Treatment of Trichinosis
For a patient with trichinosis presenting with fever, abdominal pain, and muscle weakness after consuming undercooked meat, treat with albendazole 400 mg orally twice daily for 10-15 days, and add prednisolone 30-60 mg daily for 10-15 days to manage severe symptoms and prevent life-threatening complications. 1, 2
Disease Severity Assessment
First, determine disease severity based on clinical presentation, as this guides treatment intensity:
- Mild disease: Fever, abdominal pain, myalgia without systemic complications 1
- Severe disease: Myocarditis, cardiac conduction disturbances, meningo-encephalitis, respiratory failure, or severe myositis requiring intensive care 1
The patient described has fever, abdominal pain, and muscle weakness—suggesting at least moderate disease that warrants full treatment.
Anthelmintic Therapy
Albendazole is the preferred anthelmintic agent:
- Standard dosing: 400 mg orally twice daily (or 15 mg/kg/day divided into two doses) for 10-15 days 1, 2, 3
- Alternative: Mebendazole 5 mg/kg/day (some countries use higher doses of 20-25 mg/kg/day) for 10-15 days 2
- Contraindications: Both drugs are contraindicated in pregnancy and not recommended in children under 2 years 2
The 2010 UK guidelines note that mild disease may be treated with albendazole 400 mg once daily for only 3 days, but this shorter course is insufficient for the patient described who has muscle weakness indicating parenteral phase involvement 1
Corticosteroid Therapy
Prednisolone should be added to anthelmintic therapy in symptomatic cases:
- Dosing: 30-60 mg orally daily for 10-15 days 2
- Alternative: 20 mg orally twice daily for 14 days 3
- Rationale: Corticosteroids alleviate general symptoms, reduce inflammation from larval migration, and prevent severe complications including myocarditis and encephalitis 4, 2
The FDA label specifically lists "trichinosis with neurologic or myocardial involvement" as an indication for prednisone, emphasizing its importance in preventing mortality 4
Clinical Monitoring
Monitor for life-threatening complications during treatment:
- Cardiac: Myocarditis and cardiac conduction disturbances can occur and represent major causes of mortality 1
- Neurological: Meningo-encephalitis may develop, requiring intensive care 1
- Respiratory: Severe myalgia and muscle weakness can progress to respiratory failure 1
- Laboratory: Check creatine phosphokinase (frequently elevated) and eosinophil count (typically >3 × 10⁹/L) 1
Diagnostic Confirmation
While initiating treatment, confirm diagnosis through:
- Serology: Becomes positive 3-5 weeks after infection 1
- Muscle biopsy: Demonstrates Trichinella larvae encysted in muscle tissue 1, 3, 5
- Epidemiological link: History of consuming raw or undercooked pork, wild boar, or bear meat 1, 6, 7
Common Pitfalls
Do not delay treatment waiting for serological confirmation—serology takes 3-5 weeks to become positive, and treatment is most effective when started during the enteral phase (first 7-30 days) before extensive larval migration to muscle 1
Do not withhold corticosteroids in symptomatic patients—the anti-inflammatory effects are critical for preventing myocarditis and encephalitis, which are the primary causes of death in severe trichinellosis 1, 4
Do not use shorter treatment courses—while the 2010 guidelines mention 3 days for mild disease, the presence of muscle weakness indicates parenteral phase involvement requiring the full 10-15 day course 1, 2