Pediatric Trichinosis

Pediatric Trichinosis

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In 1835, James Paget, a first-year medical student at Bartholomew’s Hospital in London, observed the postmortem examination of a middle-aged man. The autopsy revealed extensive pulmonary tuberculosis. Paget also saw numerous miniscule chalky-colored spots in the corpse’s muscles. He further verified the bony texture of these lesions and upon microscopic dissection, concluded that each lesion consisted of a coiled threadlike worm surrounded by a tiny calcified cyst. Paget’s professor, Richard Owen, confirmed his findings. Owen named it the genus Trichina, from the Greek term for hair, and the species spiralis. [1]

A parasitic zoonosis, trichinosis (or trichinellosis), is caused by human ingestion of raw or undercooked meat infected with viable larvae of parasitic roundworms in the genus, Trichinella. Genus Trichinella is a member of the phylum Nematoda within the kingdom Animalia. Within the Trichinella genus, 8 species are known. The species are further differentiated based on whether or not the worms encapsulate in the host’s muscle tissue.

Species that characteristically encapsulate are T.spiralis, T. nelsoni, T. nativa, T. murrelli and T. britovi. Three species, T. papuae, T.pseudospiralis, and T. zimbabwensis, do not encapsulate . Non-encapsulated species infect saurians and crocodilians. T. pseudospiralis infects birds . T.spiralis, T. nelsoni, T. nativa, T. murrelli and T. britovi infect mammalian hosts and encapsulate within the host’s tissues. These five species of parasitic roundworms are found in approximately 150 different carnivorous/omnivorous mammals. Throughout the world, pigs (swine) are the most common meat reservoir consumed by man. Humans are incidental hosts. [2]

For T.spiralis, larvae enter the human host when raw or undercooked meat is eaten with viable encysted larvae. In the stomach, larvae ex-cyst through acid-pepsin digestion. Peristalsis moves the larvae to the upper two-thirds of the intestine. There, they penetrate the columnar epithelium of the intestinal mucosa and occupy the cytoplasm of enterocytes. The intracellular larvae develop into mature worms through 4 molts, reaching adulthood in about 30 hours. [1, 3]

Adult T. spiralis male worms are less than 2 mm in length (approximately 1-1.5 mm long); adult female worms are longer, measuring closer to 5 mm. Maturation of the male and female worms occurs and mating follows. Five days post-copulation, each female worm can birth a huge number of live larvae (about 1000 larvae). The newborn larvae penetrate the gut lamina propria; move through the thoracic duct and into the venous circulation. They continue to move through the right side of the heart, the lungs, and then onto the left side of the heart and subsequently enter the systemic circulation. The larvae travel throughout the human body capable of entering any tissue cell. Presence of larvae in the circulation causes increased capillary permeability and vasculitis. Fine intravascular thrombi can occur. When the larval load is significant, these microvasculature changes cause cardiovascular, lung, and central nervous system (CNS) pathology. Host cells invaded by larvae will die with the exception of skeletalmyofibrils. [3]

Larvae favor striated skeletal muscle cells and prefer active muscle groups such as the diaphragm, the tongue, and the masticatory, intercostal, and pectoral muscles. Larvae burrow into individual muscle fibers, which are transformed and serve as nurturing nurse cells. These nurse cell–larva complexes further larval development until encystment occurs; a process taking about 3 weeks. After this period, the larvae, now about 1 mm long, are infective to another host, if eaten as improperly cooked meat. In humans, the larvae at this stage have reached a dead end. Larvae may remain viable for years in the human host, but usually die and calcify within the first year after cyst formation.

A fertile T. spiralis female produces approximately 500-1500 larvae over a 2-4 week period; the female is then, expelled in the feces due to the response of the host’s immune system. The host’s T-cell immune response is especially important in eradication of the adult female worms as studies of athymic mice (lacking T-cell function) show a longer intestinal phase in these mammals. [1]

In nature, the parasite’s life cycle is maintained by carnivorous and omnivorous mammals that eat infected meat and by non-carnivorous animals that ingest food containing larvae-contaminated tissue from carcasses of infected animals.

