A family outbreak of trichinellosis - difficulty in diagnosis

Introduction: Trichinellosis is a parasitic infection caused by the Trichinella genus of roundworms. The main route for contraction is eating raw or undercooked meat, especially pork. In the last report of the European Centre for Disease Prevention and Control Bulgaria and Romania account for 88% of the confirmed outbreaks in Europe with an average annual incidence of 0.8 per 100 000 for 2014.Materials and methods: A small outbreak of trichinellosis in 3 family members is presented. The re­search methods include an analysis of clinical history, physical examination, biochemical and sero­logical tests and enzyme trichinelloscopy of the meat. After the etiological treatment the development of the symptoms was monitored for the course of the hospitalisation and one month after that.Results: The initial signs of diarrhoea, nausea, abdominal pains, and high fever were treated on an ambulatory basis as originating from a flu infection. Upon the specialized physical examination mus­cle pains, periorbital oedema and macular rashes were observed which required immediate hospi­talisation. The family presented an anamnesis of consuming sausage, made of pork meat from a lo­cal farm. The laboratory tests showed extremely high numbers of eosinophils. The initial serological tests were negative, which is not unusual at this stage of trichinellosis. On the grounds of the national­ly adopted algorithm the combination of the clinical features, hypereosinophilia and a positive result for the consumed meat were sufficient for implementing a treatment course with Albendazole. The symptoms diminished during the hospitalisation period and no complications were observed upon the control examination.Conclusion: The diagnostic process of trichinellosis can be a challenging task as the mild forms are often mistaken for a flu infection. The difficulty in the diagnosis arises because the initial serologi­cal findings usually remain negative in the first weeks, but this moment is crucial for the etiological treatment to avoid the life-threatening complications as myocarditis or encephalopathy