Reviews on Trichinellosis (IV): Hepatic Involvement

Abstract

Trichinella sp. larvae are released from the intestine and usually migrate through the liver into the general circulation. Nevertheless, hepatic involvement does not represent a leading feature of human trichinellosis. This narrative systematic review focuses exclusively on hepatic complications of trichinellosis and includes a brief overview and analysis of selected cases reported in the literature. Our major goals were to gather important data to understand the substrate of trichinous liver injury and to provide helpful clinical hints for practitioners. To our knowledge, this is the first international review dedicated to this topic. Thirty two cases were detailed enough to allow pooled analysis. The mean age of the analyzed group was 30.5±17 years old with most cases aged 19 to 29 years (29%). Hepatomegaly was noticed in 34.4% of cases, hypoalbuminemia in 40.6%, and hypoproteinemia in 34.4%. Our systematic analyses demonstrated that hepatic complications were mainly evidenced in fatal cases of trichinellosis (65.6%). The most frequent necroptic findings were parenchymatous and/or fatty degeneration of the liver (59.4%). Although less discussed in the literature than other complications, hepatic involvement should be considered more carefully because of its significant consequences on protein metabolism and liver function. Difficult to be revealed intra vitam, hepatic involvement may represent an additional concern to the classical clinical picture of trichinellosis and other life-threatening complications, especially in severe cases of infection. Consequently, physicians should be aware of any possible liver involvement to ensure adequate management of their patients.

Trichinosis Imitating an Inflammatory Systematic Disease

“…In the first stage, woman experienced fever and diarrhea (intestinal stage) and in the second stage, she suffered from myalgias (the muscle stage) with the appearance of a rash, a rare manifestation of trichinosis. These stages experienced form the patient in periods which are in an absolute accordance to life cycle stages of the parasite [3][4][5]. On the other hand, it was difficult to determine the source of the transmission, until the last follow up when she mentioned the consumption of a possible undercooked wild boar minced meat.…”

“…Consumption of undercooked meat is the principal way of transmission. Trichinellosis has been reported worldwide but its prevalence is particularly high in North America, China, Thailand, Mexico, Argentina, Bolivia, Romania, and other parts of Central Europe [1][2][3][4][5][6].…”

“…For heavy infections, 2 clinical stages may be observed [3][4][5]. The intestinal stage occurs between the second and seventh day after ingestion, when encysted larvae are liberated from the infected meat.…”

“…The intestinal stage occurs between the second and seventh day after ingestion, when encysted larvae are liberated from the infected meat. This stage may be asymptomatic or symptoms including abdominal pain, nausea, vomiting, and diarrhea may be present [3][4][5].…”

“…The pain can be so intense, leading to movement difficulty, including breathing or moving the tongue. Less common manifestations include macular or urticarial rash, headache, cough, dyspnea, and dysphagia [3][4][5][6].…”