Human trichinosis in remotes of Uttarakhand, India

Abstract

Trichinosis is a parasitic zoonosis caused by ingestion of infected meat containing larvae of Trichinella, more prevalent in developing countries. Although infection with Trichinella is globally distributed, it has been documented only rarely in India. The reports are available where Trichinella larvae were found from animals in India but, to our knowledge, only one human case has been reported from India (Punjab), so far. This is the first report of small multiple outbreaks of human trichinosis in India (2009-2011). Epidemiological, clinical, and laboratory findings of trichinosis patients belonging to remote areas of Uttarakhand were analyzed retrospectively and prospectively. Patients belonged to remote areas of Garhwal, Uttarakhand, 77.78% were male, and 22.22% were female. The age of patients ranged from 9-55 yrs. History of eating meat of wild boar was given by all (100%). The signs and symptoms of the patients varied even after intake of same diet, and included generalized weakness/malaise, myalgia, fever, gastrointestinal symptoms, facial/periorbital edema, subconjunctival hemorrhages, retinal hemorrhages, muscle atrophy, and dyspnea. Laboratory investigations revealed eosinophilia, leukocytosis, creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT) elevation in 100%, 88.89%, 50% and 16.67%, respectively. Muscle biopsies revealed larvae in 27.78%. One patient expired while others improved. The prevalence of trichinosis is likely to be underestimated. The aim of this study is to emphasize on the magnitude of the problem, to educate people, especially in the affected areas about this health hazard and help implementation of epidemiological studies and preventive measures.

An Interesting Case of Inflammatory Myopathy

“…There have been very few case reports of TIM with such a kind of presentation [9,10]. In India, there have been scarce reports of trichinellosis [11], and none simulated the typical presentation of proximal myopathy akin to our case.…”

“…The most commonly involved muscle groups in TIM include the extraocular muscles, the biceps and the muscles of the jaw [3]. There have been very few case reports of TIM with a presentation akin to that of IIM along with absence of any constitutional symptoms or gastrointestinal involvement [9][10][11]. Herein we report such a rare case of TIM masquerading as IIM.…”

Uncertainties in diagnosis, treatment and prevention of trichinellosis

“…There are claims that eosinophilia appears before clinical signs and is invariably present [13,35], but the proportion of patients with eosinophilia in reported outbreaks is variable [6][7][8]20,22,24] with a prevalence of 0-100%, and a median value of around 50%. Furthermore, an increased eosinophil count is not specific, commonly found in patients with allergies and other parasitic infections.…”

“…Selected examples of reported outbreaks both in the developed and the developing countries demonstrate that the prevalence of muscle pain, fever and facial edema is highly variable [6,7,[17][18][19][20][21][22][23][24]; myalgia is generally the most common symptom in outbreaks (55-100%), with fever found in 45-100%, and facial edema in 17-91% of the patients.…”

Molecular identification and characterization of Trichinella spiralis from a leopard in India

“…infection has been reported infrequently from India (Ram et al, 2018). The first outbreak of trichinellosis in human in India was reported from Uttarakhand (Sethi et al, 2010). Presently, there are 9 valid species and 3 genotypes (Korhonen et al, 2016) and these species and genotypes are morphologically indistinguishable (Karadjian et al, 2017) excepting for the presence or absence of nurse cell capsule (encapsulated or non-encapsulated clade).…”