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.

Detection of Trichinella britovi in pork sausage suspected to be implicated in a human outbreak in Mendoza, Argentina.

Of the three Trichinella species described in South America, T. spiralis, T. pseudospiralis and T. patagoniensis, only the former has been implicated in human infections from consumption of pork-derived products. During a presumed trichinellosis outbreak in 2012 in Mendoza, Argentina, we evaluated the serological responses of three patients who had eaten the incriminated food and had signs and symptoms compatible with trichinellosis, using ELISA. We also analyzed potentially contaminated pork sausage by artificial digestion technique and recovered Trichinella muscle larvae, which were identified to the species level using a PCR multiplex assay and by sequencing a region of the mitochondrial gene coding cytochrome oxidase subunit I. No antibodies were detected in the sera of the patients, probably because the samples were collected during the immunological window period. According to molecular identification, all larvae from the sausage corresponded to T. britovi. Trichinella britovi is reported here for the first time in the American Continent, and represents the only cold-tolerant member of the genus in the Neotropics. This species was most likely introduced from Europe to South America during Spanish colonization through pigs, wild boars and/or rats.

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

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 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.

Triquinas, cerdos y salud pública veterinaria: la inclusión del mundo microscópico en la base científica de la inspección cárnica (Barcelona, 1870s) / Trichinae, pigs and veterinary public health: The introduction of the microscopic world into the scientific basis for meat inspection (Barcelona, 1870s)

Durante la segunda mitad del siglo XIX las autoridades españolas comenzaron a desarrollar programas específicos sobre la seguridad de algunos alimentos destinados al consumo humano. Este trabajo analiza las claves que propiciaron la inclusión del veterinario como parte integrante de la estructura administrativa encargada de salvaguardar la salud pública. Entre los aspectos tratados, se ha profundizado en las relaciones entre las medicinas humana y animal en un momento en que la alarma social originada por algunas zoonosis contribuyó a configurar la noción de una salud púbica veterinaria. La aparición de una enfermedad en el ganado porcino transmisible por el consumo de carne parasitada conformó un escenario favorable para equiparar inspección veterinaria con garantía sanitaria. Los brotes de triquinosis que salpicaron la geografía española en la década de 1870 evidenciaron la existencia de un contagio animado en una época prebacterilógica e impulsaron la introducción de mejoras en la inspección alimentaria. En este sentido, la indagación microscópica de los productos de origen porcino imprimió un impulso modernizador a la labor inspectora de los veterinarios, más centrada hasta entonces en vigilar las características organolépticas de carnes y pescados y en advertir fraudes. La introducción del microscopio contó con una aceptación generalizada y marcó una barrera entre las formas válidas e inválidas de realizar el reconocimiento de las carnes. Además, esa manera de diagnosticar aproximaba la veterinaria a otras profesiones sanitarias de mayor prestigio al menos en el plano teórico. Entre otras cosas, la aceptación de la triquina como causa exógena de enfermedad contribuyó a que algunos médicos decimonónicos se familiarizasen con la doctrina explicativa del contagio de la mano de los veterinarios. A nivel social, el uso de este instrumento debería prevenir la transmisión al hombre de una enfermedad animal que estaba de actualidad. Y desde el punto de vista político, este proceso, analizado en el presente trabajo desde la óptica barcelonesa, nos deja entrever un contraste entre el afán modernizador de algunos veterinarios catalanes frente a lo que ocurría en otras partes de España (AU)

