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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{DiseaseDisorder infobox |
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| Name = Trichinosis |
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| Image = |
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| Caption = |
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| ICD10 = {{ICD10|B|75||b|65}} |
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| ICD9 = {{ICD9|124}} |
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| ICDO = |
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| OMIM = |
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| DiseasesDB = 13326 |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| {{Trichinosis}} | | {{Trichinosis}} |
| {{CMG}}
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| ==[[Trichinosis overview|Overview]]==
| | {{CMG}} {{AE}} {{DL}} |
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| '''Trichinosis''', also called '''trichinellosis''', or '''trichiniasis''', is a [[parasitic disease]] caused by eating raw or undercooked pork and wild game products infected with the [[larva]]e of a species of [[roundworm]] ''[[Trichinella spiralis]]'', commonly called the trichina worm. The few cases in the United States are mostly the result of eating undercooked game or home reared pigs. It is most common in the developing world and where pigs are commonly fed raw garbage.
| | {{SK}} Trichinella spiralis infection; trichinellosis; trichiniasis |
| ==[[Trichinosis risk factors|Risk Factors]]==
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| ==[[Trichinosis history and symptoms|History & Symptoms]]==
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| Trichinosis initially involves the intestines. Within 1-2 days of contagion, manifestations such as [[nausea]], [[heartburn]], [[dyspepsia]], and [[diarrhea]]; the severity of symptoms depends on the number of worms ingested. Later on, as the worms encyst in different parts of the human body, other manifestations may occur, such as [[headache]], [[fever]], [[chills]], [[cough]], [[List of systemic diseases with ocular manifestations|eye swelling]], [[arthralgia|joint pain]] and [[myalgia|muscle pain]], [[petechiae]], and [[pruritus|itching]].
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| Most symptoms subside within a few months. The most dangerous case is worms entering the [[central nervous system]]. They cannot survive there, but they may cause enough damage to produce serious neurological deficits (such as [[ataxia]] or respiratory paralysis), and even [[death]]. Infestation of the [[heart]] may also lead to death.
| | ==[[Trichinosis overview|Overview]]== |
| | ==[[Trichinosis historical perspective|Historical perspective]]== |
| | ==[[Trichinosis classification|Classification]]== |
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| ==Life cycle== | | ==[[Trichinosis pathophysiology|Pathophysiology]]== |
| The worm can infect any species of mammal that consumes its encysted [[larva]]l stages. When an animal eats meat that contains infective ''Trichinella'' cysts, the acid in the stomach dissolves the hard covering of the cyst and releases the worms. The worms pass into the small intestine and, in 1–2 days, become mature. After mating, adult females produce larvae, which break through the intestinal wall and travel through the lymphatic system to the circulatory system to find a suitable cell. Larvae can penetrate any cell, but can only survive in [[skeletal muscle]]. Within a muscle cell, the worms curl up and direct the cell functioning much as a virus does. The cell is now called a ''[[nurse cell]]''. Soon, a net of blood vessels surround the nurse cell, providing added nutrition for the larva inside.
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| ==Diagnosis==
| | ==[[Trichinosis causes|Causes ]]== |
| ==[[Trichinosis laboratory tests|Lab Tests]]== | |
| A [[blood test]] or [[muscle biopsy]] can identify trichinosis. Stool studies can identify adult worms, with females being about 3 mm long and males about half that size.
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| ==Treatment==
| | ==[[Trichinosis differential diagnosis|Differentiating Trichinosis from other Diseases]]== |
| ==[[Trichinosis medical therapy|Medical Therapy]]== | |
| Symptoms can be treated with [[aspirin]] and [[corticosteroids]]. [[Thiabendazole]] can kill adult worms in the intestine; however, there is no treatment that kills the larvae.
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| ==[[Trichinosis epidemiology and demographics|Epidemiology & Demographics]]== | | ==[[Trichinosis epidemiology and demographics|Epidemiology and Demographics]]== |
| Trichinosis was known as early as 1835 to have been caused by a parasite, but the mechanism of infection was unclear at the time. It was not until a decade later that American scientist Joseph Leidy pinpointed undercooked meat as the primary vector for the parasite, and not until two decades afterwards that this hypothesis was fully accepted by the scientific community [http://www.acnatsci.org/museum/leidy/other/parasitology.html].
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| Infection was once very common, but is now quite rare in the developed world. From 1991 to 1996, an annual average of 12 cases per year were reported in the United States. The number of cases has decreased because of legislation prohibiting the feeding of raw meat garbage to hogs, increased commercial and home freezing of pork, and the public awareness of the danger of eating raw or undercooked pork products. Today, one of the primary causes of trichinosis in America is the consumption of raw or undercooked wild game meats.
| | ==[[Trichinosis risk factors|Risk Factors]]== |
| | ==[[Trichinosis natural history, complications, and prognosis|Natural History, Complications and Prognosis]]== |
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| In the developing world, most infections are associated with undercooked pork. For example, in Thailand, between 200 and 600 cases are reported annually around the Thai New Year. In parts of Eastern Europe, the WHO reports that some swine herds have trichinosis infection rates above 50%, and there are correspondingly large numbers of human infections [http://www.emedicine.com/emerg/topic612.htm].
| | ==Diagnosis== |
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| It has been suggested that trichinosis may be one of several factors that led to religious prohibitions in Islam, Judaism, etc. against eating pork products, such as in the [[kashrut]] and [[Halal|dhabiĥa halal]] dietary laws. The medieval Jewish philosopher Maimonides advocated such a theory in his Guide for the Perplexed.
