Parasitic Infections of The Muscle

BY
Assist .prof.Dr. Israa Mohammad
Abd AL-Khaliq

Department of Microbiology, Al-Kindy

College of Medicine, University of
Baghdad
 Trichinella sp.
1-Trichinella spiralis

Common name: The trichina worm

Is a nematode parasite, found in human,
rodents, pigs, horses, bears. It is responsible
for the disease trichinosis , sometimes
referred to as the "pork worm" due to it being
found commonly in undercooked pork
products.
Name of disease : trichinelliasis (trichiniasis or trichinosis) .

Geographical Distribution: Common in Europe and United

States, also reported from some parts of Africa and China .

Habitat: It start as intestinal parasite, remaining buried in

the duodenal or jejunal mucosa, where its adult life is
passed . The fertilized female discharges embryos into the
circulating blood which encyst in the striated muscles of the
host.
Morphology:
-Adult worm: Are the smallest nematodes infecting man.
- Male of T. spiralis measure between 1.4 and 1.6 mm long
- At the tail- end, there are two conical papillae , one on
each side .
*Female of T. spiralis : about twice the size of the male

The single uterus of the female is filled with developing

eggs in the posterior portion, while the anterior portion
contained the fully developed juveniles.

-The females are viviparous and discharge embryos instead

of eggs.

- Life span of the adult worm is very short. Male die after
fertilizing female, which live about 6 weeks, and in that
time can produce up to 1,500 larvae .
* Larvae :
- About 1mm long by 6 µm in diameter.
- Its remain encysted in the striated muscles of the host.
- Inside the cyst, larva continues to develop up to the stage of
sexual differentiation and when fully grown, it becomes ten times
its original size.
- The maximum size is obtained by the 35 day.
- Usually, one larva is present in the single cyst.
- Ellipsoidal lemon- shaped sheath develops as a result of host-
tissues reaction around the tightly coiled larva.
- The long axis of the capsule is parallel to that of the muscle fiber.
-The majority of larvae encysted in muscles die within 6 months but
some may live for many years (10 to 31 years).
After cyst formation in the muscle , muscle lysis
occur as a results of larva movement , lose of
nutrient materials , and metabolism results from
the toxic products of the larva.

*Mode of infection: By ingestion of infected pigs

flesh( raw or undercooked) containing the viable
larvae.
 .

Animal tissue infected with the parasite that causes the disease
trichinosis. Most parasites are shown in cross section but some
randomly appear in long section
Life Cycle:

Trichinella spiralis is a parasitic

nematode that has a direct life
cycle, meaning it completes all
stages of development in one
host.
- The primary host of T. spiralis is pig which serves as the
reservoir host for man.

- After 1 week, females release larvae that migrate to

the striated muscles where they encyst.

- Rats and rodents are responsible for maintaining the

endemicity of this infection.
Symptoms:

Infection with trichinosis in the human host can be divided into two
phases:
1- Intestinal (or enteral or acute ) phase (occur after one week p.i. )
2- Muscular ( or systemic or chronic) phase (between week 3 and
week 4 p.i).

Infection may or may not have any symptoms. However, after one
week from initial infection, larvae enter muscle tissues.

Trichinosis symptoms that may occur while the larvae are in the
intestine includes:
diarrhea
abdominal pain
fatigue
nausea
vomiting
flu like symptoms
Trichinosis symptoms that may occur after the larvae
enter muscle tissues includes:

muscle aches and joint aches.

high fever
facial swelling
sensitivity to light
persistent eye infections
unexplained rash
headaches
chills
weakness
Complications of Trichinosis
-In rare cases, a severe Trichinella infection could lead to the
following complications:

-myocarditis

-encephalitis

-meningitis

-pneumonia

-bronchopneumonia

-nephritis
Diagnosis:

The diagnosis of trichinellosis should be based on three main

criteria :

(i) clinical findings ( which mean recognition signs and

symptoms of trichinellosis).

At least three of the following six are found:

fever
myalgia
gastrointestinal symptoms
facial edema
eosinophilia
subconjunctival hemorrhage, or subungual hemorrhage, or
retinal hemorrhage .
(ii) laboratory findings ( includes eosinophilia ,
level of muscle enzymes , antibody detection,
and/or detection of larvae in the muscle biopsy).

At least one of the following two laboratory

tests is positive:

- Demonstration of Trichinella larvae in tissues

obtained by muscle biopsy.

- Demonstration of Trichinella-specific antibody

response by indirect immunofluorescence, or by
ELISA.
(iii) epidemiological investigation (include identification
source and origin of the infection and outbreak studies).

At least one of the following three occurred:

-Consumption of laboratory-confirmed parasitized meat.

-Consumption of potentially parasitized products from a

laboratory-confirmed infected animal.

