Cluster of trichinellosis cases in Mecklenburg-Vorpommern, Germany
Date: May 20, 2006
From: ProMED-mail<promed@promedmail.org>
Seventeen cases of trichinellosis were detected among members of an
extended family living in the state of Mecklenburg-Vorpommern, eastern
Germany (see: Google Earth images) between December 2005 and March 2006. On March 21, 2006, health authorities in the district were notified of a
laboratory diagnosed case of trichinellosis. The patient, a 30 year old
woman, had been admitted to hospital on February 22, 2006 with diarrhea, nausea, fever, facial swelling, and muscle pain. The patient's blood was tested for IgG and IgM antibodies to Trichinella as part of the differential
diagnosis, using ELISA.
Trichinella larvae were found in a muscle biopsy using immunoflourescence microscopy. The local health and veterinary authorities suspected that pork from a home-reared pig that had been slaughtered at a local butcher's was the source of infection. On March 23, a 2nd case was notified in the mother-in-law of the first patient. The 2nd patient had first become ill in
December 2005 with unexplained diarrhea, nausea, fever, facial swelling,
and muscle pain, and was admitted to hospital for 2 weeks. After the
identification of the illness in her daughter-in-law, she was again
admitted to hospital from March 21-27, 2006 and Trichinella larvae were
identified in the remainder of a frozen muscle biopsy specimen taken in
December 2005. The diagnosis was confirmed by serology.
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After exchanging information between veterinary and local government
authorities, and the Federal Authority for Risk Assessment, the local
health authorities contacted 22 people who had all consumed meat and meat
products (raw minced pork, uncooked smoked sausage or Mettwurst, and ham or
liver sausage) made from the suspect pork flesh. Blood samples from 17 of
these people tested positive for Trichinella infection using ELISA; 16 also
had clinical symptoms of trichinellosis: 12 had muscle pain and facial or
joint swelling, and 10 had diarrhea. Fifteen of these patients were
admitted to hospital for treatment. On April 20, a further case of
trichinellosis was identified in a 42 year old man, a neighbor of the
affected family. The man had also consumed smoked sausage made from the
pork from the neighbor's pig. He presented with neurological symptoms
including visual disturbances, a suspected stroke due to vasculitis, and
peripheral weakness in all limbs. He was treated in a neurological
rehabilitation centre. One serologically confirmed case had no clinical
symptoms. Four people who consumed the implicated meat did not develop
suspect symptoms, and their serology was negative. The newborn child of a
mother with trichinellosis also tested negative.
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Some bacon left over from the implicated pig was examined for
trichinellosis using the digestion method. A high density of Trichinella larvae was identified (106 larvae per gram of bacon). These were
characterized with multiplex PCR as Trichinella spiralis. Since 1900, it
has been a legal requirement in Germany for commercially slaughtered pigs
and other animals that can harbor Trichinella (particularly wild boar and
horse) to be inspected for the larvae (since 1937 for home-slaughtered
animals). However, there is evidence that this requirement is not always
adhered to, particularly when the meat is home-slaughtered, is from wild
pigs or is imported. Investigations into how meat from the infected pig was
able to pass safety inspections are continuing. Trichinellosis is a rare
disease in Germany: 5 cases were reported in 2004, and no cases were
reported in 2005.
Reference:
1. Robert Koch-Institut. Trichinellose: Zu einer Häufung in
Mecklenburg-Vorpommern. Epidemiologisches Bulletin 2006; 18: 139-40
Reported by: M Littmann (<martina.littmann@lagus.mvregierung.de>) /1, K
Noeckler /2, J Hallauer /1
1/ Landesamt fuer Gesundheit u. Soziales, Rostock
2/ Bundesamt fuer Risikobewertung (Federal Authority for Risk Assessment) |