Trichinellosis in Hospitalized Children and Adults from Western Romania: A 11-Year Retrospective Study

Trichinellosis, a serious and sometimes fatal human disease, is a consequence of consuming raw or improperly cooked meat containing the infective larvae of Trichinella spp. The aim of this observational cohort retrospective study is to compare the epidemiological, laboratory, clinical and therapeutic aspects of trichinellosis in children and adults from Western Romania. We investigated the medical records of patients who were diagnosed with trichinellosis and hospitalized between 17 January 2010 and 31 December 2020. One hundred thirty-three patients were identified according to the electronic databases of infectious disease hospitals, located in four counties from Western Romania. A total of 19 patients (14.28%) were children and 114 patients (85.71%) were adults. In children, the most frequent symptoms were digestive in 78.94%, followed by fever in 57.89%, eyelid or facial edema in 57.89% and myalgia in 52.63% of cases, while adults presented mainly myalgia in 87.71%, followed by fever in 77.19%, digestive symptoms in 68.42% and eyelid or facial edema in 66.66% of cases. The source of infection was pork meat products in the majority of patients (89.47%). Our results revealed a general declining trend in infection rates for both children and adults during the studied period. The vast majority of cases were severe and all required hospitalization. Education of the population along with public health strategies should be improved and maintained to fully prevent trichinellosis in Western Romania.

Scheme of Effective Epidemiological Investigations in Trichinella Outbreaks on Pig Farms

Trichinellosis is a parasitic, zoonotic disease caused by larvae of the genus Trichinella. Infection occurs via the consumption of raw or undercooked meat containing this parasite. Symptoms of the disease manifest as intestinal disorders, followed by facial swelling, fever, muscle pain and other symptoms, eventually leading to neurological and cardiac complications and even death. In Europe, trichinellosis is most often associated with the consumption of meat from wild boars, pigs and horses. In recent years, wild boars that are hunted illegally and not tested for Trichinella spp. have been the most common cause of trichinellosis in humans; however, there have also been cases where infected pigs have been the source of infection. When trichinellosis is suspected in humans, epidemiological measures are taken to identify the source. Similarly, an epidemiological investigation should be initiated whenever Trichinella spp. has been detected in pigs. However, commonly used actions do not provide sufficient data to determine the source of infection for pigs and to prevent further transmission. Therefore, in this article, we propose a scheme for effective epidemiological investigations into Trichinella outbreaks on pig farms that can help trace the transmission mechanisms of the parasite and that takes into account currently available testing tools. The proposed pathway can be easily adopted for epidemiological investigations in routine veterinary inspection work.

Distribution of Trichinella spiralis, Trichinella britovi, and Trichinella pseudospiralis in the Diaphragms and T. spiralis and T. britovi in the Tongues of Experimentally Infected Pigs

There is little or even no data in the global literature on the distribution of different species of Trichinella in the individual parts of the diaphragms and tongues in infected pigs. This is of particular importance from the food safety point of view and for the conduct of routine testing of pig carcasses for Trichinella as well as epidemiological surveys. Therefore, the aim of the present study was to evaluate the distribution of Trichinella spiralis (T. spiralis), Trichinella britovi (T. britovi), and Trichinella pseudospiralis (T. pseudospiralis) ML in various parts of the diaphragm (the pillars, costal, and sternal part) and the distribution of encapsulated species of Trichinella (T. spiralis and T. britovi) in various parts of the tongues (the tip, body, and root) of experimentally infected pigs. The diaphragm pillars were the most heavily parasitized part of the diaphragm both in groups of pigs infected with particular species of Trichinella and in groups of pigs presenting different levels of infection; however, statistical differences were observed only in the group of pigs with moderate (21–35 larvae per gram-lpg) or moderately high (35–55 lpg) intensity of Trichinella spp. infection in the entire diaphragm. In all groups of pigs, regardless of the infecting Trichinella species or infection level, larvae showed a homogeneous distribution on both sides of the diaphragm and excluding those of T. pseudospiralis, also in all three parts of the tongue. Histological examination showed features of a differential inflammatory response around larvae of the different Trichinella species. This study confirmed that for mandatory examination of pig carcasses using a pooled-sample digestion assay in which each pig is intended to be represented by a 1 gram sample taken from the diaphragm pillars, if that tissue is not available, the mass of the sample taken from the remaining diaphragm parts (costal or sternal) should be at least double that from the pillars. Histological findings confirmed that the inflammatory pattern of pig muscles varies depending on the Trichinella species triggering the infection and is less intense in the case of infections with T. pseudospiralis than in infections with encapsulated species of Trichinella (T. spiralis and T. britovi).

