Opinion on the diagnosis and treatment of human trichinellosis

Abstract

The clinical diagnosis of trichinellosis is difficult because there are no pathogenic signs or symptoms and in diagnosing the infection epidemiological data are of great importance. Trichinellosis usually begins with a sensation of general discomfort and headache, increasing fever, chills and sometimes diarrhoea and/or abdominal pain. Pyrexia, eyelid or facial oedema and myalgia represent the principal syndrome of the acute stage, which can be complicated by myocarditis, thromboembolic disease and encephalitis. High eosinophilia and increased creatine phosphokinase activity are the most frequently observed laboratory features and the parasitological examination of a muscle biopsy and the detection of specific circulating antibodies will confirm the diagnosis. The medical treatment includes anthelmintics (mebendazole or albendazole) and glucocorticosteroids. Mebendazole is usually administered at a daily dose of 5 mg/kg but higher doses (up to 20 - 25 mg/kg/day) are recommended in some countries. Albendazole is used at 800 mg/day (15 mg/kg/day) administered in two doses. These drugs should be taken for 10 - 15 days. The use of mebendazole or albendazole is contraindicated during pregnancy and not recommended in children aged < 2 years. The most commonly used steroid is prednisolone, which may alleviate the general symptoms of the disease. It is administered at a dose of 30 - 60 mg/day for 10 - 15 days.