0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
Trichinosis 1445■Muscle stage: starts second week after infection, fever, chills, tachy-
cardia, myalgias, headache, periorbital edema, conjunctivitis, rashes
(usually macular, brief duration), urticaria, pruritis, dry cough,
swelling of masseter muscles, splinter subungual hemorrhages.tests
■Basic tests: blood: eosinopohilia, often high, present. Sed rate normal
or slightly elevated. CPK and aldolase elevated.
■Basic tests: urine: normal or proteinuria
■Specific tests: muscle biopsy on deltoid or gastrocnemius, larvae
most numerous at 5–6 weeks after infection. Serologic tests become
positive 3–4 weeks after infection. Most used are bentonite floccula-
tion, IFA, and ELISA.
■Other tests: EKG may show tachycardia, ST-T changes, and arryth-
mias due to myocarditis.differential diagnosis
■Myositis of various types, especially dermatomyositis – distin-
guished by normal sed rate, muscle biopsy. Other allergic diseases,
serum sickness, Katayama syndrome.management
What to Do First
■Hospitalize if ill enough. Obtain history of other contacts, determine
source.General Measures
■Fluid and electrolyte support if needed. Watch for signs of myocardi-
tis, use cardiac monitor if severe case.specific therapy
Indications
■Intestinal phase: anyone suspected to be infected. Treatment in this
phase kills larvae before invasion.
■Muscle invasion phase: cases with moderate or severe symptoms.
Treatment of mild cases is optional.Treatment Options
■Intestinal phase: Mebendazole for 5 days
➣Albendazole for 3 days.
■Muscle invasion phase, moderate to severe cases: