Abstract
We reviewed the evidence on features of central nervous system (CNS) involvement in trichinellosis, systematically searching five databases (to January 2021). We categorized clinical features based on their diagnostic value as warning signs for severe CNS infection (with outcome death) or non-specific signs (outcome improvement). They were suggestive of severe infection if they substantially raised death probability. The review included 87 papers published from 1906 through 2019, with data on 168 patients. Mydriasis, paraparesis, dysphagia, psychomotor seizures, or delirium present a 30–45% increased death likelihood. The best poor prognosis predictor is mydriasis (positive likelihood ratio 9.08). Slow/absent light reflex, diminished/absent knee reflexes, globally decreased tendon reflexes present a moderate increase (20–25%) of death risk. Anisocoria, acalculia, or seizures could also indicate an increased death risk. We provided a detailed presentation of clinical and paraclinical signs that alert physicians of a possible neurotrichinellosis, emphasizing signs that might indicate a poor prognosis.
Highlights
Trichinellosis is a parasitic disease caused by the consumption of raw meat infected with larvae of nematode in the genus Trichinella
Later observations revealed the presence of Trichinella in the cerebrospinal fluid (CSF)
The most frequent clinical features of the central nervous system (CNS) involvement in Trichinella infection consist of some non-specific meningo-encephalitic findings, such as headaches, confusion, spatial and temporal disorientation, and meningeal signs, including neck stiffness and Kerning signs
Summary
Trichinellosis is a parasitic disease caused by the consumption of raw meat infected with larvae of nematode in the genus Trichinella. The first report about the new findings of Trichinella was presented to the zoological society in London in 1835, when Sir Richard. Owen, and his student, Sir James Paget, discovered the parasite during an autopsy [1]. Friedrich von Zenker reported the first acute case of human trichinellosis in 1860 [2]. He presented the dissemination mode of the parasites in the host by implicating the consumption of raw, infected pork as the vehicle of transmission. Later observations revealed the presence of Trichinella in the cerebrospinal fluid (CSF)
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