Jama 1983;249:23

Cause:Trichinella spiralis

Pathophys:Invasion of skeletal (not heart) muscle by worms, degeneration of invaded fiber causing inflammatory reaction, and finally encysted larvae (in all other tissues this reaction kills larvae)

Life cycle: infection on ingestion of meat w cysts, hatch and reproduce for 6 wk in gi mucosa, living young born and many get into skeletal muscle where grow and encyst, some calcify, and others remain viable for years

From pigs fed uncooked garbage; polar and other bears

Sx:Fever, myalgias all over including tongue, diaphragm, etc; gastroenteritis 24-72 h after ingestion from worms in gi tract

Si:Eye swelling, conjunctivitis, small conjunctival hemorrhages; splinter hemorrhages in nail beds; skin rashes both urticarial and petechial

GI sx in 24-72 h; other sx peak 1-6 wk after ingestion

Myocarditis, CNS inflammation

Lab:

Chem:CPK, AST (SGOT) markedly elevated

Hem:Elevated eosinophils; may be as high as 50%

Path:Muscle bx shows 10-100 larvae/gm tissue; 1/gm should not produce sx

Rx:

Prevent by cooking garbage fed to pigs; cook or freeze pork well

of disease (Med Let 1990;32:23):

• Mebendazole 200-400 mg po tid × 3 d, then 400-500 mg po tid × 10 d
• ASA for mild disease, or
• Steroids to decrease inflammation if becomes life threatening, but they also increase life of adult worms