Helminth

Trichinosis

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Trichinosis, Trichinellosis, Trichinella spiralis

  • See Also
  1. Infectious Diarrhea
  2. Parasitic Infection
  3. Helminth
  • Epidemiology
  1. U.S. infections are now rare
  • Pathophysiology
  1. Trichinella spiralis is a parasitic roundworm found in carnivorous mammals (esp. swine and rats fed raw garbage)
  2. Humans are infected by consuming undercooked pork infected with Trichinella larvae
    1. In addition to pork, other ingested meat sources include wild boar, bear, deer or ground beef
  • Symptoms
  1. Gastrointestinal symptoms (most common)
    1. Diarrhea
    2. Abdominal Pain or cramping
    3. Nausea or Vomiting
    4. Fever
  2. Systemic Symptoms (uncommon)
    1. Fever
    2. Eosinophilia
    3. Myositis
    4. Circumorbital edema
  • Labs
  1. Trichinella spiralis Antibody Testing
    1. Unreliable in first 3 weeks of infection
    2. Obtain 2 specimens, 2 to 3 weeks apart (consult CDC resource below)
  2. Other variable findings
    1. Lactate Dehydrogenase increased
    2. Hypergammaglobulinemia
  • Diagnostics
  1. Myositis
    1. Serum Creatine Kinase increased
    2. Muscle biopsy of Myositis location may demonstrate larvae
  2. Suspected CNS involvement
    1. Brain imaging (e.g. MRI Brain)
  • Management
  1. Albendazole
    1. Adult (and age >6 years): 400 mg orally twice daily for 8 to 14 days
    2. Child age 1 to 6 years: 5 to 10 mg/kg divided twice daily orally for 10 to 15 days
    3. Asymptomatic or mild symptoms may not require treatment
  2. Prednisone
    1. Consider with Albendazole in patients with severe systemic symptoms
    2. Prednisone (adult dose) 30 to 60 mg orally daily for 10 to 15 days or until symptoms improve
  • Complications
  1. CNS involvement
    1. Risk of fatal disease
  • Resources
  1. CDC Parasite Hotline
    1. https://www.cdc.gov/parasites/health_professionals.html
  2. Rawla (2023) Trichinella spiralis Infection, StatPearls, Treasure Island, FL
    1. https://www.ncbi.nlm.nih.gov/books/NBK538511/
  • References
  1. Pyzocha (2023) Am Fam Physician 108(5): 487-93 [PubMed]