Trichinellosis

Bruschi F,

Dept. of Translational Research, N.T.M.S., Università di Pisa, Pisa, Italy © by author ESCMID Online Lecture Library International Commission on Trichinellosis Pavia, May 8th 2015 www.trichinellosis.org Trichinellosis (the term trichinosis is obsolete) is a typical ubiquitous foodborne zoonosis, caused by the nematode Trichinella spp.

© by author ESCMID Online Lecture Library Trichinella spiralis was the first Trichinella species discovered ever, identified in 1835 by James Paget, a first year Medicine student at the St. Bartholomew’s Hospital in London. Assisting at an autopsy of an Italian 50 years old, dead because of tuberculosis, the day before, by own initiative collected a diaphragm sample, since he remained intrigued by the sandy aspect of the muscle.

© byHe author went immediately to the British Museum where by microscope he observed small transparent spots ESCMID Online whichLecture at higher Library magnification resulted containing coiled (spiral) worms. In 1865 in Heiderslen (Germany) when inhabitants were 2,100, 337 people became ill because of trichinellosis, among these 101 died (30%). Between 1858 and 1882 80 outbreaks occurred in other German © by authortowns, with other fatalities. ESCMID Online Lecture Library From 1986 through 2009, there were 65,818 cases and 42 deaths reported from 41 countries. The World Health Organization

European Region accounted for 87% of cases; 50% of those occurred in Romania, mainly© by during author 1990–1999. ESCMID Online Lecture Library © by author ESCMID Online Lecture Library High incidence rates of selected foodborne helminthiases including trichinellosis© by author, opisthorchiasis, taeniasis, and echinococcosis also occur, while brucellosis and ESCMIDleptospirosis represent Online important Lecture bacterial Library zoonoses. © by author ESCMID Online Lecture Library Taxonomy of Trichinella genus • Encapsulated • Non encapsulated species species – T. spiralis – T. pseudospiralis – T. nativa, – T. papuae Trichinella T6 – T. zimbabwensis – T. britovi, Trichinella T8 – T. murrelli © by author Trichinella T9 ESCMID– T. nelsoni Online Lecture Library – T. patagoniensis

Courtesy of Dr. E. Pozio © by author ESCMID Online Lecture Library

Pozio, 2007 Bruschi & Murrell, 2011

Figure 110.1ESCMIDTrichinella life cycle. Online Trichinella spiralis Lecture(cosmopolitan), Library nelsoni (Africa), britovi (southern Europe), murrelli (North America), nativa (Arctic), pseudospiralis (cosmopolitan), papuae (Papua New Guinea), and zimbabwensis (Tanzania). Life cycle of Trichinella spp.

Despommier, 1998 © by author ESCMID Online Lecture Library

Despommier, 1998 "Trichinella spiralis -- Breaking and Entering"

Despommier, 1998 © by author ESCMID Online Lecture Library

Courtesy of D.D.Despommier Secretion of Tyvelosylated Proteins

Despommier, 1998 DNA Sythesis and Nuclear Enlargement

Despommier, 1998 Diagnosis suspected on :

•• Myositis •• Fever •• Facial oedema •• Increased blood eosinophils Particularly suggestive if grouped and familial cases © by author

DifferentialESCMID Diagnosis Online : invasiveLecture schistosomiasisschistosomiasis Library oorr fasciolosis,fasciolosis, ChurgChurg--StraussStrauss disease… Incubation lasts approximately 1 wk for severe forms; 2 wks for the moderate, and at least 3-4 wks. for the mild or abortive forms silentsilent,, diarrhea, abdominal pain •• 22--1010 days after infection lasting 55--10 daysdays10

Enteric phase: diarrheadiarrhea •• 1 --1010 days after infection

Circulatory phase:© obyedema, author fever •• 1515--2020 days after infection ESCMID Online Lecture Library © by author ESCMID Online Lecture Library

Facial oedema (left). The same lady after recovery (right) Biological cycle & symptoms

Muscle phase: myalgiasmyalgias,, astheniaasthenia •• 15 days --monthsmonths--yearsyears

•• Non specific signs –– eosinophilia (> 1000 mm33)) –– increased CPK & aldolasealdolase •• Specific antibodies –– positive +/+/positive -- 1010--20 days after infection. seroconversion ++++++ –– false positives with ELISA •• Muscular© Biopsy by author –– at least one month after infection ESCMID((microdigestionmicrodigestion Online > microscopy)Lecture Library –– useful for typing isolates –– ethical ? © by authorsensitivity : 100 % specificity : 99 % ESCMID Online Lecture Library (Commercialized by LDBio Lyon, France) © by author ESCMID Online Lecture Library WHO/FAO/OIE Guidelines

2007

• Early occurrence of neurological signs • Concomitant acute involvement of the myocardium • Marked hypereosinophilia (> 4000/µ L) © by author • Autopsy: ischemic lesions with multiple ESCMIDarteriolar microthrombi Online Lecture in the brainLibrary and myocardium. Encephalitis • Clinical signs • disorientation, memory disturbances, frontal syndrome & behavioral disturbances • transient hemiparesia, hemiplegia, tetraparesia, tetraplegia, oculomotor dysfunction, • central visual deficit, aphasia, cerebellar syndrome

• EEG : Diffuse slowing at EEG © by author • CT scan and MRI : Infarction, hypodensities ESCMID Online Lecture Library Favourable evolution in 2-4 weeks if treated 2008

Bruschi & Murrell, 2002 Conclusions

°Trichinellosis can be a severe disease with brain and heart involvement indicating a specific treatment;

° Benzimidazoles with a seric diffusion associated with corticosteroids could reduce chronic pain and early complications; © by author ° Controlled studies are still needed :

ESCMIDBut….ethical Online reluctance Lecture to use placebo Library ! © by author ESCMID Online Lecture Library International Commission on Trichinellosis www.trichinellosis.org