ICT Recommendations

International Commission on

       ICT Recommendations

In the case of an outbreak of human trichinellosis, the ICT makes the following recommendations for responsibility:

Physicians Should:

1. Identify index cases (see the algorithm on page 43 in Dupouy-Camet & Bruschi, 2007)

1.1  Search for typical signs
  • diarrhea, fever, facial edema, myalgia
  • eosinophilia (> 1000/mm3) and increased levels of muscular enzymes and/or total IgE
1.2 Specify circumstances of the diagnosis:
  • isolated cases (hospitalized for complications, for a suspected auto-immune disease or parasitic infection)
  • grouped cases
1.3 Determine the severity of the disease : severity depends on the number of larvae ingested; the mode of cooking or preparation of the meat; the specific Trichinella species; the individual susceptibility and immune status)
  • severe form : all signs and symptoms very pronounced, metabolic disturbances, circulatory and/or neurological complications
  • moderately severe form: signs and symptoms are less pronounced, complications rare but benign and transient
  • benign or mild form : mild signs and symptoms, no complications (form rarely suspected, unless the infected person is involved in an investigated outbreak
  • abortive form : unique mild signs and symptoms
1.4  Detect primary complications
  • myocarditis (ECG) and thromboembolic disease
  • neurological complications such as encephalitis (CT scan, RMI) and neuromuscular disturbances
  • ocular disturbances
  • respiratory disturbances
  • digestive disturbances
1.5  Hospitalize severe and complicated forms

2.   Alert public health authorities
  • local human health and veterinary authorities
  • national human health and veterinary authorities
  • the International Commission on Trichinellosis
  • the OIE and/or the WHO
3.   Treat infected persons

Suggested treatments include the following:
  • mebendazole : 5 mg per kg/day (higher doses of 20-25 mg/kg/day are recommended in some countries) for 10-15 days or albendazole at 600-800 mg/day (10-15 mg/kg/day) administered in two doses for 10-15 days
  • corticosteroids (0.5-1mg/kg/d of prednisolone) for 10-15 days (in the presence of allergic manifestations in severe and moderately severe forms)

Scientists And Veterinarians Should:

1.   Confirm the diagnosis
  • positive serology or seroconversion
  • positive muscular biopsy
2.   Identify similar cases - cases with increased eosinophilia & muscular enzymes

3.   Examine suspected meat - microscopic examination of a small sample by compression between two glass slides)

4.   Isolate the parasite 
  • feed mice with infected meat or positive muscular biopsy
  • send infected samples or infected mice to the International Trichinella Reference Centre (Istituto Superiore di Sanita, viale Regina Elena 299, 00161 Rome, Italy)

Public Health Authorities Should:

1.   Alert specialized departments 
  • Infectious Disease Departments
  • Laboratory of Medical or Veterinary Parasitology
2.   Identify similar cases
  • family and persons sharing meals
  • customers of the same store or restaurant
  • interviews of physicians and medical laboratories 
3.   Assure adequate supplies of anthelmintics are available

4.   Identify the infected meat

4.1 Veterinary inquiry
  • identify butchers, dealers
  • identify meat origin (imported, hunted, organic farms, etc.)
  • check the accuracy of veterinary control
4.2 Search for remains of infected meat - meat kept by consumers in fridges or deep-freezers

4.3 Initiate a case-control study – investigate the frequency of consumption of different meats, mode of cooking, amount eaten

5.   Promote prophylaxis through media
  • describe proper cooking procedures (60°C)
  • describe the process of assuring safety by freezing meat for at least 10 days (only applies to Trichinella from domestic pigs)
  • reinforce veterinary control and quality control

Further reading

Bruschi F, Murrell KD. New aspects of human trichinellosis: the impact of new Trichinella species. Postgrad. Med. J. 2002 Jan; 78(915):15-22.

Capo V, Despommier DD. Clinical aspects of infection with Trichinella spp. Clin. Microbiol. Rev. 1996 Jan; 9(1):47-54. Online

Dupouy-Camet J, Kociecka W, Bruschi F, Bolas-Fernandez F, Pozio E. Opinion on the diagnosis and treatment of human trichinellosis. Expert. Opin. Pharmacother. 2002 Aug; 3(8):1117-30. Online

Dupouy-Camet J. Trichinellosis: a worldwide zoonosis. Vet. Parasitol. 2000 Dec 1; 93(3-4):191-200.

Dupouy-Camet J., Bruschi F. Management and diagnosis of human trichinellosis. In: Dupouy-Camet J. Murrell K.D. (Eds.)  FAO/WHO/OIE Guidelines for the surveillance, management, prevention and control of trichinellosis, 2007, O.I.E., Paris, pp. 37-69.

Gamble HR, Pozio E, Bruschi F, Nockler K, Kapel CM, Gajadhar AA. International Commission on Trichinellosis: recommendations on the use of serological tests for the detection of Trichinella infection in animals and man. Parasite. 2004 Mar; 11(1):3-13. Online

Gamble HR, Pyburn D, Anderson LA, Miller LE. Verification of good production practices that reduce the risk of exposure of pigs to Trichinella. Parasite. 2001 Jun; 8(2 Suppl):S233-5.

Gamble HR, Bessonov AS, Cuperlovic K, Gajadhar AA, van Knapen F, Noeckler K, Schenone H, Zhu X. International Commission on Trichinellosis: recommendations on methods for the control of Trichinella in domestic and wild animals intended for human consumption. Vet. Parasitol. 2000 Dec 1; 93(3-4):393-408. Online
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