Trichinella britovi outbreak: Epidemiological, clinical, and biological features - 13/11/19

Épidémie à Trichinella britovi : aspects épidémiologiques, cliniques et biologiques

Doi : 10.1016/j.medmal.2019.10.008

S. Pavic ^a,⁎ , A. Andric ^b, L.J. Sofronic-Milosavljevic ^c, M. Gnjatovic ^c, I. Mitić ^c, S. Vasilev ^c, R. Sparic ^d,^e, A. Pavic ^e
^a Department of Infectious and Tropical Diseases, General Hospital Uzice, Uzice, Serbia
^b Institute of Public Health, Uzice, Serbia
^c Reference Laboratory for Trichinellosis, Institute for the Application of Nuclear Energy – INEP, University of Belgrade, Belgrade, Serbia
^d Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
^e School of Medicine, University of Belgrade, Belgrade, Serbia

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 13 November 2019
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Highlights

•	A large trichinellosis outbreak due to consumption of wild boar meat products took place in western Serbia during the 2015–2016 winter.
•	The outbreak affected 111 individuals and was characterized by an almost equal distribution of mild (51.4%) and moderately severe (40.5%) clinical presentations.
•	Anti-Trichinella antibodies were observed in 89.7% of patients two months after disease onset, including all hospital-treated patients. Among them, serum positivity detected one year later was 100%.
•	Molecular identification of isolated larvae enabled the first Trichinella britovi outbreak recognition.
•	Trichinella species detection could contribute to better understanding the clinical and serological signs of T. britovi infection.

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Abstract

Objectives

We aimed to describe the first cases of human trichinellosis due to Trichinella britovi in Serbia. A large trichinellosis outbreak due to the consumption of wild boar meat products took place during the 2015–2016 winter.

Patients and methods

In January 2016, the Department of Infectious Diseases in Uzice examined 111 individuals with clinical and biological signs of trichinellosis, of whom 19 were hospitalized. Trichinella species identification was performed by multiplex PCR. Serodiagnosis was performed using immunofluorescence antibody assay, indirect ELISA, and Western Blot as confirmatory tests.

Results

The main symptoms included myalgia (83%), weakness (82%), joint pain (80%), fever (77%), facial edema (74%), and diarrhea (23%). Eosinophil levels>500/μl were observed in 98% of patients. Elevated CPK levels were detected in 71% of patients and elevated LDH levels in 75%. Three patients had cardiac complications. Treatment included mebendazole, nonsteroidal anti-inflammatory drugs, and corticosteroids. Anti-Trichinella antibodies were observed in 89.7% of patients two months after disease onset, including all hospital-treated patients. Among them, serum positivity detected one year later was 100%.

Conclusions

This outbreak highlighted communication failures, from hunters to consumers. Awareness should be raised on the relation between trichinellosis and game meat. Trichinella species detection is important for adequate outbreak recording and could contribute to better understanding the clinical and serological signs of T. britovi infection.

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Keywords : Epidemic, Human trichinellosis, Trichinella britovi