Definition and cause

Human trichinellosis, otherwise called Trichinosis, is caused by a worm named Trichinella. Richard Owen and James were the first ones to see and be able to describe the Trichinella in the human diaphragm in 1835. Before this discovery, trichinella had been infecting people since the 1800s. It was discovered in mummies and documented as the earliest human infection around 1300 BC. Data from 2020 shows that about 10,000 Trichinella infections occur annually worldwide, making this a global health problem.¹

In this article, we are going to explain what Trichinosis is, how the symptoms come about, what the symptoms are, the significance of supportive care, and the kinds of supportive care and management needed by patients suffering from this syndrome.

How does trichinosis develop in the human body?

After ingestion of raw or undercooked meat infected with first-stage larvae. The larvae decapsulate in the stomach and then invade the small intestine lining, where they begin to develop. This happens in a span of 24 to 30 hours. The larvae will then moult into different stages from L1 and so on to grow into adult worms that release new larvae into the bloodstream as early as 5 days after infection.¹

After this, they remain asleep in the skeletal muscle in small, enclosed cysts, growing into their infective stage. Here, they cause disease in the body through an inflammatory and immune response, with the following symptoms.¹

It is important to note that Trichinosis is not communicable from person to person, meaning the patient cannot spread it to another person if they have contracted it.²

Typical symptoms

For the infected individual, the signs and symptoms of trichinosis can vary. In the early stages, the patient should expect:²

• Nausea
• Diarrhea
• Fever
• Fatigue, and
• Discomfort in your abdominals

These can progress into:²

• Headaches
• Chills
• Cough
• Swelling in the face and eyes
• Joint and muscle pains
• Constipation, and
• Itchy skin

There is also a chance that the patient may experience loss of direction and an issue with breathing. Severe cases can also cause death. Clearly highlighting the importance of getting in contact with a healthcare provider as soon as the patient encounters these symptoms.

Purpose of supportive care

Trichinosis treatment is done using antiparasitic medicine and steroids such as albendazole and mebendazole.³ There is no effective treatment for trichinosis once the larvae are in the muscles and the cysts have developed. This is why we need to employ supportive care methods to monitor the patient, relieve pain, alleviate symptoms, and ensure the patient is comfortable.

The trichinella can migrate into the heart or nervous system in some patients. In this case, the patient needs to be monitored closely due to the inflammation that happens to both the heart muscles (myocarditis) and the brain (encephalitis).^4,5

To prevent further complications that can become fatal and encourage recovery, one needs consistent supportive care.

Initial supportive measures

Rest and comfort

Rest is important for recovery because trichinosis can leave patients weak and tired. Whether the patient is recovering at home or in the hospital, active rest is essential for the body to heal and regain its strength quickly.  

Pain and fever management

Fever symptoms must be managed accordingly, as they could be an indication of inflammation in the body. Employing over-the-counter pain-relieving medication like paracetamol and ibuprofen is a good way to alleviate pain in the muscles and fever. Patients need to confirm with a healthcare provider on the medication they should be taking.

Keep an eye on the patient’s temperature to ensure it is normal to avoid fever spikes. To stabilise the body and level out the body temperature, make sure the patient is taking enough fluids.

Gastrointestinal symptom support

Hydration and electrolyte balance

Make sure that you are keeping an eye on your patient to notice any signs of dehydration. These can be:

• Reduced urination
• Dizziness
• Dry mouth

So, if you notice any signs of dehydration with these symptoms, you will need to introduce fluids. Fluids are a great way to encourage hydration and electrolyte balance in the body. You can also prescribe oral rehydration salts (ORS), which can be acquired over the counter. These contain electrolytes and sugars that help to rehydrate the body and restore electrolytes lost from diarrhoea or vomiting.

Dietary adjustments

Due to the gastrointestinal issues that present themselves with Trichinosis, you need to make sure your patient is eating in small intervals and small meals. This is because small portions are not only easy to digest but also easy to eat, encouraging good eating habits while experiencing this disease.

Try to introduce bland foods like rice that can be easily eaten, and avoid acidic types of foods that can worsen the gastrointestinal symptoms of your patient. Avoid foods like coffee, black tea, alcohol, vinegar, tomatoes, and spicy foods.

Antiemetics (if necessary)

To manage the nausea symptoms, doctors can prescribe over-the-counter antiemetics, which help with nausea. Keep in mind that these are chosen based on the cause of nausea, the patient’s medical history, and any other medications they may be taking.

Muscle pain and swelling management

Analgesics and anti-inflammatory agents

To manage the muscle swelling and the pain, you may need medication like ibuprofen. This will reduce the inflammation in the muscles, hence relieving pain and lowering your patient’s fever. These are also called nonsteroidal anti-inflammatory drugs (NSAIDs)

Warm compresses, light exercise and stretching

Using a warm compress on the parts of the patient’s body that hurt can help relax the muscles and relieve the pain. With the strain and pain in the muscles, your patient can become stiff, which may contribute to more pain. Make sure you are initiating some stretches and gentle movements to prevent stiffness.

You must stretch your patient only after the muscle pains have reduced. Your aim here is to be supportive and reduce pain, try your level best not to hurt them.

Monitoring for complications

These can include, but are not limited to, muscle pains, severe fever, difficulty breathing, and heart irregularities. All these could indicate serious complications, so it’s important to keep a consistent eye on your patient.

Assess the patient's vital signs regularly to make sure their heart rate, blood pressure, and respiratory health are normal and not indicating any complications for the patient. Monitor for potential oedema around the face and limbs because this can indicate an escalated immune response.

Patients can sometimes develop heart and brain complications that need to be managed to ensure the disease doesn’t become fatal.  This is something to keep in mind when checking in with your patients. 

Adjunctive therapies

As an alternative therapy, you can give your patient corticosteroids for severe inflammatory responses like a high fever or significant muscle swelling. You can also include an antiparasitic treatment in your patient’s regimen, such as albendazole- these aid in targeting any underlying infections caused by the larvae in the muscles.

Psychological support

The symptoms of trichinosis cause distress in the patients. The pain can cause the patients a lot of stress, which can cause depression. This makes psychological support essential for recovery.

Follow-up and long-term care

A lot of emphasis needs to be put on consistent checks to ensure the symptoms have gone away, and when changes to the medication dosage need to be adjusted. If the disease affects the mobility of the patient due to muscle strain and pain, physical therapy needs to be included in the patient’s treatment regimen. Physical therapy and gentle exercise can be a great starting point for the patient to push them towards their normal daily activities prior to becoming infected.

Most importantly, healthy governments around the world need to emphasise providing food safety education. Ensure people know the significance of properly cooking meat to ensure the incidence of reinfection is low.  

Summary

Supportive care for patients with trichinosis is essential. This is due to the effects this disease has on its patients- it affects them holistically. As healthcare providers, we need to be at the forefront of advertising and pushing for holistic care for diseases like trichinosis. The patient needs physical and psychological care to ensure they are weathering trichinosis sustainably.