the intestinal and muscular stages of trichinellosis.

The numerous factors which play a role in the pathological mechanisms of trichinellosis include cells of the inflammatory infiltrate (mast cells,

Organ pathology

Organ pathology in the course of trichinellosis represents a combination of immunological, pathomorphological and metabolic disturbances which develop due to Trichinella spiralis invasion. Organ pathology in trichinellosis is dominated by involvement of the gastrointestinal tract and the small intestine in particular, the latter serving as a biotope for development of mature Trichinella stages, and of the muscular system in which the larvae become encapsulated. Involvement of the two organs

Incubation period

The duration of the incubation period depends upon a few variables, including invasive dose, frequency of consuming infected meat and how the meat was prepared (raw, semi-raw), and the species or isolate of Trichinella involved. It is generally accepted that shorter the incubation period the more severe course the disease follows (Januszkiewicz, 1969). In severe forms, the incubation period is approximately 7 days, in infections of moderate intensity 16 days, in the benign form 21 days, and in

Leukocytosis

Increased levels of leukocytes are typical of trichinellosis. The levels may reach 15 to 30 thousand per mm³. The high leukocytosis appears early and rapidly increases between the second and fifth week of the disease and subsides in parallel to clinical signs and symptoms while eosinophilia persists.

Eosinophilia is a hallmark of clinical trichinellosis, being present in every case. It appears early, before development of the general syndrome of clinical signs and symptoms, and increases between

Complications in trichinellosis

Complications develop in the early or the late stages of severe or, occasionally, moderately severe trichinellosis and in patients improperly treated or in patients for whom treatment was started too late (Ozieretskovskaya, 1978, Pawlowski, 1983, Kociecka et al., 1987). Complications of the respiratory system appear in the late period, i.e. between the third and seventh week of the disease, pneumonia and pleuritis of bacterial etiology may appear as well as lung infarction (Januszkiewicz, 1967).

Diagnosis

Principles of diagnosing trichinellosis include the following criteria:

1.
epidemiological anamnesis (source of infection, amount of infected meat consumed, numbers of larvae present in the infected meat, and number of cases in the epidemic focus),
2.
clinical evaluation (recognition of the syndrome of acute signs and symptoms of trichinellosis and definition of the form of disease, which significantly affects the choice of therapeutic procedures),
3.
laboratory tests
- 3.1.
  preliminary augmented leukocyte content

Differential diagnosis

Differential diagnosis is particularly important at the acute stage of trichinellosis due to the need to begin appropriate treatment early. Diagnosis is particularly difficult in cases of sporadic incidence or of an atypical course of the disease.

In view of the presence of periocular edema or facial edema and fever, differentiation should include acute glomerulonephritis, serum sickness, toxico-allergic reactions to drugs or allergens, or dermatomyositis.

In cases with intense headaches and

Therapy

Drugs administered in trichinellosis include anthelmintics, glucocorticosteroids, immunomodulating drugs, and preparations which compensate protein and electrolyte deficits. Anthelmintics are the principal drugs used for trichinellosis. They include mebendazole (Vermox, Janssen Pharmaceutica, Beerse, Belgium), albendazole (Zentel, Smith-Kline Beecham), and pyrantel (Terpol, Sieradz; Combantrin, Pfizer).

Mebendazole (Vermox) of the benzimidazole group is poorly absorbed from the intestinal lumen,

Conclusions

Trichinellosis in humans represents a complex problem both as far as the pathomechanisms involved and clinical pathology are concerned. Appraisal of the patient’s condition requires medical knowledge and skillful interpretation of laboratory test results. Early administration of anthelmintics, the drugs of choice for early treatment of infection, cause significant reductions in worms in the intestine and limits the number of larvae invading muscles. On the other hand, application of

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Trichinellosis: human disease, diagnosis and treatment

Abstract

Introduction

Section snippets

Pathological mechanisms of lesions in trichinellosis

Organ pathology

Incubation period

Leukocytosis

Complications in trichinellosis

Diagnosis

Differential diagnosis

Therapy

Conclusions

Exp. Parasitol.

Zentralbl. Bacteriol. Microbiol. Hyg. (A)

Trans. Roy. Soc. Trop. Med. Hyg.

Blood vessels in Trichinella spiralis infection: a study using vascular casts

J. Parasitol.

The diagnostic value of enzymatic and immunological tests in human trichinellosis

Tropenmed. Parasitol.

Outbreak of trichinosis near Paris

Br. Med. J.

Electrographic changes in acute trichinellosis. I. Observations in human trichinellosis

Wiad. Parazytol.

Influence of enteroparasitism on hormone-regulated pancreatic secretion in dogs

Am. J. Physiol.

Trichinella spiralis and concept of niche

J. Parasitol.

Etude des immunoglobulines specifiques (totales IgG, IgM, IgA, IgE) en immunofluorescence indirecte et en ELISA chez quarante maladies trichines suivis pendant neuf mois

Pathol. Biol.

Lymphopenie au cours de la trichinose

Presse Med.

Detection of a circulating parasitic antigen in acute infection with Trichinella spiralis diagnostic significance of findings

Zbl. Bakt.

A case of trichinellosis of a grave course with late eosinophilia in the peripheral blood (in Polish)

Wiad. Parazytol.

Randomized trial of albendazole versus thiabendazole plus flubendazole during an outbreak of human trichinellosis

Parasitol. Res.

Neurotrichinosis: a cerebrovascular disease associated with myocardial injury and hypereosinophilia

Brain

Pathomorphology of muscular trichinellosis in comparative histological, histochemical, ultrastructural, autoradiographic and immunofluorescent investigations

Wiad. Parazytol.

The unique and specific transformation of muscle cell infected with Trichinella spiralis

Basic Appl. Myol.

A monoclonal antibody-purified antigen for the immunodiagnosis of trichinosis

Am. J. Vet. Res.

The in vivo role of stem cell factor (c-kit ligand) in mastocytosis and host protective immunity to the intestinal nematoda, Trichinella spiralis in mice

Parasite Immunol.

Increase of mucosal mast cells in the jejunum of patients infected with Trichinella spiralis

Int. Arch. Allergy Appl. Immunol.

Significance of cell nucleus in mechanism of the transformation of muscle cell after infection by Trichinella spiralis larvae. II. Histochemical features of the functional transformation of the muscle cell nucleus in the course of infection (in Polish)

Wiad. Parazytol.

Comparative efficacy of antigen and antibody detection tests for human trichinellosis

J. Parasitol.

Participation of the respiratory system in trichinosis

Epidemiol. Rev.

The incubation period of trichinosis (in Polish)

Przegl. Epidemiol.

Activity of some enzymes in muscle homogenates during the course of trichinosis in humans and animals

Przegl. Epidemiol.

Trichinella spiralis-infected skeletal muscle cells arrest in G2/M and cease muscle gene expression

J. Cell Biol.