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*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).
*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]].<ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref><ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref>
*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]].<ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref><ref name="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Trichinosis Classification Based on the Severity of Signs and Larval Density''' <br><SMALL>Adapted from Clin Microbiol Rev. 2009 Jan; 22(1): 127–145.<ref>{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref></SMALL>
! style="width: 180px;background: #4479BA" |{{fontcolor|#FFF| Classification}}
! style="width: 120px;background: #4479BA" |{{fontcolor|#FFF| Fever, Edema, and Myalgia}}
! style="width: 120px;background: #4479BA" |{{fontcolor|#FFF| Recovery Time}}
! style="width: 120px;background: #4479BA" |{{fontcolor|#FFF| Approx. number of larvae/g of muscle}}
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Asymptomatic
| style="background: #F5F5F5; text-align:center" | None
| style="background: #F5F5F5; text-align:center" | N/A
| style="background: #F5F5F5; text-align:center" | <10
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Abortive
| style="background: #F5F5F5; text-align:center" | 1-2 days
| style="background: #F5F5F5; text-align:center" | N/A
| style="background: #F5F5F5; text-align:center" | 10-100
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Mild
| style="background: #F5F5F5; text-align:center" | +
| style="background: #F5F5F5; bold; text-align:center" | 3 weeks
| style="background: #F5F5F5; text-align:center" | 10-100
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Pronounced
| style="background: #F5F5F5; text-align:center" | ++
| style="background: #F5F5F5; bold; text-align:center" | 6 weeks
| style="background: #F5F5F5; text-align:center" | 10-100
|-
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Severe
| style="background: #F5F5F5; text-align:center" | +++
| style="background: #F5F5F5; bold; text-align:center" | >6 months
| style="background: #F5F5F5; text-align:center" | >100
|-
|}
==Complications==
==Complications==
Common complications of trichinosis include:
Common complications of trichinosis include:<ref name="abc">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  </ref>


=== Cardiovascular: ===
=== Cardiovascular: ===
** [[Heart failure]]
* [[Heart failure]]
** [[Heart rhythm]] problems ([[arrhythmias]]) from heart inflammation ([[myocarditis]])
* [[Heart rhythm]] problems ([[arrhythmias]]) from heart inflammation ([[myocarditis]])
**[[Thromboembolic disease]]
*[[Thromboembolic disease]]
*** [[Deep thrombophlebitis]]
** [[Deep thrombophlebitis]]
***Intraventricular thrombi
**Intraventricular thrombi
***[[Pulmonary embolism]]
**[[Pulmonary embolism]]
**[[Paroxysmal tachycardia]]
*[[Paroxysmal tachycardia]]
**[[Pericardial effusion]]
*[[Pericardial effusion]]


=== Neurological: ===
=== Neurological: ===
**[[Encephalomyelitis]]
*[[Encephalomyelitis]]
**[[Neuromuscular disorder|Neuromuscular disturbances]]:
*[[Neuromuscular disorder|Neuromuscular disturbances]]:
***Decreased [[muscular strength]] and [[Tendon reflex|tendon reflexes]]
**Decreased [[muscular strength]] and [[Tendon reflex|tendon reflexes]]
***[[Dysphagia]]
**[[Dysphagia]]
***[[Trismus]]
**[[Trismus]]


=== Ocular: ===
=== Ocular: ===
**[[Edema]] and [[Vascular anomaly|vascular lesions]] within the [[conjunctiva]], [[uvea]], [[retina]], and, in some cases, the [[optic nerve]]
*[[Edema]] and [[Vascular anomaly|vascular lesions]] within the [[conjunctiva]], [[uvea]], [[retina]], and, in some cases, the [[optic nerve]]
**Pain when moving the eyeballs
*Pain when moving the eyeballs
**[[Muscle]] paralysis
*[[Muscle]] paralysis
**[[Diplopia]]
*[[Diplopia]]
**Disturbed [[Accommodation (eye)|accommodation]]
*Disturbed [[Accommodation (eye)|accommodation]]


