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Trichinellosis (trichinosis)

• caused by nematodes (roundworms) of the


genus Trichinella.
• several other species of Trichinella are:
-T. pseudospiralis (mammals and birds worldwide)
-T. nativa (Arctic bears)
-T. nelsoni (African predators and scavengers),
-T. britovi (carnivores of Europe and western Asia).

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 1


life span in the small bowel:
4 weeks

•encysted larvae
•remain viable for several years. female 2.2 mm
males 1.2 mm

Encystment is completed
in 4 to 5 weeks

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 2


Clinical Features
• light infections: asymptomatic
• Intestinal invasion: diarrhea, abdominal pain,
vomiting.
• Larval migration into muscle tissues (one week
after infection): periorbital and facial edema,
conjunctivitis, fever, myalgias, splinter
hemorrhages, rashes, & blood eosinophilia.
• Occasional: myocarditis, central nervous system
involvement, and pneumonitis.
• Larval encystment in the muscles: myalgia &
weakness
9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 3
laboratory finding
• Eosinophilia always associated with T. spiralis
• In severely infected cases, eosinophils may be
as high as 80-95%.
• Overall, the total WBC count is slightly elevated.
• In patients moderately or severely infected with
this nematode, muscle enzymes such as CPK
and LDH are released into the circulating blood
and their presence inthe serum can be another
clue
• ELISA can detect antibodies as early as 12 days
after infection

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 4


Diagnosis

• based on clinical symptoms and


eosinophilia
• can be confirmed by specific diagnostic
tests, including antibody detection, muscle
biopsy, and microscopy.
• Trichinosis is definitely diagnosed by the
detection of larvae in the biopsied muscle.

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 5


Encysted larvae of Trichinella in pressed muscle tissue sample.
The coiled larvae can be seen inside the cysts.

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 6


Larvae of Trichinella, freed from their cysts, typically coiled;
length: 0.8 to 1 mm

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 7


Treatment

• Begin as soon as possible


• The decision to treat is based upon symptoms,
exposure to raw or undercooked meat, and
laboratory test results.
• Thiabendazole and mebendazole are useful
(Miyazaki, 1991).
• Albendazole may be effective, but its role is not
yet established (Markell et al., 1999).
• Steroids are used for infections with severe
symptoms

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 8


Case report from Korea
• A 35- year-old men residing in Kochang-up was admitted
to Seokyong Hospital
• Complained of high fever, facial and periorbital edema,
and myalgia,
• A common past history of eating raw liver, spleen, blood
and muscle of a badger, Meles meles melanogenys.
• Hematologic and biochemical examinations :
- leukocytosis
- eosinophilia,
- highly elevated levels of GOT, GPT, LDH and CPK.
• symptoms & the laboratory findings: trichinosis?
Sohn, Korean J Parasitol. 2000;38(2):111-5.

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 9


Muscle biopsi
(By pressure method using two slide glasses)

• Biopsi of Gastrocnemius
muscle
• After 24 d eating badger
• Roundly coiled
nematode larvae
• Size: 0.775-1.050 x
0.026-0.042 mm

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 10


Fig 2. A sectioned larva in the worm cyst of muscle biopsied(H-E stained).
Fig. 3. Enlarged view of Fig. 2, showing the intense inflammatory response
around the nurse cells (arrow
heads)-larva (L) complex (H-E stained).

9/3/2018 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 11


• Intensity of infection: Muscle biosy digested with pepsin-HCl solution.
• 212 larvae/gram muscle was recovered & then given orally to a ICR
mouse.
• At 50 days after:: a large number of larval T. spiralis was harvested
from the mouse.
• 7 days flubendazole & 3d albendazole the larvae in biopsied muscle
were uncoiled (Figs. 4, 5),

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Treatment to the patient
• Helminths eradication: Praziquantel,
flubendazole & albendazole given orally
• Symptoms & other infection: antibiotics
and steroids were administered.
• discharged at 13-34 days post-admission
• What we can learn?:
Trichinellosis not only be found in pig

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