Myocarditis and Raw Meat Consumption: Strange Bedfellows!

Trichinellosis is a parasitic infection that is associated with the consumption of raw meat. The specific genotype Trichinella nativa has been found in raw bear meat. The most common genotype that has been linked with myocarditis is T spiralis. We present a case of T nativa myocarditis secondary to consumption of raw bear meat. The clinical manifestations as well as therapy of this specific genotype is outlined.

A cien años del inicio de la Gran Guerra: brote de triquinosis en marinos del Dresden en Chile: Crónica de una infección anunciada / A hundred years since the beginning of the Great War: trichinosis outbreak in Dresden marine in Chile: Chronicle of an announced infection

In commemoration of one hundred years of the beginning of World War I, the occurrence of an outbreak of trichinosis in the crew of the SMS Dresden, a German ship that participated in that world conflagration, is re-viewed. In September 1915, while the sailors of SMS Dresden were forcibly detained on Isla Quiriquina, Bío Bío Region, Chile, 60 individuals became ill. The cause of the outbreak was the consumption of sausages made from pork infected with the parasite Trichinella spiralis. There was a fatal case. The review of the epidemiological aspects that facilitated the presentation and spread of human trichinosis at that time allows to conclude that, pork breeded in poor hygienic conditions, meat and its by-products clandestinely sold without sanitary inspection and the language barrier were determinant in the occurrence of the epidemic outbreak.

A propósito de la conmemoración de los cien años del inicio de la Primera Guerra Mundial, se revisa la ocurrencia de un brote epidémico de triquinosis en tripulantes del SMS Dresden, buque alemán que participó en esa conflagración mundial. Este suceso, acaecido en septiembre de 1915, ocurrió mientras los marinos se encontraban forzosamente recluidos en la Isla Quiriquina, Región del Bío Bío, Chile. La causa del brote fue el consumo de embutidos fabricados a partir de carne de cerdo infectada con el parásito Trichinella spiralis e involucró a 60 mari-neros, de los cuales hubo un caso fatal. La revisión de los aspectos epidemiológicos que favorecían la presentación de triquinosis humana en la época permite concluir que, la crianza porcina en malas condiciones higiénicas, la venta clandestina de carnes y subproductos sin inspección sanitaria y la barrera idiomática fueron determinantes en la ocurrencia del brote epidémico.

Trichinellosis in Vietnam.

Trichinellosis is a zoonotic parasitic disease with a worldwide distribution. The aim of this work was to describe the epidemiological and clinical data of five outbreaks of trichinellosis, which affected ethnic minorities living in remote mountainous areas of northwestern Vietnam from 1970 to 2012. Trichinellosis was diagnosed in 126 patients, of which 11 (8.7%) were hospitalized and 8 (6.3%) died. All infected people had consumed raw pork from backyard and roaming pigs or wild boar at wedding, funeral, or New Year parties. The short incubation period (average of 9.5 days), the severity of the symptoms, which were characterized by diarrhea, abdominal pain, fever, myalgia, edema, weight loss, itch, and lisping, and the high mortality, suggest that patients had ingested a high number of larvae. The larval burden in pigs examined in one of the outbreaks ranged from 70 to 879 larvae/g. These larvae and those collected from a muscle biopsy taken from a patient from the 2012 outbreak were identified as Trichinella spiralis. Data presented in this work show that the northern regions of Vietnam are endemic areas for Trichinella infections in domestic pigs and humans.

[First report of a human case of trichinellosis due to Trichinella britovi after jackal (Canis aureus) meat consumption in Algeria]. / Première observation d'un cas humain de trichi- nellose due à Trichinella britovi en Algérie après consommation de viande de chacal (Canis aureus).

We report a single case of trichinellosis contracted in Algeria (Batna region), in a practising Moslim. Shortly after returning to France in November 2004, the patient developed the typical clinical and biological signs of the disease. Although the patient claimed having only eaten mutton, an unusual host for Trichinella, a meticulous investigation revealed that he also had eaten a grilled leg of jackal (Canis aureus). One of the four Trichinella larvae detected in a muscular biopsy enabled us to identify the parasite as Trichinella britovi by a multiplex PCR analysis. This is the first identification of the etiological agent of sylvatic trichinellosis occurring in North Africa and the first case of symptomatic trichinellosis due to jackal meat consumption in Africa.

