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