Abstract
We report an outbreak of trichinosis from the consumption of locally processed, cold smoked wild boar meat of a domestically reared animal from a farm in Dufferin County, Ontario.
Between January and March 1993, 24 cases of trichinosis were identified and of these, 21 patients were symptomatic. The most common symptoms were myalgia (75%), weakness (75%), fever (71%) and periorbital edema (67%). Eosinophilia and elevated creatine phosphokinase levels were noted in 86% and 89% of patients respectively. Trichinella serology was positive in 55%. Two patients were hospitalized, one with severe diarrhoea and another with myalgia and fever. Several patients appeared to improve temporarily after treatment with albendazole.
This outbreak reminds us that although trichinosis is rare in Ontario, physicians must maintain a high index of suspicion for the disease. To prevent further outbreaks, the Ontario Government has instituted new guidelines for the processing of all wild boar meat.
Résumé
Nous rapportons ici une éclosion de trichinose en Ontario associée à la consommation de viande froide fumée localement et provenant d’un sanglier sauvage gardé en élevage sur une ferme du comté de Dufferin.
Entre janvier et mars 1993, 24 cas de trichinose furent identifiés, dont 21 patients symptomatiques. Les symptômes les plus fréquents étaient : myalgies (75 %), faiblesse (75 %), fièvre (71 %) et oedème péri-orbital (67 %). L’eosinophilic et une élévation des niveaux de créatinine-phosphokinase étaient présentes chez 86 % et 89 % des patients respectivement. La sérologie pour trichinella était positive dans 55 % des cas. Deux patients furent hospitalisés, un présentant des diarrhées sévères et l’autre des myalgies et de la fièvre. Plusieurs patients notèrent une amélioration temporaire après un traitement avec l’albendazole.
Cette éclosion nous rappelle que, bien que la trichinose soit rare en Ontario, les médecins doivent continuer à l’inclure dans leurs diagnostics différentiels. Pour prévenir d’autres éclosions, les autorités sanitaires ontariennes ont mis en place de nouvelles lignes directrices pour le traitement de toute viande de sanglier sauvage.
References
- 1.Dorland R. Ministry of Health Report. 1977. [Google Scholar]
- 2.MacLean JD, Poirier L, Gyorkas TW, et al. Epidemiologic and serologic definition of primary and secondary trichinosis in the Arctic. J Infect Dis. 1993;162:908–12. doi: 10.1093/infdis/165.5.908. [DOI] [PubMed] [Google Scholar]
- 3.MacLean JD, Viallet J, Law C, Staudt M. Trichinosis in the Canadian Arctic: Report of five outbreaks and a new clinical syndrome. J Infect Dis. 1989;160:513–20. doi: 10.1093/infdis/160.3.513. [DOI] [PubMed] [Google Scholar]
- 4.Gray DF, Morse BS, Phillips WF. Trichinosis with neurologic and cardiac involvement, review of the nature and report of three cases. Ann Intern Med. 1962;57:230–44. doi: 10.7326/0003-4819-57-2-230. [DOI] [PubMed] [Google Scholar]
- 5.Hulbert T, Larsen R. Review of Trichinosis with a report of a case. Inf Dis Clin Practice. 1993;2:21–30. doi: 10.1097/00019048-199301000-00002. [DOI] [Google Scholar]
- 6.Spink WW. Cardiovascular complications of trichinosis. Arch Intern Med. 1935;56:238–49. doi: 10.1001/archinte.1935.03920020030002. [DOI] [Google Scholar]
- 7.Centers for Disease Control. Trichinosis surveillance, United States, 1986. MMWR. 1987;37:1–8. [PubMed] [Google Scholar]
- 8.Centers for Disease Control. Trichinella spiralis infection-United States, 1990. MMWR. 1991;40:57–60. [PubMed] [Google Scholar]
- 9.Feldmeier H, Bienzle U, Jansen-Rosseck R, et al. Sequelae after infection with Trichinella spiralis: A prospective cohort study. Wien Klin Wochenscrift. 1991;103(4):111–16. [PubMed] [Google Scholar]
- 10.Froscher W, Gullotta F, Saathoff M, Tackmann W. Chronic trichinosis. Clinical, bioptic, serologic and electromyographic observations. Eur Neurol. 1988;38(4):221–26. doi: 10.1159/000116271. [DOI] [PubMed] [Google Scholar]
- 11.Harms G, Binz P, Feldmeier H. Trichinosis: A prospective control study of patients ten years after acute infection. CID. 1993;17:637–43. doi: 10.1093/clinids/17.4.637. [DOI] [PubMed] [Google Scholar]
- 12.Morakote N, Sukhavat K, Khamboonruang C, et al. Persistence of IgG, IgM, and IgE antibodies in human trichinosis. Trop Med Parasitol. 1992;43(3):167–69. [PubMed] [Google Scholar]
- 13.Olaison L, Ljungström I. An outbreak of trichinosis in Lebanon. Trans Soc Trop Med Hyg. 1992;86:658–60. doi: 10.1016/0035-9203(92)90178-F. [DOI] [PubMed] [Google Scholar]
- 14.Drugs for Parasitic Infection. The Medical Letter. 1988;30(Issue759):15–24. [PubMed] [Google Scholar]
- 15.Levin ML. Treatment of Trichinosis with Mebendazole. Am J Trop Med Hygiene. 1983;32(5):980–83. doi: 10.4269/ajtmh.1983.32.980. [DOI] [PubMed] [Google Scholar]
- 16.Fourestié V, Bougnoux ME, Ancelle T, et al. Randomized trial of albendazole versus thiabendazole plus flubendazole during an outbreak of human trichinellosis. Parasitol Res. 1988;75:36–41. doi: 10.1007/BF00931188. [DOI] [PubMed] [Google Scholar]
- 17.Ryczak M, Sorber WA, Kandor TF, et al. Difficulties in diagnosis of trichinella encephalitis. Am J Trop Med Hyg. 1987;36:573–75. doi: 10.4269/ajtmh.1987.36.573. [DOI] [PubMed] [Google Scholar]
- 18.Bailey TM, Schantz PM. Trends in the incidence and transmission patterns of trichinosis in humans in the United States: Comparisons of the periods 1975–1981 and 1982–1986. Rev Infect Dis. 1990;12:5–11. doi: 10.1093/clinids/12.1.5. [DOI] [PubMed] [Google Scholar]