Trichinella britovi infection in wild boar in Portugal

Trichinella spp. infection occurs when a host ingests muscle tissue containing infective larvae (L1 stage). Wild boar meat and its products represent the second largest source of human trichinellosis worldwide. For this reason, and since that in Portugal wild boar is the most hunted large game specie, the laboratory of Technology, Quality and Food Safety (TQFS) from the University of Trás-os-Montes e Alto Douro created a free service to test wild boar meat for Trichinella spp. From December 2015 to February 2020, and 857 samples were analysed. From those, the majority (719/857, 83.9%) were tested after October 2018 when a specific national legislation came into force, demanding that meat from wild boar hunted in a defined risk area should be tested for Trichinella spp. Under TQFS laboratory activity, in January 2020, a positive case was identified, being the first molecular confirmation of Trichinella britovi infection in wild boar in Portugal. Additionally to this activity, in 2019, a questionnaire was submitted to 100 hunters to acquire information about wild boar meat usage and consumption behaviours. From the total respondents, 86% declared they intended to use meat for private consumption. Of those, 93% also stated that have sold part of the meat and/or homemade sausages, the majority (80%) without prior testing for Trichinella spp., as required by EU Regulation. These results alert the hunters to a risk for human infection, which could be extended to outside the hunter's household. Given the actual epidemiological situation, it should be emphasized that testing for Trichinella spp. in wild boar meat should be maintained and reinforced, particularly in the risk area. The results presented in this report strongly support the importance of specific national legislation to mitigate the risk of trichinellosis due to consumption of non-tested wild boar meat.

Acute phase protein pattern and antibody response in pigs experimentally infected with a moderate dose of Trichinella spiralis, T. britovi, and T. pseudospiralis

The aim of the present study was to evaluate the acute-phase protein (APP) response in three groups of pigs experimentally infected with a moderate infective dose, i.e. 1000 muscle larvae (ML) of Trichinella spiralis, 3000 ML of Trichinella britovi, and 2000 ML of Trichinella pseudospiralis. Over a 62-day period of infection, we examined the serum level and kinetics of the haptoglobin (Hp), C-reactive protein (CRP), serum amyloid A (SAA), and pig major acute-phase protein (pig-MAP). In addition, to better understand the immune response of pigs experimentally infected with three different species of Trichinella, the kinetics of IgG and IgM antibodies against excretory-secretory (ES) antigens of Trichinella ML were also investigated. In order to assess anti-Trichinella IgG dynamics, we used a commercial and an in-house ELISA based on both heterologous (T. spiralis) and homologous (T. spiralis, T. britovi, and T. pseudospiralis) Trichinella species ES antigens. Among the four APPs analyzed, the concentration of CRP and pig-MAP significantly increased only in T. britovi-infected swine when compared with control pigs. This took place as early as 6 days post-infection (dpi). Hp was the only APP whose concentration significantly increased in pigs infected with T. pseudospiralis, this occurring as late as on day 62 pi. Despite the statistical differences found, increases in pig-MAP, CRP, and Hp levels were rather mild and transitory; none of these proteins were found to be elevated in the serum of all experimental groups of pigs at the same time point after infection. Specific IgG antibodies against ES antigens of Trichinella ML were first detected by the commercial and in-house T. spiralis ML ES-antigen ELISAs on days 30, 36 and 36 pi in pigs experimentally infected with T. spiralis, T. britovi, and T. pseudospiralis, respectively. However, seroconversion in pigs experimentally infected with T. britovi was detected slightly earlier (30 dpi) when the ELISA based on homologous rather than heterologous ES antigens was applied. In serum samples from pigs infected with T. spiralis, statistically significant increases in the level of specific IgM antibodies against T. spiralis ML ES antigens were first detected on day 30 pi and after this time, their concentration began to decrease. No changes in the level of anti-Trichinella IgM were observed in T. britovi- or T. pseudospiralis-infected pigs throughout the entire period of the experiment.