United States

Trichinosis (also known as trichinellosis ) is a reportable disease to the Centers for Disease Control and Prevention (CDC) Parasitic Diseases Hotline (parasites@cdc.gov). The clinical case definition for trichinosis is ” Trichinella –positive muscle biopsy or a positive serologic test for trichinosis in a patient with one or more clinical symptoms compatible with trichinosis such as eosinophilia, fever, myalgia, or periorbital edema.”

In the 1940s, an average of 400 cases and 10-15 deaths were reported each year. The incidence of trichinosis has significantly decreased since this time. From 1991-1996, 230 cases and 3 deaths were reported. [4] From 2002-2007, 66 cases were reported. [5] In approximately 60% of these cases, information on the suspected ingested food product was available. The frequency of implicated meat was 60% pork, 23% bear meat, 10% walrus meat, and 7% cougar meat. Sausage was the most commonly cited pork product. Sampling uncooked spiced pork used to make sausage is a common way to acquire infection.

Federal regulations and changes in management standards of the pork industry have played major roles in the decreased frequency of trichinosis. Today the vast majority of domestic swine in the United States are grain-fed and uninfected. Swine fed meat from uncooked garbage containing remnants of small mammals such as skunks, raccoons and rats, are at-risk to be infected if the feed contains Trichinella larvae-contaminated sources. Infections do occur sporadically in people who ingest undercooked bear meat. [6, 7]

International

Trichinosis usually occurs as point-source outbreaks in all areas of the world, except Australia and some South Pacific islands. [8, 9] Incidence is low in Europe due to mandatory inspection of pork for Trichinella species, although outbreaks have been reported. [10, 11] In Arctic regions, T. nativa is found in meat from walrus, seal, and polar bear. [12, 1] In Africa and southern Europe, most infections stem from T. nelsoni found in meat from wild canids and felids. [1]

Potential clinical course and illness severity depend on the initial tissue load of viable larvae ingested and the number of newborn larvae produced per mature female.

Most infections are asymptomatic or subclinical.

One week post-ingestion, abdominal discomfort, nausea, vomiting and/or diarrhea may occur

When these symptoms occur, the illness is usually self-limited.

Two to 8 weeks post-ingestion, symptoms can include fever, myalgias, and periorbital edema, urticarial rash, conjunctival hemorrhages and subungual hemorrhages.

During this time, the larvae are migrating into the host’s tissues.

In patients with severe acute infection, there may be long-lasting sequelae (eg, muscle aches and pain, headaches, eye disturbances, cardiac symptoms).

Although rare, the illness can cause death. Death is usually due to cardiac or CNS involvement and occurs 3-5 weeks post-ingestion. The mortality rate has decreased to about 0.3% due to improved patient care and pharmaceutical treatment. [6]

This infection has no racial predilection.

Both sexes are equally susceptible. Differential rates of infection between sexes may reflect differences in behavior as related to food preparation and food choices.

People of all age groups are susceptible.

Markell EK, Voge M, John DT. Medical Parasitology, 6th ed. Philadelphia, PA: WB Saunders Company; 1986. 270-74.

Knopp S, Steinmann P, Keiser J, Utzinger J. Nematode infections: soil-transmitted helminths and trichinella. Infect Dis Clin North Am. 2012 Jun. 26(2):341-58. [Medline].

Oski FA, et al. Tissue nematodes Trichinella spiralis. In Principles and Practices of Pediatrics 2nd edition. Philadelphia, PA: JB Lippincott; 1994. 1413-14.

Moorhead A, Grunenwald PE, Dietz VJ, Schantz PM. Trichinellosis in the United States, 1991-1996: declining but not gone. Am J Trop Med Hyg. 1999 Jan. 60(1):66-9. [Medline]. [Full Text].

Kennedy ED, Hall RL, Montgomery SP, Pyburn DG, Jones JL. Trichinellosis surveillance – United States, 2002-2007. MMWR Surveill Summ. 2009 Dec 4. 58(9):1-7. [Medline].

American Academy of Pediatrics. Trichinellosis (Trichinella spiralis). Red Book: 2009 Report of the Committee on Infectious Diseases. 28th. Elk Grove Village, IL: American Academy of Pediatrics; 2009. 673-4.

Hall RL, Lindsay A, Hammond C, Montgomery SP, Wilkins PP, da Silva AJ, et al. Outbreak of human trichinellosis in Northern California caused by Trichinella murrelli. Am J Trop Med Hyg. 2012 Aug. 87(2):297-302. [Medline]. [Full Text].

Murrell KD, Pozio E. Worldwide occurrence and impact of human trichinellosis, 1986-2009. Emerg Infect Dis. 2011 Dec. 17(12):2194-202. [Medline].

Cui J, Wang ZQ, Xu BL. The epidemiology of human trichinellosis in China during 2004-2009. Acta Trop. 2011 Apr. 118(1):1-5. [Medline].

Pannwitz G, Mayer-Scholl A, Balicka-Ramisz A, Nockler K. Increased Prevalence of Trichinella spp., Northeastern Germany, 2008. Emerg Infect Dis. 2010 Jun. 16(6):936-42. [Medline].

Neghina R, Neghina AM, Marincu I, Iacobiciu I. Trichinellosis in children and adults: a 10-year comparative study in Western Romania. Pediatr Infect Dis J. 2011 May. 30(5):392-5. [Medline].

Moller LN, Koch A, Petersen E, et al. Trichinella infection in a hunting community in East Greenland. Epidemiol Infect. 2010 Sep. 138(9):1252-6. [Medline].

Capo V, Despommier DD. Clinical aspects of infection with Trichinella spp. Clin Microbiol Rev. 1996 Jan. 9(1):47-54. [Medline]. [Full Text].

Cabie A, Bouchaud O, Houze S, et al. Albendazole versus thiabendazole as therapy for trichinosis: a retrospective study. Clin Infect Dis. 1996 Jun. 22(6):1033-5. [Medline].

Messiaen P, Forier A, Vanderschueren S, Theunissen C, Nijs J, Van Esbroeck M, et al. Outbreak of trichinellosis related to eating imported wild boar meat, Belgium, 2014. Euro Surveill. 2016 Sep 15. 21 (37):[Medline]. [Full Text].

Lo YC, Hung CC, Lai CS, Wu Z, Nagano I, Maeda T. Human trichinosis after consumption of soft-shelled turtles, taiwan. Emerg Infect Dis. 2009 Dec. 15(12):2056-8. [Medline].

Kusolsuk T, Kamonrattanakun S, Wesanonthawech A, et al. The second outbreak of trichinellosis caused by Trichinella papuae in Thailand. Trans R Soc Trop Med Hyg. 2010 Jun. 104(6):433-7. [Medline].

Intapan PM, Chotmongkol V, Tantrawatpan C, Sanpool O, Morakote N, Maleewong W. Molecular identification of Trichinella papuae from a Thai patient with imported trichinellosis. Am J Trop Med Hyg. 2011 Jun. 84(6):994-7. [Medline]. [Full Text].

Rosenblatt JE. Laboratory diagnosis of infections due to blood and tissue parasites. Clin Infect Dis. 2009 Oct 1. 49(7):1103-8. [Medline].

Yang Y, Cai YN, Tong MW, Sun N, Xuan YH, Kang YJ, et al. Serological tools for detection of Trichinella infection in animals and humans. One Health. 2016 Dec. 2:25-30. [Medline]. [Full Text].

