Holzbauer Stacy M, Agger William A, Hall Rebecca L, Johnson Gary M, Schmitt David, Garvey Ann, Bishop Henry S, Rivera Hilda, de Almeida Marcos E, Hill Dolores, Stromberg Bert E, Lynfield Ruth, Smith Kirk E
Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia Minnesota Department of Health, Saint Paul.
Infectious Disease and Microbiology, Gundersen Medical Foundation, La Crosse, Wisconsin.
Clin Infect Dis. 2014 Dec 15;59(12):1750-6. doi: 10.1093/cid/ciu713. Epub 2014 Sep 11.
Rates of trichinellosis have declined significantly in the United States due to improved pork production practices and public awareness of the danger of eating raw or undercooked pork. In April 2011, the Minnesota Department of Health received a report of presumptive trichinellosis in a 50-year-old man with a history of wild boar consumption. A public health investigation was initiated.
Medical record reviews and patient and family interviews were conducted. Trichinella species serology was performed on patient and family serum samples, and larval identification was attempted on clinical specimens and meat samples.
The index patient harvested a wild boar from an Iowa game farm; he processed the meat after returning home and developed gastrointestinal symptoms 2 days later. Four days after his illness onset, all 5 family members consumed a roast from the boar. The index patient sought healthcare 4 times after illness onset before being definitively diagnosed with trichinellosis. Following initiation of albendazole therapy, the index patient developed atrial fibrillation. One additional family member who processed the raw meat was diagnosed with trichinellosis. Trichinella spiralis larvae were identified in wild boar meat samples.
Trichinellosis has long been recognized as a potential hazard of consuming undercooked wild carnivore meat, and historically has been associated with consumption of pork from domestic swine, but may be unfamiliar to practicing clinicians in the United States. Education of hunters and the broader population on the potential for trichinellosis and the importance of proper handling and cooking meat from wild or free-range animals needs to be reinforced.
由于猪肉生产方式的改进以及公众对食用生猪肉或未煮熟猪肉危险性的认识提高,美国旋毛虫病的发病率已显著下降。2011年4月,明尼苏达州卫生部收到一份报告,称一名有食用野猪史的50岁男子疑似感染旋毛虫病。于是展开了一项公共卫生调查。
查阅了病历并对患者及其家属进行了访谈。对患者及其家属的血清样本进行了旋毛虫属血清学检测,并尝试对临床标本和肉类样本进行幼虫鉴定。
索引患者从爱荷华州的一个狩猎农场捕获了一头野猪;他回家后对肉进行了加工,两天后出现了胃肠道症状。他发病四天后,所有五名家庭成员都食用了用这头野猪做的烤肉。索引患者发病后寻求了4次医疗救治,最终才被确诊为旋毛虫病。在开始使用阿苯达唑治疗后,索引患者出现了心房颤动。另外一名处理生肉的家庭成员也被诊断为旋毛虫病。在野猪肉样本中发现了旋毛形线虫幼虫。
长期以来,旋毛虫病一直被认为是食用未煮熟的野生食肉动物肉的潜在危害,并且在历史上一直与食用家猪的猪肉有关,但美国的执业临床医生可能对此并不熟悉。需要加强对猎人及更广泛人群关于旋毛虫病的潜在风险以及正确处理和烹饪来自野生或散养动物肉类的重要性的教育。