Trichinosis is caused by the nematode Trichinella spiralis. For humans, the most important source of infection is eating undercooked pork containing Trichinella cysts, from pigs fed untreated garbage containing infected rodents. Following ingestion, larvae hematogenously disseminate and invade skeletal muscle—the only tissue of encystment.

The most common symptoms and signs of infection are:

  • gastrointestinal distress
  • muscular pain
  • periorbital and peripheral edema

An inflammatory response can be evoked, however, which can affect other organ systems, including the central nervous system (CNS). A meningoencephalitis can result. About 5% of patients with trichinosis demonstrate neurologic signs, including seizures.174

Diagnosis

The clinical syndrome of fever, periorbital and peripheral edema, and firm and tender muscles in a patient who has eaten pork within the past 2 to 10 days is suggestive of trichinosis. Eosinophils, larvae, or both can be found in cerebrospinal fluid (CSF) in up to 28% of cases.162 Muscle biopsy can confirm the diagnosis.

Treatment

Treatment is thiabendazole and steroids. Seizure management is routine.

Adapted from: Goldstein MA and Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;83-133. 
With permission from Elsevier (www.elsevier.com). 

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Reviewed By: 
Steven C. Schachter, MD
on: 
Monday, March 1, 2004