=== Respiratory: ===
=== Respiratory: ===
**[[Dyspnea]]
*[[Dyspnea]]
**[[Pneumonia]]
*[[Pneumonia]]
**Obstructive [[bronchitis]]
*Obstructive [[bronchitis]]
**Löffler-type infiltrates or ventilature failures
*Löffler-type infiltrates or ventilature failures


=== Digestive: ===
=== Digestive: ===
**[[Hypoalbuminemia]]
*[[Hypoalbuminemia]]
**Acute [[intestinal]] [[necrosis]]  
*Acute [[intestinal]] [[necrosis]]  
**Prolonged [[diarrhoea]]<ref name="abc">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  </ref>
*Prolonged [[diarrhoea]]


==Prognosis==
==Prognosis==
Line 65: Line 100:
*Most people with trichinosis have no symptoms, the infection is usually self-limited.<ref name="bb">Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016  </ref>  
*Most people with trichinosis have no symptoms, the infection is usually self-limited.<ref name="bb">Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016  </ref>  
*The mortality rate of trichinosis is approximately 0.2% worldwide.<ref name="pmid17689195">{{cite journal| author=Pozio E| title=World distribution of Trichinella spp. infections in animals and humans. | journal=Vet Parasitol | year= 2007 | volume= 149 | issue= 1-2 | pages= 3-21 | pmid=17689195 | doi=10.1016/j.vetpar.2007.07.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17689195  }} </ref>
*The mortality rate of trichinosis is approximately 0.2% worldwide.<ref name="pmid17689195">{{cite journal| author=Pozio E| title=World distribution of Trichinella spp. infections in animals and humans. | journal=Vet Parasitol | year= 2007 | volume= 149 | issue= 1-2 | pages= 3-21 | pmid=17689195 | doi=10.1016/j.vetpar.2007.07.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17689195  }} </ref>
*Prompt treatment with antiparasitic drugs can help prevent the progression of trichinosis by killing the adult worms and so preventing further release of larvae.
*Once the [[''Trichinella'']] larvae have become established in skeletal muscle cells, usually by 3 to 4 weeks post infection, treatment may not completely eliminate the infection and associated symptoms.
*If trichinosis treatment is not initiated within the first several days of infection, more prolonged or repeated courses of treatment may be necessary.<ref name="d">Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Infectious disease]]

Latest revision as of 19:01, 18 September 2017

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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:

Parenteral/muscle phase:

Trichinosis Classification Based on the Severity of Signs and Larval Density
Adapted from Clin Microbiol Rev. 2009 Jan; 22(1): 127–145.[5]
Classification Fever, Edema, and Myalgia Recovery Time Approx. number of larvae/g of muscle
Asymptomatic None N/A <10
Abortive 1-2 days N/A 10-100
Mild + 3 weeks 10-100
Pronounced ++ 6 weeks 10-100
Severe +++ >6 months >100

Complications

Common complications of trichinosis include:[3]

Cardiovascular:

Neurological:

Ocular:

Respiratory:

Digestive:

Prognosis

  • The prognosis of trichinosis is good with adequate treatment.
  • Most people with trichinosis have no symptoms, the infection is usually self-limited.[4]
  • The mortality rate of trichinosis is approximately 0.2% worldwide.[6]
  • Prompt treatment with antiparasitic drugs can help prevent the progression of trichinosis by killing the adult worms and so preventing further release of larvae.
  • Once the ''Trichinella'' larvae have become established in skeletal muscle cells, usually by 3 to 4 weeks post infection, treatment may not completely eliminate the infection and associated symptoms.
  • If trichinosis treatment is not initiated within the first several days of infection, more prolonged or repeated courses of treatment may be necessary.[7]

References

  1. 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. 2.0 2.1 Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016
  3. 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
  4. 4.0 4.1 Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016
  5. 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.
  6. Pozio E (2007). "World distribution of Trichinella spp. infections in animals and humans". Vet Parasitol. 149 (1–2): 3–21. doi:10.1016/j.vetpar.2007.07.002. PMID 17689195.
  7. Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016