New aspects of human trichinellosis: the impact of new Trichinella species.

Trichinellosis is a re-emerging zoonosis and more clinical awareness is needed. In particular, the description of new Trichinella species such as T. papuae and T. murrelli and the occurrence of human cases caused by T pseudospiralis, until very recently thought to occur only in animals, requires changes in our handling of clinical trichinellosis, because existing knowledge is based mostly on cases due to classical T spiralis infection. The aim of the present review is to integrate the experiences derived from different outbreaks around the world, caused by different Trichinella species, in order to provide a more comprehensive approach to diagnosis and treatment.

Búsqueda de anticuerpos contra trichinella spiralis en roedores de libre desplazamiento capturados en un zoológico de la Ciudad de México / Search for antibodies against trichinella spiralis in free roaming rodents caught in a zoological park from Mexico City

A serological survey to search for antibodies against T. spiralis was performed in free roaming rats (n=64) and mice (n=35) caught in zoological park from Mexico City. Serum samples were analyzed by ELISA and immunoelectrotransfer blot assay (EIBT). None serum show positive absorbance values in ELISA nor recognized T. spiralis specific antigenic fractions in EIBT. However, two rat samples recognized three antigens of 31,37 y 55 kDa, while one of them reacted with two additional antigens of 64 and 67 kDa. As it is known that the antigen epitope profiles varied among trichinella species, it could be possible that in rats, there is 3 percent of antibody prevalence agains trichinella sp.; however, due that other organisms could induce the production of cross-reacting antibodies, such conclusion can not be supported at all. These results suggest that T. spiralis was not part of helminthological fauna in these rodents

Triquinosis: importancia del caso índice / Trichinosis: importance of the index case

Se reporta el caso de un paciente varón de 28 años, previamente sano, proveniente de Curicó, que tras haber ingerido carne de cerdo faenado en domicilio, inició un cuadro clínico y exámenes de laboratorio altamente sugerentes triquinosis. Se notificó de inmediato a la sección de Epidemiología del ministerio de Salud, con lo que se logró precozmente encontrar al resto de los afectados y decomisar la carne contaminada para evitar nuevos casos, destacando de esta forma la importancia del caso índice. Posteriormente se apoyó el diagnóstico con test de ELISA para trichinella spiralis, y se inició el tratamiento anti parasitario con albendazol y sintomático, con lo cual el paciente evolucionó satisfactoriamente. Se destaca la importancia del diagnóstico precoz y de la oportuna notificación a las autoridades sanitarias cuando se tiene un cuadro clínico compatible, y exámenes de laboratorio generales, como hemograma y los niveles de CPK alterados, aun cuando no se disponga de exámenes serológicos específicos, como ELISA para triquinosis

Técnicas inmunoenzimáticas en el diagnóstico de la trichinellosis porcina / Immunoenzymatic assays in the diagnosis of swine trichenellosis

Se estandarizó un protocolo de ELISA como técnica de diagnóstico de la triquinosis porcina. Se verificó la parasitosis, en cerdos alimentados con diferentes dosis de carne de ratas infectadas con larvas de triquina, a los 30 y 60 días postinfección. No se observaron diferencia de porcentaje por distribución normal, no mostró diferencias significativas entre los valores de densidad óptica a 490 nm entre los sueros de cerdos infectados con una misma dosis de carne a los 30 y 60 días postinfección. Resultados similares se obtuvieron con los sueros de cerdos infectados con una misma dosis de carne a los 30 y 60 días postinfección. Resultados similares se obtuvieron con los sueros de animales infectados con diferentes dosis de carne. Estos sueros constituyeron controles positivos de infección para triquinosis porcina y se utilizaron para identificar epítopes antigénicos característicos de esta parasitosis. Por SDS-PAGE se caracterizó el componente peptídico del extracto crudo de proteínas de larvas de Trichinella spiralis. Se identificaron 10 péptidos, cuya movilidad electroforética se determinó por el programa computacional "Gel-perfect".Por electroinmuno transferencia se identificaron 4 polipéptidos de 77, 66, 47 y 43 KDa. Los polipéptidos de 47 y 43 KDa que presentan una señal más intensa,no fueron encontrados en los preparados antigénicos de Cysticercus cellulosae y líquido de quiste hidatídico. Dichos polipéptidos son detectados desde los 30 días postinfección con una intensidad de señal permanente en el tiempo e independiente de la dosis de infección de los cerdos

