Clinical Manifestations and Pathology

The first symptoms of Trichinella infection occur 1 to 2 days after ingestion of infected meat. Initial symptoms are vague and often lead to misdiagnosis, if apparent at all. As a host reacts to the waste products produced by the worms, lesions develop and enteric bacteria are introduced into them. Nausea, toxic diarrhea, sweating, and vomiting may occur, mimicking an acute food-poisoning syndrome. Respiratory symptoms may follow between the second and sixth day, and last for 6 days. In addition, there may be red blotches erupting on the skin.

During the period of migration of juveniles, there are muscular pains as inflammatory processes develop in the muscles. Difficulty in breathing, chewing, and swallowing develops. Edema around the face and hands is due to endovascular and perivascular inflammation. Edema around the eyes is a common early sign. Lymph nodes become enlarged and tender. Enlarged parotid or sublingual glands often lead to misdiagnosis of mumps. Eosinophilia may be present but often does not occur, even in the most extreme cases. Myocarditis, peritonitis, pneumonia, encephalitis, pleurisy, meningitis, and eye damage may result from migrating juveniles. Death from myocarditis may occur at this stage.

Penetration by juveniles into muscle cells, and subsequent encystment, may result in toxic edema, cachexia, or dehydration. Blood pressure drops rapidly, and the patient may display nervous disorders such as defects of vision, altered or lost reflexes, hallucinations, delirium, and encephalitis. Severe cases can result in death 4 to 6 weeks after infection. Death may occur as a result of toxemia, myocarditis, nephritis, peritonitis, or other complications.

It is important to recognize that most cases of trichinosis go undetected and that in milder cases no special series of symptoms may be present. Accurate diagnosis is made by employing muscle biopsy, pressing the tissue between glass slides, and examining it under a microscope. Alternatively, tissue may be digested in artificial gastric juice and the sediment examined for freed juveniles. Xenodiag-nosis (feeding biopsy material to laboratory rats) is a useful diagnostic technique. Immunodiagnostic techniques may be useful when carried out by competent workers.

There is no thoroughly effective treatment for trichinosis. Thiabendazole has been somewhat effective, but serious side effects are known to occur. Steroids are given if myocarditis develops or if there are central nervous system complications. However, because corticosteroid therapy will inhibit the inflammatory reaction, an increase in larvae in the muscles will accompany this treatment.

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