Centers for Disease Control and Prevention. Laboratory Identification of Parasitic Diseases of Public Health Concern. CDC. Available at http://www.cdc.gov/dpdx/trichinellosis/dx.html. Accessed: November 29, 2013.

Escalante M, Romaris F, Rodriguez M, et al. Evaluation of Trichinella spiralis larva group 1 antigens for serodiagnosis of human trichinellosis. J Clin Microbiol. 2004 Sep. 42(9):4060-6. [Medline]. [Full Text].

Wang ZQ, Shi YL, Liu RD, Jiang P, Guan YY, Chen YD, et al. New insights on serodiagnosis of trichinellosis during window period: early diagnostic antigens from Trichinella spiralis intestinal worms. Infect Dis Poverty. 2017 Feb 20. 6 (1):41. [Medline]. [Full Text].

Morakote N, Sukhavat K, Khamboonruang C, Siriprasert V, Suphawitayanukul S, Thamasonthi W. Persistence of IgG, IgM, and IgE antibodies in human trichinosis. Trop Med Parasitol. 1992 Sep. 43(3):167-9. [Medline].

Watt G, Saisorn S, Jongsakul K, et al. Blinded, placebo-controlled trial of antiparasitic drugs for trichinosis myositis. J Infect Dis. 2000 Jul. 182(1):371-4. [Medline].

Centers for Disease Control and Prevention. Parasites – Trichinellosis (also known as Trichinosis), Prevention and Control. CDC. Available at http://www.cdc.gov/parasites/trichinellosis/prevent.html. Accessed: December 13, 2013.

Neghina R, Iacobiciu I, Neghina AM, Marincu I. Trichinellosis, another helminthiasis affecting the central nervous system. Parasitol Int. 2011 Jun. 60(2):230. [Medline].

Aronson SM. A tale of an inconsequential worm. Med Health R I. 1999 Oct. 82(10):347. [Medline].

Astudillo LM, Arlet PM. Images in clinical medicine. The chemosis of trichinosis. N Engl J Med. 2004 Jul 29. 351(5):487. [Medline].

Barennes H, Sayasone S, Odermatt P, De Bruyne A, Hongsakhone S, Newton PN, et al. A major trichinellosis outbreak suggesting a high endemicity of Trichinella infection in northern Laos. Am J Trop Med Hyg. 2008 Jan. 78(1):40-4. [Medline].

Bruschi F. Trichinellosis in developing countries: is it neglected?. J Infect Dev Ctries. 2012 Mar 12. 6(3):216-22. [Medline].

Bruschi F, Chiumiento L. Trichinella inflammatory myopathy: host or parasite strategy?. Parasit Vectors. 2011 Mar 23. 4:42. [Medline]. [Full Text].

Bruschi F, Korenaga M, Watanabe N. Eosinophils and Trichinella infection: toxic for the parasite and the host?. Trends Parasitol. 2008 Oct. 24(10):462-7. [Medline].

CDC. Trichinellosis associated with bear meat–New York and Tennessee, 2003. MMWR Morb Mortal Wkly Rep. 2004 Jul 16. 53(27):606-10. [Medline].

De Bruyne A, Ancelle T, Vallee I, Boireau P, Dupouy-Camet J. Human trichinellosis acquired from wild boar meat: a continuing parasitic risk in France. Euro Surveill. 2006. 11(9):E060914.5. [Medline].

Dubey ML, Khurana S, Singhal L, Dogra S, Singh S. Atypical trichinellosis without eosinophilia associated with osteomyelitis. Trop Doct. 2011 Oct. 41(4):244-6. [Medline].

Dupouy-Camet J, Lecam S, Talabani H, Ancelle T. Trichinellosis acquired in Senegal from warthog ham, March 2009. Euro Surveill. 2009 May 28. 14(21):[Medline].

Feigin RD, Cherry JD. Parasitic myocarditis. Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders Co; 2004. 407-9.