| | [[Trichinosis diagnostic criteria|Diagnostic Criteria]] | [[Trichinosis history and symptoms|History and Symptoms]] | [[Trichinosis physical examination|Physical Examination]] | [[Trichinosis laboratory tests|Laboratory Findings]] | [[Trichinosis other diagnostic studies|Other Diagnostic Studies]] |
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| ==International Commission on trichinellosis== | | ==Treatment== |
| The International Commission on trichinellosis (ICT) was created in 1958 in Budapest and is aiming to exchange information on the biology, the physiopathology, the epidemiology, the immunology, and the clinical aspects of trichinellosis in humans and animals. Prevention is a primary goal. Since the creation of the ICT, its members (more than 110 from 46 countries) have regularly gathered and worked together during meetings held every 4 years : the [[International Conference on Trichinellosis]].
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| ==[[Trichinosis primary prevention|Primary Prevention]]==
| | [[Trichinosis medical therapy|Medical Therapy]] | [[Trichinosis primary prevention|Primary Prevention]] | [[Trichinosis secondary prevention|Secondary Prevention]] | [[Trichinosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Trichinosis future or investigational therapies|Future or Investigational Therapies]] |
| *Cooking [[meat]] products until the juices run clear or to an internal temperature of 170 °[[Fahrenheit|F]] (77 °[[Celsius|C]]).
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| *Freezing pork] less than 6 inches thick for 20 days at 5 °F (−15 °C) or three days at −4 °F (−20 °C) kills larval worms.
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| *Cooking wild game meat thoroughly. Freezing wild game meats, unlike freezing pork products, even for long periods of time, may not effectively kill all worms. This is because the species of trichinella that typically infects wild game is more resistant to freezing than the species that infects pigs.
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| *Cooking all meat fed to pigs or other wild animals.
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| * Keeping pigs in clean pens with floors that can be washed (such as concrete). This is standard in Germany, where raw pork is a common delicacy and trichinosis is rarer than in the U.S.
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| *Not allowing hogs to eat uncooked carcasses of other animals, including rats, which may be infected with trichinosis.
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| *Cleaning meat grinders thoroughly when preparing ground meats.
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| *Control and destruction of meat containing trichinae, e.g., removal and proper disposal of porcine diaphragms prior to public sale of meat.
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| The [[Centers for Disease Control and Prevention]] makes the following recommendation: "Curing (salting), drying, smoking, or microwaving meat does not consistently kill infective worms."<ref>
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| {{cite web
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| | url = http://www.cdc.gov/ncidod/dpd/parasites/trichinosis/factsht_trichinosis.htm | |
| | title = Parasitic Disease Information - Trichinellosis
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| | author = [[Centers for Disease Control and Prevention]], Division of Parasitic Diseases
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| | date = 2004-07-15
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| | accessdate = 2007-01-28
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| }}
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| </ref>
| | ==Case Studies== |
| However, under controlled commercial food processing conditions some of these methods are considered effective by the [[United States Department of Agriculture]].<ref>
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| {{cite web
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| | url = http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=f9361ee66063187dffee4c083c24b6a7&rgn=div5&view=text&node=9:2.0.2.1.19&idno=9#9:2.0.2.1.19.1.21.9
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| | title = Electronic Code of Federal Regulations; Title 9: Animals and Animal Products; PART 318—ENTRY INTO OFFICIAL ESTABLISHMENTS; REINSPECTION AND PREPARATION OF PRODUCTS; § 318.10 Prescribed treatment of pork and products containing pork to destroy trichinae
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| | author = [[United States Department of Agriculture]]
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| | accessdate = 2007-01-28
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| }}
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| </ref>
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| ==References==
| | [[Trichinosis case study one|Case #1]] |
| {{reflist|2}}
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| ==Additional Resources==
| | [[Category:Conditions diagnosed by stool test]] |
| *''The text of the original version of this article was taken from the public domain resource at http://www.cdc.gov/ncidod/dpd/parasites/trichinosis/factsht_trichinosis.htm''
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| *[[Centers for Disease Control and Prevention]]. Trichinosis Surveillance, United States, 1987-1990, MMWR 1991;40:(SS-3)35-42.
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| *Moorhead A, Grunenwald PE, Dietz VJ, Schantz PM. Trichinellosis in the United States, 1991-1996: Declining but not gone. Am J Trop Med Hyg 1999; 60:66-69.
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| * [http://www.cfsan.fda.gov/~lrd/9CF318.html US FDA regulations - Title 9 - Chapter 3 - Part 318 - includes "Prescribed treatment of pork and products containing pork to destroy trichinae."]
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| ==Web pages==
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| [http://www.med.unipi.it/ict/welcome.htm International Commission on trichinellosis web pages]
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| [[bg:Спирална трихина]]
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| [[ca:Triquinosi]]
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| [[cs:Trichinelóza]]
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| [[da:Trikin]]
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| [[de:Trichinellose]]
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| [[es:Trichinellosis]]
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| [[fr:Trichinose]]
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| [[it:Trichinellosi]]
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| [[he:שערוניות]]
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| [[lt:Trichineliozė]]
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| [[pt:Triquinose]]
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| [[sv:Trikinos]] | |
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| | [[Category:Parasitic diseases]] |
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| [[Category:Conditions diagnosed by stool test]]
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| [[Category:Infectious disease]]
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| [[pl:Włośnica (choroba)]]
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |