Prognosis
The course of trichinellosis is usually benign and self-limiting, with full recovery of patients within 6 weeks to 6 months of infection. However, severe cases and even death can occur. The intensity of the clinical manifestations and the prognosis of the disease are proportionately correlated with the parasitic burden (estimated number of larvae per gram of muscle) of the infection.
Uncomplicated trichinellosis
In the majority of cases, signs and symptoms gradually disappear within 6-8 weeks of infection, when adult worms, overcome by the immune system of the host, cease releasing migratory larvae from the gut to the skeletal muscles.[65]
Severe or complicated trichinellosis
In cases with high parasitic load, the clinical manifestations of fever, periorbital edema, myalgia, and eosinophilia are very prominent, and it may take up to 6 months for these features to resolve completely.
In addition, severe cases may develop cardiac or neurologic complications or be complicated by secondary infections.
Chronic trichinellosis
The existence of chronic trichinellosis remains disputed among experts.[50] Nevertheless, some patients may experience chronic pain, asthenia, excessive diaphoresis, chronic sensation of insects crawling beneath their skin, and rarely conjunctivitis and psychosis for months to years following the acute infection. In these patients, abnormal electromyography findings and positive serum antibodies may persist for years after the initial infection.[50][65]
Course in special populations
In pregnant women, trichinellosis can cause miscarriage and premature delivery. The infection may be congenitally acquired, although the majority of babies born to infected women are uninfected.[51]
Trichinellosis infection is milder in children. This is due to a lower parasitic load secondary to ingestion of smaller portions of affected meat and to the lack of a strong allergic response.[52]
Trichinellosis in immunosuppressed patients has been reported only anecdotally. The severity does not seem to differ between reported cases and immunocompetent patients.
Death
This is a rare outcome in trichinellosis. From 1986 through 2009, there were 65,818 cases and 42 deaths reported from 41 countries.[76]
When death occurs, it is usually secondary to complications, such as myocarditis or encephalitis.[8][77] Cardiac arrhythmias in myocarditis are considered the most common cause of death associated with trichinellosis.
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