Trichinellosis (trichinosis)

caused by nematodes (roundworms) of the genus Trichinella. several other species p of Trichinella are: -T. pseudospiralis (mammals and birds worldwide) -T. T nativa (Arctic bears) -T. nelsoni (African predators and scavengers), -T britovi (carnivores of Europe and western Asia) -T. Asia).

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

life span in the small bowel: 4 weeks y larvae encysted remain viable for several years.

female 2.2 mm males 1.2 mm

Encystment is completed in 4 to 5 weeks 6/18/2012 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 2

Clinical Features
light infections: asymptomatic Intestinal I t ti l invasion: i i di diarrhea, h abdominal bd i l pain, i vomiting. Larval migration into muscle tissues (one week after infection): periorbital and facial edema, conjunctivitis fever conjunctivitis, fever, myalgias myalgias, splinter hemorrhages, rashes, & blood eosinophilia. Occasional: myocarditis, central nervous system involvement, and pneumonitis. Larval encystment y in the muscles: myalgia y g & weakness
6/18/2012 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 3

laboratory finding
Eosinophilia always associated with T. spiralis In severely infected cases, eosinophils may be as high as 80-95%. Overall, Overall the total WBC count is slightly elevated elevated. In patients moderately or severely infected with this nematode, muscle enzymes such as CPK and LDH are released into the circulating blood and their presence inthe serum can be another clue l ELISA can detect antibodies as early as 12 days after infection
6/18/2012 S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas 4

Diagnosis
based on clinical symptoms and eosinophilia can be confirmed by specific diagnostic tests, including antibody detection, muscle biopsy and microscopy biopsy, microscopy. Trichinosis is definitely diagnosed by the d t ti of detection f larvae l i in th the bi biopsied i d muscle. l

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

Encysted larvae of Trichinella in pressed muscle tissue sample. The coiled larvae can be seen inside the cysts.

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

Larvae of f Trichinella h ll , freed f d from f their h cysts, typically ll coiled; l d length: 0.8 to 1 mm

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

Treatment
Begin g as soon as p possible The decision to treat is based upon symptoms, exposure to raw or undercooked meat, and laboratory test results results. Thiabendazole and mebendazole are useful (Miyazaki, 1991). Albendazole may be effective, but its role is not yet established (Markell et al., 1999). Steroids are used for infections with severe symptoms

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

Case report p from Korea

A 35- year-old men residing in Kochang-up was admitted to Seokyong Hospital Complained of high fever, facial and periorbital edema, and myalgia, A common p past history y of eating g raw liver, , spleen, p , blood and muscle of a badger, Meles meles melanogenys. Hematologic and biochemical examinations : - leukocytosis - eosinophilia, - highly elevated levels of GOT, GPT, LDH and CPK. symptoms & the laboratory findings: trichinosis?
Sohn, Korean J Parasitol. 2000;38(2):111-5.

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

Muscle biopsi
(By pressure method using two slide glasses)

Biopsi of Gastrocnemius muscle After 24 d eating badger y coiled Roundly nematode larvae Size: 0.775-1.050 x 0.026-0.042 mm

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

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Fig g 2. A sectioned larva in the worm cyst y of muscle biopsied(H-E ( stained). ) Fig. 3. Enlarged view of Fig. 2, showing the intense inflammatory response around the nurse cells (arrow heads)-larva (L) complex (H-E stained).

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

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Intensity of infection: Muscle biosy digested with pepsin-HCl solution solution. 212 larvae/gram muscle was recovered & then given orally to a ICR mouse. At 50 days after:: a large number of larval T. T spiralis was harvested from the mouse. 7 days flubendazole & 3d albendazole the larvae in biopsied muscle were uncoiled (Figs. 4, 5),

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S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

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Treatment to the patient

Helminths eradication: Praziquantel Praziquantel, flubendazole & albendazole given orally Symptoms & other infection: antibiotics and steroids were administered. discharged di h d at t 13 13-34 34 d days post-admission t d i i What we can learn?: Trichinellosis not only be found in pig

6/18/2012

S. Wahyuni, Parasitology Dept, Medical Faculty, Unhas

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