Actualidades sobre la triquinelosis equina / Current facts about horse trichinellosis

La triquinelosis es una zoonosis causada por parásitos del género Trichinella que es trasmitida principalmente por la ingestión de carne de animales como el cerdo, oso y zorro entre otros. Sin embargo, en Europa se han reportado varios brotes debido al comsumo de carne de caballo. La presencia del parásito no ha sido demostrada de manera directa en la carne de estos animales, sin embargo, la identificación de las especies de Trichinella (T. spiralis T. britovi y T. nativa) involucradas en estos brotes ha sido posible a partir de biopsias tomadas de individuos que consumieron carne de caballo. Recientemente, se identificaron por primera vez larvas de T. spiralis en caballos sacrificados en un rastro del Estado de México, presentando así evidencia directa de la infección de estos animales con el parásito. Por otro lado empleando extractos totales o antígenos TSL-1 de T. spiralis se han detectado anticuerpos en contra de Trichinella en caballos sacrificados en rastros de diferentes paises de Europa así como en México. Asimismo, la infección con varias especies de Trichinella se ha logrado reproducir experimentalmente en caballos y los resultados obtenidos son importantes en el desarrollo de métodos de diagnóstico que permitan estimas la prevalencia de esta infección en caballos cuya carne se destina para el consumo tanto animal como humano y eventualmente instrumentar medias para el control de la trasmisión de la triquinelosis por carne de caballos

Trichinosis from wild boar meat in Gojjam, north-west Ethiopia.

An outbreak of trichinosis associated with ingestion of meat from a wild boar in Gojjam administrative region, Ethiopia, is reported. Of the 30 soldiers, 20 who ate the meat raw, became ill and 5 of them were admitted to the Armed Forces General Hospital (AFGH). Even though they presented with a typical history and clinical features the disease was not even suspected at the peripheral hospital. The diagnosis was confirmed, at the AFGH, by deltoid muscle biopsy in all the 5 cases. Trichinosis being increasingly recognized as a public health problem in Ethiopia, warrants public education and more awareness by health workers.

[A family outbreak of trichinosis acquired in Israel].

Trichinosis is a parasitic disease transmitted to man by ingestion of contaminated raw meat, usually pork, containing cysts of Trichinella spiralis. Formerly appearing as serious epidemics, it has now become uncommon due to public health control measures. Since the Jewish and Moslem religions forbid consumption of pork, the disease is even rarer in Israel. The literature indicates that all the cases of trichinosis hospitalized in Israel were contaminated abroad. We describe an Israeli family in which trichinosis following the eating of boar meat, hunted along Israel's northern sea coast (Hof HaCarmel). We believe that this is the first report of trichinosis acquired in Israel. Only family members who ate the meat raw became ill, while those who ate it well-cooked were spared. However, not all of our cases were symptomatic, some showing only laboratory evidence (eosinophilia and a rise in CPK). In accord with postmortem data in the USA, this indicates that trichinosis is probably more common than estimated due to the many asymptomatic cases (about 4% of all Americans).

Pathogenesis and serodiagnosis of experimental Trichinella spiralis spiralis and Trichinella spiralis nativa infections in cattle.

Trichinella spiralis spiralis infections were established in cattle by gavage and by feeding infected musculature in the ration. Trichinae were present in greatest numbers in masseter, tongue and diaphragm. Trichinella spiralis nativa had a low infectivity to cattle although a light infection was established in one cow by a heavy challenge. Cattle had an aversion to eating musculature unless it was camouflaged with molasses. Clinical signs of reluctance to eat and masticate were observed between 10 and 30 days postinfection. Eosinophil counts started to increase at seven days and peaked at about 30 days postinfection. By day 60 eosinophil counts returned to near preinfection levels but in animals examined greater than 90 days postinfection, the counts were variable. Focal lesions of eosinophilic myositis were observed up to about 90 days postinfection. Little cellular reaction was observed surrounding trichinae after muscle invasion and cyst development was completed except for cysts undergoing disintegration. Seroconversion occurred in all cattle examined between 7 and 14 days postinfection. Seroconversion was associated with IgG1 and IgG2 immunoglobulins. Peak levels of antibody occurred between 30 and 60 days. Cattle examined at 182 and 369 days postinfection showed a gradual decrease in antibody levels over time.

