Trichinella spiralis
Trichinella spiralis or Trichine is a Ver parasitizes, agent of the Trichinose at the man and of many mammals.
Definition
The Trichine ( Trichinella spiralis ) is a round worm of very small size. Nonspecific parasite, it can develop in all the mammals. The presence of the adults in the intestine, then larvae in the muscular masses, constitutes the Trichinose.
Geographical Répartion and importance
Although the human cases of trichinose became rather rare, 4 orders of facts justify the interest which sticks to this parasitosis:
- the revolved extrème of the massive infestations, which very often lead to 50% of mortality;
- the persistence of important hearths in Asia, Africa and with the the Middle East;
- current increase of the rate of the infestations in the European countries where one again consumes the pig believed, salted or smoked, or insufficiently cooked, whereas only cooking " with coeur" , carrying each muscle fiber with more 55°C, keep silent infectious larvae;
- very particular character of this verminose which results clinically in a major inflammatory syndrome ordering the therapeutic one.
Morphology
The male, out of bludgeon, measurement hardly 1,5 Misters the female, twice longer, is blanchâtre and recalls, with its frayed former end, that of the Trichocéphale.
Biology
Trichine is a parasite of the mammals. The cycle is with only one host, without phase of free life. The adult worm saw in the Small intestine . After the coupling, the female penetrates in the Cryptes of Lieberkühn then in lymphatic spaces. Viviparous, it releases an average of 15 000 larvae which, by the right heart, gain the muscular masses where they enkystent.
So that the cycle is buckled, is needed that the parasitized muscles is used as meal with a new mammal, carnivorous or omnivorous. Released by digestion of their cyst, the larvae gain the intestine grèle and become adult.
The man infects himself by eating the parasitized flesh of the Porc, of the Sanglier, the Phacochère, the Chien, the Phoque or the Polar bear. At his place, the enkystées larvae are in parasitic dead end and evolve to calcification.
Private clinic
The light infestations, badly labelled or unapparent are systematic diagnoses of autopsies: 16% on average in the U.S.A., where the disease would be currently related to the consumption of " sausages of été" , made at the house.
On the other hand, Trichine releasing in the organization of the highly toxic metabolites and allergisants, the massive infestations constitute serious affections often leading to death. Their dramatic clinical picture associates to an important inflammatory syndrome with the actions successive or combined adult worms on the intestine ( phase of invasion ), of the larvae in migration towards the muscles ( phase of state ) and of the enkystées larvae ( phase of chronicity ).
After a phase of incubation dumb and very short, 24 to 48 hours, one enters the phase of invasion or phase intestino-inlammatoire :
- gastro-intestinal turbid violent ones of type catarrhal beginning pes pains epigastric with vomiting and outcome with an abundant diarrhea, grisâtre, cholériforme;
- strong thermal rise with 40-41°C, giving a fever in plate;
- sick cut down, covered of sweats profuses, without appetite, but presenting an intense thirst;
- the laboratory reveals an acceleration of the Sedimentation test, a fall of the Sérine, a peak of Gamma-globuline S and an increasing éosinophilie, reaching up to 30% and more.
In the most serious cases, the emissions cholériformes subintrantes lead to dead the of 24 or 48 hours. Otherwise, the evolution is done in one week towards the following phase; period of state or allercico-muscular phase :
- the patient is completely prostrate, adynamic with some delirious puffs;
- the thermal plate persists with 40-41°C;
- moreover, one sees appearing important oedemas, especially with the eyelids and the face, from where the name of " diseases of the grosses têtes" given in Germany;
- finally of the Myalgia S, spontaneous or caused, brings embarrassments to the mastiction, swallowing and disorders the word.
The laboratory confirms the data obtained as of the phase of invasion, with a peak of the gamma globulins proportional to the gravity of the infestation, and a éosinophilie higher than 50% which passes by a maximum often reaching 70% and even 90%. Here still, the very serious forms are stopped by a death fast, an acute edema of the lung, myocarditis or encéphalite, or later, by anemia, slimming and cachexy.
The more benign forms will evolve into 2 to 4 weeks to the last phase, phase of chronicity or muscular pure : it is the phase of enkystement and fibrosis during which the inflammatory syndrome regresses with progressive return of the temperature with the normal. The painful myosite makes place with stiffnesses and diminish chronic involving functional embarrassments, deformations and atrophies.
This stage, the muscular biopsy shows the enkystées larvae and reveals the rate of infestation which can reach the considerable figures of 1 200 with 1 500 cysts per gram of muscle. When the cysts are calcified, radiography gives the typical images with sowing of " grains of semoule".
Diagnosis
The clinical diagnosis will be made exceptionally (known active hearth, local pseudo-epidemic), and the seldom possible parasitologic confirmation, by discovered adults in the saddles at the beginning, of larvae in blood, the lymph or LCR later, of cysts in muscular biopsies finally. Strong the éosinophilie must direct towards examinations serologic which will be positive, and finally worms of radiographies at the stage of calcification.
Treatment
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With the phase of beginning, intestinal, but she is not practically diagnosed, any antihelmintic can cure the patient, Pipérazine for example.
- At the tissue stage, only one treatment seems active at present: the Thiabendazole or Mintezol.
- Against the inflammatory or allergic phenomena, one will employ the Cortancyl.
- a intrveineuse calcithérapie associated with a Antibiothérapie will help the patient to fight and will avoid to him the secondary infections.