I had a visitor who almost lost his life because of severe stomach pain. He came to visit last week Tuesday and we had dinner together. At 1:20AM, he came knocking that he had stomach pain and asked if he could get Gbogbonise Epa Ijebu, a herbal remedy that most average-class parents in southwest Nigeria have in their homes. My Mum would always ensure there was a bottle in the house, and whenever I go visit her, she would give me one. It is surprising how you would see this epa ijebu even in the homes of people who are medical practitioners and health workers. Since I have a bottle at home, I decided to give him but then the pain didn't subside, so I was forced to call the security of the area if I could leave at that time of the night as there was a health emergency in my apartment. He agreed and helped me to the hospital. He told other people to keep doing their jobs. My concern was the fact that he might have suffered from food poisoning but we had the same food for dinner so it became worrisome. My friend however when he arrived was asking for where he could eat pork meat and I didn't know so I had promised him that we would go check for it the following day but when I got to the hospital, my plans to help him search for it ended when the doctor said he had a parasitic larva in his GIT (Trichinosis).
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Trichinellosis which is often referred to as Trichinosis is a nematodal parasitic infection caused by the genus Trichinella. This is a foodborne infection from eating uncooked or undercooked pork-related products or other meat. There is a very low prevalence of the infection as it has an estimated 10,000 cases every year. While this number might look very low, there is a possibility of having an underreported case but also, increased improved food standards can also be a reason for the decline in incident cases. Its breakout is common in developing countries where pork is consumed regularly.
While it is common in pigs, other animals such as wild pigs and bears that can be consumed by humans can be a host to the parasite including the specie T. spirallis. Humans can get infected with this infection if they ingest the encysted trichinella larva along with contaminated meat products. In the small intestine of the human host, the larva is released into the small intestine which subsequently matures into an adult form which then begins to produce more larvae in the host. As the larvae increase, they invade the mucosa of the intestine and enter into the circulation of the patients. The larva then is transported in the blood and can get deposited in the striated muscle where a nurse cell is produced to nourish and feed the larva and the larva becomes encapsulated. This causes the host cell to become basophilic with alterations in nuclei position and number of nuclei properties, causing the immune system to react to the larvae and its metabolite. It can also get into the Central nervous system and the heart and the lungs.
Patients with a low number of infective trichinellosis can be asymptomatic but as the number of infective organisms increases the symptoms begin to show. In the intestinal phase where the larva is in the intestine, the patient would experience Diarrhea which is common, Constipation, Anorexia, Nausea, vomiting, and Abdominal Discomfort. In the invasive phase where the larvae have invaded the mucosal of the intestine and are in circulation or the striated muscles, symptoms are going to be Myositis/Myalgia which has to do with the inflammation of the skeletal muscles leading to aches and pains. The CNS can be involved and this would cause headache and can lead to death. If the pulmonary system is affected, it can lead to cough and dyspnea. Patients with trichinosis can suffer from periorbital edema, and fever. In the convalescent phase, the symptoms can be cachexia and edema.
Diagnosing trichinosis includes Serology where anti-trichinella antibodies are identified this is not found in the early phase but can show off in patients after 2 to 3 weeks of the infection. Blood Work is also important, looking at the level of Eosinophils in patients which would peak, Creatine Kinase which is elevated, and Immunoglobulin E which is increased. A muscle Biopsy can also be done. Lumbar puncture, ECG in case of pulmonary involvement, CT scan, and MRI in cases of CNS involvement. Treatment of Trichinosis would be Albendazole/mebendazole which is given for seven days and given at the early phase so as to prevent the trichinosis from spreading to the skeletal muscles. Pyrantel can also be used to treat in the case of children and pregnant women.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2620635/
- https://www.ojafr.ir/main/attachments/article/147/OJAFR%2010
- https://www.msdmanuals.com/professional/infectious-diseases/nematodes-roundworms/trichinosis
- https://www.ncbi.nlm.nih.gov/books/NBK536945/
- https://www.cdc.gov/parasites/trichinellosis/epi.html