During the second half of the 19 th century, Spanish authorities began developing specific programs on the safety of certain foods intended for human consumption. This paper analyses the key features that gave rise to the inclusion of the veterinarian in the administrative structure responsible for safeguarding public health. Among the aspects covered, special focus is put on the relationship between human and animal medicine at a time when growing public alarm in relation to certain zoonoses contributed to shaping the notion of veterinary public health. The appearance of a disease in pigs that was transmissible through the consumption of parasitized meat set the scene for veterinary inspection to be associated with the protection of public health. The outbreaks of trichinosis all over Spain in the 1870´s proved the existence of contagium animatum in a pre-bacterioloty era, and this led to the introduction of improvements in food inspection. In this sense, microscopic examination of pork products encouraged the modernization of inspection tasks undertaken by veterinarians, which had previously focuses on the organoleptic evaluation of meat and fish and on unveiling fraud. The introduction of microscopes was widely accepted and established a watershed between acceptable and unacceptable methods of carrying out the examination of meat. Furthermore, this technological method of diagnosis brought veterinary medicine closer to other more prestigious health professions, at least in theory. Among other aspects, the acceptance of trichinae as an exogenous cause of disease contributed to 19th century doctors learning about the idea of pathogenic microorganisms form veterinarians. At a social level, the use of the microscope was seen as a way of preventing the transmission to people of an animal disease that was very much in the public eye at the time. From the political point of view, the process, analysed in this paper from the perspective of veterinarians in Barcelona- allows a glimpse of the contrast between the desire of some Catalan veterinarians to modernize their profession and what was happening in others parts of Spain (AU)

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.

Outbreak of Trichinella spiralis infections associated with a wild boar hunted at a game farm in Iowa.

BACKGROUND: Rates of trichinellosis have declined significantly in the United States due to improved pork production practices and public awareness of the danger of eating raw or undercooked pork. In April 2011, the Minnesota Department of Health received a report of presumptive trichinellosis in a 50-year-old man with a history of wild boar consumption. A public health investigation was initiated. METHODS: Medical record reviews and patient and family interviews were conducted. Trichinella species serology was performed on patient and family serum samples, and larval identification was attempted on clinical specimens and meat samples. RESULTS: The index patient harvested a wild boar from an Iowa game farm; he processed the meat after returning home and developed gastrointestinal symptoms 2 days later. Four days after his illness onset, all 5 family members consumed a roast from the boar. The index patient sought healthcare 4 times after illness onset before being definitively diagnosed with trichinellosis. Following initiation of albendazole therapy, the index patient developed atrial fibrillation. One additional family member who processed the raw meat was diagnosed with trichinellosis. Trichinella spiralis larvae were identified in wild boar meat samples. CONCLUSIONS: Trichinellosis has long been recognized as a potential hazard of consuming undercooked wild carnivore meat, and historically has been associated with consumption of pork from domestic swine, but may be unfamiliar to practicing clinicians in the United States. Education of hunters and the broader population on the potential for trichinellosis and the importance of proper handling and cooking meat from wild or free-range animals needs to be reinforced.

An outbreak of trichinellosis in Hungary.

In a small village of Hungary, a human trichinellosis outbreak (affecting eight people) occurred in January-February, 2009. In the outbreak investigation (i) Trichinella spiralis larvae were detected in meat products derived from the pigs slaughtered in the backyard of one of the patients (a foxhunter) in December 2008, and in a brown rat captured in the same backyard; (ii) sera of 24 pigs held in 11 yards of the village and that of some dogs of the foxhunter were found Trichinella-positive; (iii) sera of five villagers who could not be infected in the particular outbreak were also found reactive in Trichinella-specific laboratory tests. The followings helped the rise of an outbreak: the geographical position and the presence of empty houses favoured the multiplication of rats; there was no extermination of rats in the previous years; there was no meat inspection; raw meat and improperly processed meat products were tasted at the pig-slaughter; villagers gave tastes to each other. People were informed on the symptoms, the way of transmission, and the possibilities of prevention of trichinellosis by experts. With the help of local authorities, all the properties including the grounds with empty houses were involved in the extermination of rodents.

From science to action and from action to science: the Nunavik Trichinellosis Prevention Program.