-Epidemiological link to a laboratory-confirmed human

case by exposure to the same common source.
Laboratory Diagnosis:
1-Blood test: Demonstrate leukocytosis combined with
eosinophilia and increased levels of muscle enzymes .
Besides elevation of white blood cell counts, eosinophilia
appears already early after infection and increases
between the second and the fifth week p.i. in various
degrees: low (<1,000 white blood cells/mm3), moderate
(1,000 white blood cells/mm3 to 3,000 white blood
cells/mm3), and high (>3,000 white blood cells/mm3).

Elevated levels of muscle enzymes (such as creatinine

phosphokinase, lactate dehydrogenase, and aldolase) in
blood, which indicate myositis, are found in 75 to 90% of
infected persons between the second and fifth weeks of
infection and may persist for up to 4 months.
2-Muscle biopsy: A small piece of muscle is removed ,usually 0.2 - 0.5
g of muscle tissue without fat and skin, is collected from the deltoid or
another skeletal muscle. Examination of muscle biopsy can be
performed through artificial digestion and examined under a
microscope to look for Trichinella larvae (3rd or 4th week of
infection).

The following measures may be adopted:

3-Serological tests, such as:

-ELISA test is also available (by using antigen obtained from the
infective stage larvae of T. spiralis), it may be falsely negative within 2
weeks of onset of illness.

-Following ingestion of high numbers of T. spiralis larvae, anti-

Trichinella immunoglobulin G (IgG) can be detected in about 2 to 3
weeks post infection.
4- Bachman test (Skin Test) :Intradermal injection of diluted
Bachman's antigen (prepared from Trichinella larvae obtained
from infected rabbits muscle) causes an immediate erythematous
patch (within 15 to 20 minutes).

5- Xenodiagnosis: Biopsy bits are fed to laboratory rat and killed

after one month. larvae can be demonstrated in the muscles of
that killed rat.

6- X-ray examination may be important if the cysts are calcified

(represents old infection), but the worms are too small to be
detected .

7- Stool examination, for adult worms or for larvae (rarely used).

Trichinella larvae bury themselves inside muscle tissues rather
than remain in the intestine as in other roundworms infections, so
stool sample test don't often show evidence of the parasite.
Treatment:
Trichinosis often gets better on its own, usually within a few
months.

1-Anti parasitic medications (anti helminthic) medications: is the

first line of treatment against trichinosis. If trichinella parasite
discovered early (in the intestinal phase) Thiabendazole
,albendazole or mebendazole can be effective in eliminating the
intestinal worms and larvae.
- Thiabendazole have been obtained in the treatment of trichinosis
(in a dose of 25 mg/ kg twice daily for one week ) .
- Albendazole (400 mg twice daily for 8-15 days).
-Mebendazole (400 mg three times daily for two weeks) is also an
effective drug.
If the disease is discovered after the larvae bury themselves in the
tissues, the benefit of antiparasitic medications is less
effectiveness.
2-Pain relievers: After muscle invasion, pain relievers may be
given for muscle aches, at last, larva cyst in the muscles tend
to calcify, resulting in destruction of the larva and the end of
muscle aches and fatigue.

Prevention

- Freezing pork meat , Trichinella infection can be prevented.

However, freezing pork is not an effective method for killing
larvae.

-Cooking meat at temperature ( 63 °C) , a food thermometer

should be used to measure the internal temperature of cooked
meat.
2-Trichinella britovi

Found within sylvatic life cycles of Europe,

Asia, and Africa . It can also affect domestic
pig populations from feeding with scraps or
carrion originating from sylvatic carnivores.

T. britovi is the second-most common species

of Trichinella that may affect human health.
3-Trichinella nativa

Geographical Distribution: Found in arctic and subarctic regions.

It is highly pathogenic and has a high resistance to freezing. It is

encapsulated, and infects a wide variety of mammals and birds. Its
life cycle and pathogenesis are similar to Trichinella spiralis.

This worm remains viable even after being frozen at −18 °C for five
years.

Humans who are at risk for infection are meat-consuming people,

living in frozen zones of Canada, and Russia , or hunters from
Europe and United States who consume raw or undercooked meat
from bears hunted in arctic or subarctic regions.
4-Trichinella nelsoni

Geographical Distribution: In Eastern Africa from

Kenya to Southern Africa, infects predators and
scavengers. The host range includes sylvatic
carnivores , some of which have been the source of
infection for humans. Less than 100 human
infections have been documented for this species in
Kenya and Tanzania.
5- Trichinella murrelli

Geographical Distribution: Spread among sylvatic

carnivores across United States and some southern
regions of Canada. It is the causative agent of
infection in humans, especially following the
consumption of meat originating from hunted
black bears. Clinical information on this species
was gained from a 1985 outbreak in France due to
consumption of horse meat imported from
United States.
6-Trichinella pseudospiralis

Geographical Distribution :It is wide world in

distribution and infects both mammals and birds. Cases
of trichinellosis in humans with some deaths have been
documented in Thailand, and France .
7-Trichinella papuae

Geographical Distribution: Guinea and Thailand

circulates in both mammals and reptiles. Infections in
humans have been documented.