We are a bit dubitative about the case of pediatric trichinellosis (the term trichinosis used by the authors is now obsolete…) reported in the November 2024 issue of Int J Surg Case Rep [1]. As experts in the field, we found many drawbacks in this report [2,3]. According to the authors, the child developed clinical signs compatible with trichinellosis after family pork consumption. “None of them had developed these symptoms except this child” but the only symptoms reported in the child were “fever, cough, weight loss, night sweating, loss of appetite, pressure effects, or bowel, bladder, joints or nervous system involvement”. These signs are not at all specific to Trichinella infection! No muscular pain, no facial oedema, were mentioned. In addition, at presentation, there was no fever and just a moderate increased eosinophilia (900 eosinophils/microl). Serological tests for Trichinella, filariasis and Toxocara, blood search for microfilariasis and stool examination were not performed. According to the authors, the diagnosis is only based on a muscular biopsy showing “calcified larvae and encysted Trichinella larvae (nurse cell) in skeletal muscle cells”. In our opinion, the figure shows a granuloma, but we do not see any nurse cell, there is no modified muscular fiber and no collagen capsule. There is a probable section of a nematode worm, but it is not a Trichinella larva. In the discussion, the authors are only comparing this clinical case with a previous Ethiopian case [4]. “Similar to our case, a 14-year-old male patient from West Arsi Zone, Oromia Region, Ethiopia, presented with a complaint of asymmetric right thigh enlargement of one month duration for which biopsy was done and diagnosed to have trichinosis”. In this case, the biopsy shows indisputable Trichinella larvae.
In conclusion, the case reported by Kindie et al. cannot be defined as a case of trichinellosis. A lymphatic filariasis such as Wuchereria could have been responsible for this neck enlargement, but ultrasounds did not evidence any lymph node enlargement, and the blood eosinophile counts were not so high as expected in such helminthiasis. Furthermore, Wuchereria nematodes do not, usually, migrate in the muscles. On the contrary, Toxocara larvae can migrate in the muscles and might be responsible for this swelling, which could have been cured by the albendazole treatment prescribed to the child. Unfortunately, no search for Toxocara antibodies was performed to confirm this hypothesis. Ethiopia is, without any doubt, a country where nematodes of the genus Trichinella are circulating in wildlife [5], but this case does not fit with the clinical signs of trichinellosis.
Author contribution
JDC, FB & EP contributed equally to the writing of the letter. They are members of the International commission on trichinellosis.
Consent
Not applicable.
Ethical approval
Not applicable.
Guarantor
Jean Dupouy-Camet.
Research registration number
Not applicable.
Funding
No funding.
Conflict of interest statement
None of the authors have conflict of interest.
References
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