Trichinosis natural history, complications, and prognosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
m (Changes made per Mahshid's request)
 
(10 intermediate revisions by one other user not shown)
Line 4: Line 4:


==Overview==
==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]].<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> [[Complications]] of trichinosis affect the [[cardiovascular]], [[neurological]], [[ocular]], [[respiratory|respiratory,]] and [[Digestive system|digestive systems]].<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> Most people with trichinosis have no [[symptoms]], the [[infection]] is usually self-limited. The [[prognosis]] of trichinosis is good with adequate treatment.<ref name="bb">Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016  </ref>  
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]].<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> Complications of trichinosis affect the [[cardiovascular]], [[neurological]], [[ocular]], [[respiratory|respiratory,]] and [[Digestive system|digestive systems]].<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> Most people with trichinosis have no symptoms, the infection is usually self-limited. The prognosis of trichinosis is good with adequate treatment.<ref name="bb">Trichinosis. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000631.htm Accessed on January 28, 2016  </ref>  


==Natural History==
==Natural History==
*Trichinosis is usually self-limited, and the majority of individuals with trichinosis are asymptomatic.
*Trichinosis is usually self-limited, and the majority of individuals with trichinosis are asymptomatic.
*The [[symptoms]] vary depending on the phase, species of [[Trichinella|''Trichinella'']], amount of encysted larvae ingested, [[age]], gender, and host immunity.
*The symptoms vary depending on the phase, species of [[Trichinella|''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]].
*Patients infected by 10 or less larvae have either minor or no symptoms and no complications.


=== ''Enteral/Intestinal phase:'' ===
=== ''Enteral/Intestinal phase:'' ===
**From two to seven days after [[infection]].
*From two to seven days after infection.
**The large burden of adult worms in the [[intestines]] promote [[symptoms]] such as [[nausea]], [[heartburn]], [[dyspepsia]], and [[diarrhea]].
*The large burden of adult worms in the intestines promote symptoms such as [[nausea]], [[heartburn]], [[dyspepsia]], and [[diarrhea]].


=== ''Parenteral/muscle phase:'' ===
=== ''Parenteral/muscle phase:'' ===
*The parental phase starts approximately seven days after [[infection]].
*The parental phase starts approximately seven days after infection.
*The severity of [[symptoms]] caused by larval migration from the [[intestines]] depends on the number of larvae produced.  
*The severity of symptoms caused by larval migration from the intestines depends on the number of larvae produced.  
*As the larvae migrate through [[tissue]] and [[vessels]], the body's inflammatory response results in [[edema]], [[muscle pain]], [[fever]], and [[Weakness (medical)|weakness]].  
*As the larvae migrate through tissue and [[vessels]], the body's inflammatory response results in [[edema]], [[muscle pain]], [[fever]], and [[Weakness (medical)|weakness]].  
*A classic sign of trichinosis is [[periorbital edema]], [[Periorbital edema|swelling around the eyes]], which may be caused by [[vasculitis]].  
*A classic sign of trichinosis is [[periorbital edema]], [[Periorbital edema|swelling around the eyes]], which may be caused by [[vasculitis]].  
*If left untreated, the worms may cause enough damage to produce serious [[Neurological disorders|neurological deficits]] (such as [[ataxia]] or respiratory paralysis) from worms entering the [[central nervous system]] (CNS).  
*If left untreated, the worms may cause enough damage to produce serious [[Neurological disorders|neurological deficits]] (such as [[ataxia]] or respiratory paralysis) from worms entering the [[central nervous system]] (CNS).  
*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="wiki1234">Trichinosis. Wikipedia. https://en.wikipedia.org/wiki/Trichinosis. Accessed on January 22, 2016</ref><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>
*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]]:
 
**[[Edema]] and [[Vascular anomaly|vascular lesions]] within the [[conjunctiva]], [[uvea]], [[retina]], and, in some cases, the [[optic nerve]]
=== Ocular: ===
**Pain when moving the eyeballs
*[[Edema]] and [[Vascular anomaly|vascular lesions]] within the [[conjunctiva]], [[uvea]], [[retina]], and, in some cases, the [[optic nerve]]
**[[Muscle]] paralysis
*Pain when moving the eyeballs
**[[Diplopia]]
*[[Muscle]] paralysis
**Disturbed [[Accommodation (eye)|accommodation]]
*[[Diplopia]]
*[[Respiratory]]:
*Disturbed [[Accommodation (eye)|accommodation]]
**[[Dyspnea]]
 
**[[Pneumonia]]
=== Respiratory: ===
**Obstructive [[bronchitis]]
*[[Dyspnea]]
**Löffler-type infiltrates or ventilature failures
*[[Pneumonia]]
*[[Digestive]]:
*Obstructive [[bronchitis]]
**[[Hypoalbuminemia]]
*Löffler-type infiltrates or ventilature failures
**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>
=== Digestive: ===
*[[Hypoalbuminemia]]
*Acute [[intestinal]] [[necrosis]]  
*Prolonged [[diarrhoea]]


==Prognosis==
==Prognosis==
*
*The prognosis of trichinosis is good with adequate treatment.
*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>
*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:Conditions diagnosed by stool test]]
[[Category:Infectious disease]]
[[pl:Włośnica (choroba)]]
{{WH}}
{{WS}}

Latest revision as of 19:01, 18 September 2017

Trichinosis Microchapters

Home

Patient Information

Overview

Historical perspective

Classification

Pathophysiology

Causes

Differentiating Trichinosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Trichinosis natural history, complications, and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Trichinosis natural history, complications, and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Trichinosis natural history, complications, and prognosis

CDC on Trichinosis natural history, complications, and prognosis

Trichinosis natural history, complications, and prognosis in the news

Blogs on Trichinosis natural history, complications, and prognosis

Directions to Hospitals Treating Trichinosis

Risk calculators and risk factors for Trichinosis natural history, complications, and prognosis

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
Retrieved from "https://www.wikidoc.org/index.php?title=Trichinosis_natural_history,_complications,_and_prognosis&oldid=1360184"