OBJECTIVES: During the 1980s, walrus-meat consumption caused infections with the parasite Trichinella nativa in Nunavik inhabitants. In response to these events, stakeholders set up the community-based Nunavik Trichinellosis Prevention Program (NTPP). The objectives of the present communication are to review the NTPP, describe how science and action were interwoven in its development and identify its assets and limitations. Study design. Descriptive study. METHODS: The NTPP relies on a pooled digestion assay of tongue samples taken from each harvested walrus. The public health recommendations depend on the results of the analyses: infected walrus meat should be destroyed; parasite-free meat may be eaten raw or cooked. RESULTS: All communities involved in the walrus hunt participate in the NTPP and a high percentage of harvested walruses are included in the NTPP. Infected animals account for 2.9% of the walruses tested (20/694) since 1992. The NTPP permitted the early management of a trichinellosis event in 1997. Since then, it prevented the new occurrence of outbreaks related to walruses hunted by Nunavimmiut. CONCLUSIONS: The absence of recent major outbreaks of trichinellosis in Nunavik may reasonably be attributed to the NTPP. The success of the program stands on many facilitating factors such as the nature of the disease and its source, the existence of an efficient analytic method, the strong involvement of the different partners including direct resource users, as well as the comprehensive bidirectional science-to-action approach that has been followed.

Investigation on a focus of human trichinellosis revealed by an atypical clinical case: after wild-boar (Sus scrofa) pork consumption in northern Italy.

Trichinellosis is one of the most serious foodborne parasitic zoonoses in Europe. Wild carnivorous and omnivorous hosts are the main reservoirs of Trichinella spp. nematodes in nature. In the winter of 2008-2009, an atypical clinical case of trichinellosis occurred for the consumption of pork from a wild boar (Sus scrofa) hunted in southwestern Alps in Italy. The symptomatic individual showed delayed development of oedemas in the lower limbs and eosinophilia, which appeared three months after infection. Muscle samples harboured 3.8 larvae/g, which were identified as Trichinella britovi. During the epidemiological investigation, anti-Trichinella IgG were detected in five hunters.

Trichinella spiralis: genomic application to control a zoonotic nematode.

The nematode Trichinella spiralis and related species are zoonotic food-borne pathogens of humans. The muscle larval stage of this parasite establishes a chronic infection in skeletal muscle cells of humans who acquire trichinellosis. Muscle larvae also reside in skeletal muscles of animals, swine in particular, and other food animals, including game animals. These muscle larvae are the source of zoonotic transmission to humans. Once established, muscle larvae become less susceptible to anthelmintics that are effective against other stages of the parasite. Very little information exists to guide discovery of new drug targets and improved methods of eliminating muscle larvae established in muscle cells of humans or food animals. Here we discuss progress that has been made on sequencing the genome of T. spiralis. This informational resource should prove valuable for dissecting molecular characteristics of this parasite that warrant investigation as targets for chemotherapy. The availability of the T. spiralis genome has made possible the comparison of genomes from nematodes that span the evolutionary extremes of the phylum Nematoda. We describe a pan-phylum comparison of genomes that is underway. This comparative genomics approach is expected to identify molecular characteristics that are conserved among all nematodes, and hence applicable to nematode pathogens throughout the phylum, including species from the genus Trichinella. T. spiralis expression data for muscle larvae has been integrated with genome sequences to identify specific genes and proteins with relevance to control of this stage of the parasite. Examples are discussed in which genomic information may advance understanding of T. spiralis biology and new methods for treating infections by this parasite.

Human trichinosis after consumption of soft-shelled turtles, Taiwan.

In 2008, an outbreak of human trichinosis associated with ingestion of raw soft-shelled turtles was identified and investigated in Taiwan. The data suggested that patients were likely infected with Trichinella papuae.

Trichinellosis acquired in Senegal from warthog ham, March 2009.

Three confirmed and three suspected cases of trichinellosis have been reported in France with onset of symptoms in March 2009, linked to consumption of smoked warthog ham in Senegal.

[Establishment of irritable bowel syndrome rat model by combination of intestinal infection with Trichinella spiralis and acute stress].