Gamble HR, Pozio E, Bruschi F, et al. International Commission on Trichinellosis: recommendations on the use of serological tests for the detection of Trichinella infection in animals and man. Parasite. 2004 Mar. 11(1):3-13. [Medline].

Golab E, Szulc M, Wnukowska N, Rozej W, Fell G, Sadkowska-Todys M. Outbreak of trichinellosis in North-Western Poland–update and exported cases, June-July 2007. Euro Surveill. 2007 Jul. 12(7):E070719.2. [Medline].

Gomez-Morales MA, Ludovisi A, Amati M, Cherchi S, Pezzotti P, Pozio E. Validation of an enzyme-linked immunosorbent assay for diagnosis of human trichinellosis. Clin Vaccine Immunol. 2008 Nov. 15(11):1723-9. [Medline].

Gotistein B, Piarroux R. Current trends in tissue-affecting helminths. Parasite. 2008 Sep. 15(3):291-8. [Medline].

Gottstein B, Pozio E, Nöckler K. Epidemiology, diagnosis, treatment, and control of trichinellosis. Clin Microbiol Rev. 2009 Jan. 22(1):127-45, Table of Contents. [Medline]. [Full Text].

Hall RL, Lindsay A, Hammond C, Montgomery SP, Wilkins PP, da Silva AJ. Outbreak of human trichinellosis in Northern California caused by Trichinella murrelli. Am J Trop Med Hyg. 2012 Aug. 87(2):297-302. [Medline].

Hidron A, Vogenthaler N, Santos-Preciado JI, Rodriguez-Morales AJ, Franco-Paredes C, Rassi A Jr. Cardiac involvement with parasitic infections. Clin Microbiol Rev. 2010 Apr. 23(2):324-49. [Medline].

Ilic N, Gruden-Movsesijan A, Sofronic-Milosavljevic L. Trichinella spiralis: shaping the immune response. Immunol Res. 2012 Apr. 52(1-2):111-9. [Medline].

Jansen A, Schoneberg I, Stark K, Nockler K. Epidemiology of trichinellosis in Germany, 1996-2006. Vector Borne Zoonotic Dis. 2008 Apr. 8(2):189-96. [Medline].

Kaewpitoon N, Kaewpitoon SJ, Philasri C, et al. Trichinosis: epidemiology in Thailand. World J Gastroenterol. 2006 Oct 28. 12(40):6440-5. [Medline].

Kociecka W. Trichinellosis: human disease, diagnosis and treatment. Vet Parasitol. 2000 Dec 1. 93(3-4):365-83. [Medline].

Lazarevic AM, Neskovic AN, Goronja M, et al. Low incidence of cardiac abnormalities in treated trichinosis: a prospective study of 62 patients from a single-source outbreak. Am J Med. 1999 Jul. 107(1):18-23. [Medline].

Lindh J, Ljungstrom I. Trichinella spp. Akuffo H, Linder E, Ljungstrom I, Wahlgren M. Parasites of the Colder Climates. London and New York: Taylor & Francis; 2003. 195-204.

Long SS, Pickering LK, Prober CG. Trichinella spiralis. Pediatric Infectious Diseases. 2003. 1344-46.

Madariaga MG, Cachay ER, Zarlenga DS. A probable case of human neurotrichinellosis in the United States. Am J Trop Med Hyg. 2007 Aug. 77(2):347-9. [Medline].

Mandell GL, Bennett JE, Dolin RD. Tissue nematodes, including trichinosis, dracunculiasis, and the filariases. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Philadelphia, Pa: Churchill Livingstone; 2005. 3267-76.

Marva E, Markovics A, Gdalevich M, et al. Trichinellosis outbreak. Emerg Infect Dis. 2005 Dec. 11(12):1979-81. [Medline].

McIntyre L, Pollock SL, Fyfe M, Gajadhar A, Isaac-Renton J, Fung J. Trichinellosis from consumption of wild game meat. CMAJ. 2007 Feb 13. 176(4):449-51. [Medline].

