Introduction

Many of our foods today contain all the nutrients we need, and are treated with thorough care to ensure the right growth and preparation of food. However, as with all food, some precautions need to be put in place, especially during preparation and sourcing. Trichinosis and encephalitis are infections arising from improper food preparation, especially in meat, which makes the brain swell due to parasites from the improper care and storage of these meats, namely wild game and pork.¹

What is trichinosis

Trichinosis is mainly contracted from parasite-infected food such as raw or undercooked meat. These parasites are mainly a class of roundworm called Trichinella, which stomach acid doesn’t break down, but instead encourages the growth of the larvae inside the body.¹ Most signs of this condition take several weeks to show up due to the larvae maturing and migrating through the bloodstream and body in general. An estimated number of 10,000 people each year in the US get infected with trichinosis, as all ages are susceptible to this no matter of their condition. However, with regulations on produce and improved understanding of food preparation, the numbers have decreased over time since 2015. Much of the statistics now of trichinosis comes from rural and lower economic standing countries where regulations aren’t as tightly monitored compared to a population-dense country, as well as the main eaters of pork.²

Signs and symptoms

The main signs of this condition include the common food poisoning symptoms, such as:

• Sickness, vomiting, and nausea
• Diarrhoea
• Abdominal pain
• Bloating of the stomach
• Loss of appetite
• Fatigue and weakness

Most people infected with Trichinella often have abdominal pain due to the larvae migrating into the small intestine to grow, inhibiting intestinal function such as uptaking nutrients that are needed from food, consequently resulting in fatigue and weakness.³ Symptoms can last a while due to the reproduction of larvae between 5 to 25 days, with the initial appearance of symptoms 10 days after being infected. Trichinosis is not contagious from other people normally; however, proper preparation is crucial to prevent the transmission of this to other people or places. Patients who are pregnant may have a chance of passing trichinosis down to the womb. Taking the proper medication is advised as larvae can live from months to years up till the end of life of the host.¹

Diagnosis and treatment

Most treatments require initial screening of symptoms from a blood test and, occasionally, a biopsy to see the infected site. After assessing severity, if cases are severe, medication such as mebendazole and albendazole is prescribed to kill pathogens in the gut by stopping glucose production in these worms, so that no energy will allow them to reproduce. This is usually collected over the counter or administered by your GP,⁴ and patients are advised to finish a course so that all worms are removed from the body, as the medication does not affect worm eggs. Prevention of this infection is also put in place, such as avoiding meat that isn't properly sourced or certified, checking if the meat is cooked properly, and maintaining good hand hygiene so that diseases on the hands aren’t transmitted to the food you touch.

Other non-related medications are also prescribed for treatment, such as NSAIDs to prevent inflammation of the gut and painkillers to ease symptoms of abdominal pain. Generally, prognosis tends to be different depending on the severity, with a mortality rate of 5% if severe. Therefore, these medications will help in preventing these cases and decrease the mortality rate.²

What is encephalitis?

Encephalitis is an inflammatory reaction in the brain with various causes, such as viral infections, autoimmunity of self-cells, bacteria, or fungi.⁴ Mainly, these organisms invade the brain to cause infection. Autoimmune encephalitis is different, as self-antibodies fight against the brain tissue to cause a reaction. This can also be triggered by tumours, causing an autoimmune attack. Like trichinosis, the onset of this disease does not have a clear demographic, as it can affect anyone. Immunocompromised people, however, have a higher risk of developing encephalitis.⁵

Another form of encephalitis is Japanese encephalitis, which is prominent in Asia and spread by mosquitoes. It is estimated that around 100,000 cases occur each year, which is more severe than normal encephalitis with a 30% fatality rate.⁶ More commonly, this disease affects children around the age of 15, and symptoms are similar to normal encephalitis.

Signs and symptoms

The disease progression is fast, and symptoms can occur quickly. Key symptoms of encephalitis are:

• Flu-like symptoms such as temperature, migraine, and body aches
• Confusion
• Impairment of speech
• Vision loss or loss of consciousness
• Motor function impairment
• Neck stiffness

These symptoms usually appear over a few days or hours if cases are severe. It affects the brain and spinal cord, so it is classed as a neurological disease; therefore, urgent treatment is needed when symptoms occur to prevent the onset of brain damage, stroke, and decrease the mortality rate.⁵ Some forms of encephalitis are contagious through saliva, snot, and droplets from coughing, sneezing, or sharing items.

Diagnosis and treatment

Physical and medical exams will be conducted, such as observation of symptoms and blood tests to confirm infection. Neurological tests will be performed as well to see the severity of symptoms in the brain and to test motor function or nerve damage. Cerebrospinal fluid will also be analysed to check for damage and detect infections.⁴ The results will allow proper precautions and medication to be administered depending on the type of encephalitis. This can range from antivirals such as acyclovir to treat viral encephalitis, antibiotics, or immunosuppressants for autoimmunity.⁵ Alongside these, other medications such as painkillers are administered, as well as anticonvulsants to prevent seizures. Corticosteroids are also used to decrease swelling.

Preventative methods should be put in place so that the infection does not spread to others. Good hygiene practices, such as washing hands and avoiding sharing items such as cups or utensils, can all decrease infection rates. Routine vaccinations should be regularly done so that encephalitis from mosquitoes is prevented, and the risk of development is reduced. For viral encephalitis, most vaccinations have been developed to prevent the onset, which is recommended especially when travelling.⁶

How are trichinosis and encephalitis linked?

Trichinosis is linked with encephalitis when the ringworms in the bloodstream travel through the brain and impact tissues to cause swelling. This usually takes around 2 weeks for the invasion to occur and for symptoms of both to arise.⁷ The comorbidity of symptoms with other neurological symptoms may impact the diagnosis, such as with meningitis.  However, lab tests such as blood tests, cerebrospinal fluid analysis, and imaging diagnosis can help to differentiate them so that the appropriate prevention and treatments are put in place.⁸

Conclusion

Trichinosis and encephalitis are both severe conditions which need urgent treatment when symptoms arise. This ensures that no further complications take place, as well as keeping other people around you safe to prevent the spread of this disease. If treatments have no effect and symptoms get worse, seek a medical professional for help.