A trichinosis outbreak in Iowa.

During December 1975 and January 1976, seventy-nine persons in Postville, Iowa, and nearby communities were infected with trichinosis by eating locally produced summer sausage made from a mixture of venison (provided by deer-hunting parties) and pork. More than 242 local residents and holiday visitors from five other states and Canada were exposed to the sausage, in which the venison was mixed in a 2:1 ratio with government-inspected and commercially obtained pork. Laboratory examinations of incriminated sausage samples showed one to 65 Trichinella larvae per 100 g and indicated that temperatures during processing had not exceeded 54 degrees C. Corrective measures centered on improving temperature monitoring during the smoking process at the sausage-preparation plant to ensure that adequate temperatures are achieved. Persons possessing the implicated sausage were advised to destroy it or to cook it adequately before eating it.

Trichinosis in an immunosuppressed human host.

The clinical presentation and autopsy findings in the case of a patient with acute myelomonocytic leukemia and trichinosis are described. Cellular immunity is an important host defense against nematode infections such as strongyloidiasis. It is therefore probable that the severe trichinosis seen in this immunosuppressed patient was more than coincidental. Due to concomitant failure of humoral immunity, serodiagnosis of trichinosis would have been impossible. The only means of making the diagnosis antemortem would have been muscle biopsy.

Trichinosis: severe myopathic involvement with recovery.

A case of clinically severe trichinosis following ingestion of commercially prepared pickled pigs' feet is reported. An unusual finding on muscle biopsy was a larval count of 4,046 per gram of muscle, the second highest density of muscle invasion recorded to date. Survival has not been reported previously in patients with greater than 1,000 trichinae per gram of muscle. Complete symptomatic recovery followed combined corticosteroid and thiabendazole administration.

Trichinosis: A recent outbreak in Northern Thailand.

During April, 1973, and outbreak of trichinosis occurred in Mae Sruay District, Chiang Rai Province, about 900 kilometers north of Bangkok, Thailand. Thirty-one persons were involved, of whom 27 (20 males, and 7 females), ranging in age from 9 to 72 years, were questioned. One adult female died before being brought to hospital. All subjects gave a history of having consumed raw pork in the form of "lahb" and "nahm", favourite dishes of the northern Thai. Beginning the third week after exposure, all developed fever and myalgia. Other less common complaints were diarrhoea and oedema of extremities and palpebral skin. Leucocytosis was revealed in 37% and 55% had eosinophilia exceeding 20%. Nineteen patients had hookworm and Opisthorchis infections. About 63% were skin test positive with Trichinella antigen. Eight patients were admitted to hospital; muscle biopsy was done on one serious case and trichina larvae were detected.

Bear meat trichinosis with a concomitant serologic response to Toxoplasma gondii.

A severe case of trichinosis occurred following the ingestion of raw meat from a common black bear, Ursus americanus, that was shot in Butte County, California. Examination of steaks cut from the bear revealed heavy infection with T. spiralis. A good clinical response was obtained following treatment with prednisone (1 mg/kg body weight per day) and thiabendazole (50 mg/kg body weight per day); no toxic effects were observed. In comparison with the pre-treatment biopsy, a more intense inflammatory response was seen following the administration of thiabendazole. Nevertheless, a muscle biopsy taken several months after discharge still showed well-encapsulated, morphologically intact larvae. In addition to the expected immunological responses to T spiralis, a marked rise in titer of antibodies to Toxoplasms gondii was observed by the fluorescent antibody and Sabin-Feldman dye test methods. Since toxoplasma infection of muscle is widespread in man, it is possible that an unrelated disease of muscle could result in stimulation of anti-toxoplasma antibodies similar to the findings in polymyositis and dermatomyositis. Alternatively, the possibility that a dual infection was acquired from the bear meat cannot be excluded.