A Trichinella britovi outbreak in the Northern Alps of France: investigation by a local survey network.

We describe a small family outbreak of trichinellosis caused by the consumption of raw ham from a wild boar (Sus scrofa) hunted in the northern Alps of France in February 2022. Out of the six people, aged 3-69 years, who consumed the meat, three were confirmed cases, and three were suspected cases. Eosinophilia detected in four people was the hallmark that drove the diagnosis. Three patients presented with myalgia, two with intense and prolonged chest pain, and one with elevated troponin. One patient presented with dermographism during treatment. Anti-Trichinella IgG were detected in three symptomatic individuals after about ten weeks. One patient had negative serology and no symptoms, but was on long-term corticosteroid therapy. Trichinella britovi larvae (8.3 larvae/g) were detected in the wild boar meat remnants. Trichinellosis is rare in France, but this family outbreak is reminiscent of the circulation of this pathogen in wild animals, highlighting the need to inform hunters about the risk of infection linked to the consumption of raw meat of game animals, and about the need for veterinary inspection of game meat. The consumption of raw meat outside controlled circuits is a practice not devoid of risks, which justifies raising the awareness of hunters, doctors, and medical biologists.

Title: Un foyer de Trichinella britovi dans les Alpes du Nord françaises : investigation par un réseau local de prospection. Abstract: Nous décrivons une épidémie familiale de trichinellose causée par la consommation de jambon cru d'un sanglier (Sus scrofa) chassé dans le nord des Alpes françaises en février 2022. Sur les six personnes âgées de 3 à 69 ans qui ont consommé la viande, trois étaient des cas confirmés, et trois étaient des cas suspects. L'éosinophilie détectée chez quatre personnes a permis d'évoquer le diagnostic. Trois patients présentaient des myalgies, et deux des douleurs thoraciques intenses et prolongées dont un avec une troponine élevée. Un patient a présenté un dermographisme pendant le traitement. Des IgG anti-Trichinella ont été détectées chez trois individus symptomatiques après environ dix semaines. Un des patients avait une sérologie négative et aucun symptôme mais était sous corticothérapie au long cours. Des larves de Trichinella britovi (8,3 larves/g) ont été détectées dans les restes du jambon de sanglier incriminé. La trichinellose est rare en France, mais cette épidémie familiale rappelle la circulation de cet agent pathogène chez les animaux sauvages, qui nécessite d'informer les chasseurs sur les risques d'infections liés à la consommation de viande crue de gibier, et de préconiser un contrôle vétérinaire des viandes de gibier. La consommation de viande crue en dehors des circuits contrôlés est une pratique non dénuée de risques, qui justifie une sensibilisation des chasseurs, médecins et biologistes médicaux.

Hypereosinophilia: Biological investigations and etiologies in a French metropolitan university hospital, and proposed approach for diagnostic evaluation.

OBJECTIVES: We aimed to evaluate the usefulness of biological investigations in cases of eosinophilia in our area (French Alps). METHODS: We retrospectively included all adult patients attending the infectious disease and internal medicine units between 2009 and 2015 with eosinophilia ≥1 G/l. RESULTS: We identified 298 cases (129 women and 169 men). In 139 patients, eosinophilia had not been addressed. In the 159 others, the cause of eosinophilia was identified in 118 (74.2%). The main identified causes at the time were drug reactions (24.5%, mostly ß-lactams and allopurinol), infectious diseases (17.0%), vasculitis (8.2%), autoimmune diseases (6.9%), and malignant diseases (6.2%). In patients with a skin rash, eosinophilia was significantly more often investigated, and a diagnosis significantly more often made. Helminthosis were mainly diagnosed in tropical travelers (18/24) excepting toxocariasis (3 non-travelers). Stool examination for helminthosis was positive in 5/76 patients (6.6%) (all tropical travelers); 391 helminth serologies were performed in 91 patients, with 7.9% being positive (all but 3 positive cases were travelers). Anti-neutrophil cytoplasmic antibodies (ANCA) were positive in 26/112 patients (23.2%), with 9 cases of vasculitis identified. CONCLUSIONS: Drug-related eosinophilia is the main etiology. Search for helminthosis is not recommended among non-travelers (excepting toxocariasis). ANCA should be performed early so as not to overlook vasculitis.