OBJECTIVE: To establish the irritable bowel syndrome (IBS) rat model by the combination of acute stress and transient intestinal infection with Trichinella spiralis (T.S.). METHODS: The rat model of acute cold restraint stress post-infection (PI + ACRS) was established as following: the intestinal infection with 1500 T.S. in 1 ml saline to adult male BN rats was performed at Day 0 by gastric lavage. Then a 2-hour stimulus of ACRS was administered at Day 100. Age matched transiently infected without stress rats (PI) and normal rats served as controls (CON) (n = 6, for each). After anesthesia, all the rats underwent colonic manometry in vivo at Day 100. The colonic pressures at 3 different states (baseline for 20 min; 1 ml balloon distension stimulation for 5 min and 2 ml balloon distension stimulation for 20 min) were traced with a 5-minute interval between each two. The following parameters were recorded: (1) Duration (Dur.): total time of contractions during each state. (2) Maximum (Max.): highest amplitude of constructional waves (mm Hg). (3) Area: area under contraction waves. (4) Number (Num.): frequencies of contraction wave during each state. The visceromoter response to colorectal distension (CRD) was analyzed at Day 100 post-infection. And the distension volume of AWR 3 was detected for 5 times with a 20-min interval in each rat. RESULTS: The histological damage of intestine induced by T.S. infection is transient. Although such acute infectious features as epithelial edema, hyperemia and marked eosinophil infiltration appeared at Day 10 PI, the histological changes almost recovered at Day 100 PI in both the PI group and the PI + ACRS group. Both the stimuli of transient infection and the ACRS post-infection induced intestinal dysmotility and visceral hypersensitivity. The ACRS post infection further worsened the transiently induced infection. The parameters of Num, Max and Area in the PI + ACRS group were all significantly higher than those of the PI group [Max: (41 +/- 17) mm Hg vs (22 +/- 6) mm Hg, P = 0.000; Area: (7693 +/- 2822) mm Hg.s vs (5092 +/- 1687) mm Hgxs, P = 0.000; Num: 9.5 +/- 2.6 vs 6.6 +/- 3.1, P = 0.000]; so was the distension volume of AWR3 [(2.25 +/- 0.29) ml vs (2.52 +/- 0.32) ml, P = 0.004]. As compared with the range of normal values from controls, the abnormality rates of motility parameters and visceral threshold in PI + ACRS group also had an larger increment than those of the PI group (PI + ACRS: 50.0% - 87.5% and 100% respectively, PI: 25.0% - 37.5% and 90.0% respectively). CONCLUSION: The pathophysiological changes in the PI + ACRS rats are consistent with those of IBS. Aggravated by psychological factors, these rats reproduce the symptoms of intestinal dysmotility and visceral hypersensitivity. A proper animal model has been established for the investigation of IBS.

A major trichinellosis outbreak suggesting a high endemicity of Trichinella infection in northern Laos.

Trichinellosis is an important and under-recognized food-borne zoonosis in Southeast Asia. After 30 years of no reports, a small outbreak was described in Central Lao PDR (Laos) in 2003. Here we report a large outbreak of at least 650 estimated patients in Udomxay (northern Laos) in June 2005. Trichinella ELISA assays on serum from 133 patients and Western blot assays on 16 patients were positive in 67.6% and 81.2%, respectively. No deaths were recorded. Consumption of uncooked or fermented pork at funeral and wedding ceremonies was the main source of infection. Larvae of Trichinella spiralis were found in 1 of 11 local pigs not involved in this outbreak. The results suggest that trichinellosis may be an under-recognized but important endemic disease in Laos and reinforces the need to urgently implement veterinary and educational programs.

[Troponin dosage in a patient with asymptomatic myocarditis due to trichinellosis]. / Myocardite asymptomatique au cours d''un cas de trichinellose: intérêt du dosage de la troponine.

Human trichinellosis is a potentially severe parasitic disease occurring after ingestion of undercooked meat infected with Trichinella sp. larvae. We report the case of a patient who ate an undercooked bear meat hunted in Canada; he presented with the usual symptoms of trichinellosis (i.e, facial oedema, myalgias and fever) complicated with an asymptomatic myocarditis. Myocarditis is a rare, but potentially lethal complication of trichinellosis. Myocarditis should be screened systematically even when specific symptoms are missing; dosage of troponin serum is a simple and reliable mean for such screening.