Uncertainties in diagnosis, treatment and prevention of trichinellosis

Abstract

This review summarizes expert opinion and evidence on the diagnosis, treatment and prevention of trichinellosis. Laboratory test results are not sufficiently sensitive for the diagnosis of individual patients when outbreaks are suspected. A likely diagnosis depends on identifying a potential common source of exposure supported by detection of antibodies to Trichinella antigens in a higher than expected proportion of exposed patients. Expert opinion is discordant, but for patients with symptomatic disease, there are theoretical reasons to recommend treatment with albendazole (rather than mebendazole) taken with fatty meals and prednisone. Education of the public is probably not a reliable way to prevent trichinellosis and when feasible should be augmented with mandatory testing of all potentially infected meat.

Keywords:

• albendazole
• complications
• corticosteroids
• diagnosis
• laboratory tests
• mebendazole
• prevention
• symptoms
• trichinellosis

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

No writing assistance was utilized in the production of this manuscript.

Key issues

• Laboratory test results are not sufficiently sensitive for the diagnosis of individual patients when outbreaks are suspected and a probable diagnosis depends on identifying a potential common source of exposure supported by the detection of antibodies to excretory/secretory Trichinella in a higher than expected proportion of the exposed patients.

• In convalescent serum, the demonstration of a three-band pattern of 53–72 kDa may be the gold standard for identifying patients whose acute symptoms were due to trichinellosis.

• Theoretically, treatment with albendazole is preferable to treatment with mebendazole for patients with symptomatic disease, and both drugs should be taken with a fatty meal.

• It is prudent to add corticosteroid treatment to all symptomatic patients being treated with benzimidazoles to possibly shorten the early and late symptomatic periods and lower the risk of complications.

• The frequency of testing commercial pork meat should be dependent on the risk of discovering infected meat.

• Education of the consumer is probably not a reliable way to prevent trichinellosis and when feasible should be augmented with mandatory testing of all potentially infected meat from wild animals and pigs are not grown in biocontainment facilities.