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Trichinellosis/Trichinosis

Background

Trichinellosis, formerly called trichinosis or trichiniasis (Trich from Greek thrix meaning hair), is an infection caused by nematodes of the genus Trichinella, most commonly T spiralis in humans. Through historical, paleopathologic, and, most recently, genomic studies, the complex intertwined history of humans, their food, and this worm has become better defined. Genomic evidence suggests the presence of Trichinella as a distinct species since some time in the mid to latter Miocene period (around 20 million years ago).
To date, 8 distinct species and 3 genotypes in 2 clads, encapsulated and nonencapsulated, have been found to infect mammals, birds, and reptiles around the globe.
Not all of these have been identified in humans.

The earliest human infection is reported to have been documented in an Egyptian mummy that dates to approximately 1300 BCE.
Religious injunctions on the consumption of pork may reflect early cultural awareness of this human-animal infection link.

The first modern scientific observations of human Trichinella infection, from the autopsy of a man with “sandy diaphragm, were reported by medical student James Paget (of Paget disease) to a medical student society and published by his lecturer in clinical anatomy, Sir Richard Owen, then assistant curator at the Royal College of Surgeons.
The initial life cycle was worked out by Rudolf Virchow and associates over the years 1850-1870.

By the 1860s, trichinellosis was well-recognized as a disorder spread through infected pigs, leading to a cultural aversion to certain pork products, particularly German and Dutch sausage.

Geopolitical and cultural factors, such as increases in global movement of food products and persons, evolving into the 21st century are leading to a resurgence of human infections in areas that have been free of infection for decades.
This resurgence has particular relevance to emergency medicine because people may present to EDs in areas with little or no presence of trichinellosis locally, as they may have contracted it while travelling and because early diagnosis is associated with improved treatment outcomes.

Early diagnosis depends on clinician awareness and uncovering relevant patient history since the initial clinical presentation may be nonspecific.

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