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Trichinosis

Trichinosis, also called trichinellosis, is a parasitic disease caused by eating raw or undercooked pork and wild game products infected with the larvae of a species of roundworm Trichinella spiralis, commonly called the trichina worm. Infection is common where raw or undercooked pork, such as ham or sausage, is regularly consumed as part of the diet. more...

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Signs and symptoms

Symptoms can be divided into two types: symptoms caused by worms in the intestine, and symptoms caused by worms elsewhere.

In the intestine, infection can cause:

Nausea, diarrhea, vomiting, fatigue, fever, and abdominal discomfort

Later, as the worms encyst in different parts of the body, other symptoms occur such as:

Headaches, fevers, chills, cough, eye swelling, aching joints and muscle pains, pinpoint hemorrhages, itchy skin, and heightened numbers of white blood cells.

If worms penetrate nervous tissue, they cannot survive, but patients may experience difficulty coordinating movements, and respiratory paralysis. In severe cases, death may occur. Heart infection can also cause death.

For mild to moderate infections, most symptoms subside within a few months. Fatigue, weakness, and diarrhea may last for months.

Incubation time

Abdominal symptoms can occur 1-2 days after infection. Further symptoms usually start 2-8 weeks after eating contaminated meat. Symptoms may range from very mild to severe and relate to the number of infectious worms consumed in meat. Often, mild cases of trichinosis are never specifically diagnosed and are assumed to be the flu or other common illnesses.

Life cycle

The worm can infect any species of mammal (including humans) that consumes its encysted larval stages. When an animal eats meat that contains infective Trichinella cysts, the acid in the stomach dissolves the hard covering of the cyst and releases the worms. The worms pass into the small intestine and, in 1-2 days, become mature. After mating, adult females produce larvae, which break through the intestinal wall and travel through the lymphatic system to the circulatory system to find a suitable cell. Larvae can penetrate any cell, but can only survive in skeletal muscle. Within a muscle cell, the worms curl up and direct the cells functioning much as a virus does. The cell is now called a nurse cell. Soon, a net of blood vessels surround the nurse cell, providing added nutrition for the larva inside.

Risk factors

Eating raw or undercooked meats, particularly pork, bear, wild feline (such as a cougar), fox, dog, wolf, horse, seal, or walrus puts one at risk for trichinosis. This is the only way that infection can occur. It is not transmitted from one person to another, except through cannibalism. Even ingesting infected feces will not cause trichinosis because adults and unencysted larvae cannot survive in the stomach.

Diagnosis

A blood test or muscle biopsy can identify trichinosis. Stool studies can identify adult worms, with females being about 3 mm long and males about half that size.

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Trichinosis outbreaks
From FDA Consumer, 5/1/91

Two outbreaks in 1990 of trichinosis (infection with Trichinella spiralis worm larvae) due to eating undercooked infested pork point up the need for consumers to continue guarding against this preventable, sometimes fatal illness. The U.S. Centers for Disease Control in Atlanta warned in its Feb. 1, 1991, Morbidity and Mortality Weekly Report that the risk is particularly high when people routinely eat undercooked pork, as is the practice among Southeast Asian immigrants.

Of the 250 people at a wedding of Southeast Asians last July in Des Moines, Iowa, 90 developed trichinosis--the fourth outbreak since 1975 among the 900,000 immigrants in the United States. The illnesses were linked to pork sausage that was uncooked, which is the customary way to serve that food in Southeast Asian culture. To kill T. spiralis larvae, a person must cook pork until it is well done, to 66 degrees Celsius (150 degrees Fahrenheit).

Last November and December, four Virginia counties reported another outbreak of 15 sausage-related cases. One victim denied eating undercooked sausage but was a meat handler in the plant that processed the implicated meat. CDC received reports of 15 additional cases occurring singly in 1990. No deaths were reported.

Trichinosis symptoms are fever, muscle soreness, and upper-eyelid swelling. Lab tests show increased eosinophils (white blood cells).

CDC noted that the proportion of cases from commercial pork has declined since 1975, probably because of laws prohibiting feeding raw garbage to pigs, increased use of home freezers, and the practice of thoroughly cooking pork. On the other hand, there has been an increase in the relative importance of another source: wild game--including bear, boar and walrus.

Warning on Importing Drugs

Importing drugs from abroad except under certain circumstances is illegal, FDA warns, and potentially harmful. The agency is especially concerned with foreign versions of U.S.-approved drugs imported from abroad.

There has recently been some confusion over FDA's policy on drugy importation, with some claims that people can save money on drugs and doctor bills by "legally" importing foreign versions of drugs that have been approved in the United States. This is not true.

FDA does allow individuals to import drugs that are not approved in the United States if they meet specific conditions. The drugs must be for personal use only, in amounts to be used by one person for up to three months. This personal use policy does not extend to U.S.-approved drugs.

This policy allows people with serious conditions, such as AIDS, to import through the mail personal-use quantities of unapproved drugs that they feel might be helpful in treating their conditions. The policy is also intended to allow people to import through their personal baggage small quantities of medicines with which they may have been treated while traveling abroad.

The drugs cannot pose any "unreasonable or significant" safety risks, cannot be commercialized, and must be used for a serious condition for which no satisfactory treatment is available in this country.

According to FDA to otherwise import foreign drugs could pose an "unreasonable" risk to public health. Because the drugs may be of unknown quality with inadequate or foreign-language directions and because there is no medical supervision, severe adverse reactions, including death, could result.

The agency also warned consumers that to buy and use prescription drugs without the help of a doctor or other licensed health professional may violate state or local laws.

FDA will recommend automatic detention of imported products that appear to violate FDA's personal-import policy. People importing such products are informed in writing that the shipment has been detained and will not be released unless it can be shown to meet the personal-use entrace criteria. Those importing such products with the intent to sell may face civil and criminal penalties.

(For more information on FDA import policies, see "From Psyllium Seeds to Stoneware: FDA Insurance Quality of Imports" in the March 1991 FDA Consumer.)

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