Mitreva M, Jasmer DP. Biology and genome of Trichinella spiralis. WormBook. 2006 Nov 23. 1-21. [Medline].

Murrell KD, Bruschi F. Clinical trichinellosis. Prog Clin Parasitol. 1994. 4:117-50. [Medline].

Neghina R, Moldovan R, Marincu I, Calma CL, Neghina AM. The roots of evil: the amazing history of trichinellosis and Trichinella parasites. Parasitol Res. 2011 Oct 8. [Medline].

Neghina R, Neghina AM. Reviews on trichinellosis (IV): hepatic involvement. Foodborne Pathog Dis. 2011 Sep. 8(9):943-8. [Medline].

Outbreak of trichinellosis in French hunters who ate Canadian black bear meat. Can Commun Dis Rep. 2006 May 1. 32(9):109-12. [Medline].

Ozdemir D, Ozkan H, Akkoc N, et al. Acute trichinellosis in children compared with adults. Pediatr Infect Dis J. 2005 Oct. 24(10):897-900. [Medline].

Papatsiros VG, Boutsini S, Ntousi D, Stougiou D, Mintza D, Bisias A. Detection and zoonotic potential of Trichinella spp. from free-range pig farming in Greece. Foodborne Pathog Dis. 2012 Jun. 9(6):536-40. [Medline].

PDR. Physician’s Desk Reference. Montvale, NJ: Thomson Healthcare; 2000.

Pozio E, Darwin Murrell K. Systematics and epidemiology of trichinella. Adv Parasitol. 2006. 63:367-439. [Medline].

Pozio E, Gomez Morales MA, Dupouy-Camet J. Clinical aspects, diagnosis and treatment of trichinellosis. Expert Rev Anti Infect Ther. 2003 Oct. 1(3):471-82. [Medline].

Pozio E, Hoberg E, La Rosa G, Zarlenga DS. Molecular taxonomy, phylogeny and biogeography of nematodes belonging to the Trichinella genus. Infect Genet Evol. 2009 Jul. 9(4):606-16. [Medline].

Taratuto AL, Venturiello SM. Trichinosis. Brain Pathol. 1997 Jan. 7(1):663-72. [Medline].

Taylor WR, Tran GV, Nguyen TQ, Dang DV, Nguyen VK, Nguyen CT, et al. Acute Febrile Myalgia in Vietnam due to Trichinellosis following the Consumption of Raw Pork. Clin Infect Dis. 2009 Aug 27. [Medline].

Tint D, Cocuz ME, Ortan OF, Niculescu MD, Radoi M. Cardiac involvement in trichinellosis: a case of left ventricular thrombosis. Am J Trop Med Hyg. 2009 Aug. 81(2):313-6. [Medline].

Turk M, Kaptan F, Turker N, et al. Clinical and laboratory aspects of a trichinellosis outbreak in Izmir, Turkey. Parasite. 2006 Mar. 13(1):65-70. [Medline].

Watt G, Silachamroon U. Areas of uncertainty in the management of human trichinellosis: a clinical perspective. Expert Rev Anti Infect Ther. 2004 Aug. 2(4):649-52. [Medline].

Youn H. Review of zoonotic parasites in medical and veterinary fields in the Republic of Korea. Korean J Parasitol. 2009 Oct. 47 Suppl:S133-41. [Medline]. [Full Text].

Germaine L Defendi, MD, MS, FAAP Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Ashir Kumar, MD, MBBS FAAP, Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS is a member of the following medical societies: Infectious Diseases Society of America, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Basim Asmar, MD Director, Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Michigan; Professor, Department of Pediatrics, Wayne State University School of Medicine

Basim Asmar, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Swati Garekar, MBBS Staff Physician, Department of Pediatrics, Children’s Hospital of Michigan

Swati Garekar, MBBS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

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