Severe trichinellosis with neurological involvement - neurotrichinellosis: A case report

Trichinellosis is the most common and most important parasitic zoonosis in Serbia. Complications of this disease are frequent, and a fatal outcome is possible. A particularly significant complication is the involvement of the central nervous system ? neurotrichinellosis. This case report presents a previously healthy, 51-year-old female from Belgrade, Serbia, a teacher by profession. The disease started with symptoms of gastroenteritis in April, after which symptoms and signs characteristic of trichinellosis occurred (myalgia, fever, bilateral eyelid edema, conjunctivitis). About two weeks before the onset of the first symptoms, the patient consumed pork sausages that had been purchased at a green market. Seven days after the disease started, she was hospitalized at the Clinic for Infectious and Tropical Diseases in Belgrade and the diagnosis of trichinellosis was established. Two days after admission, neurological symptoms appeared ? confusion, apathy, right side weakness of the mimic and limb muscles. The medical imaging techniques (CT scan, MRI) showed multiple hypodense changes in different parts of the brain, which corresponded to vasculitis due to parasitic infection. She was treated with approved antiparasitic and corticosteroid therapy. Despite adequate treatment, neurological sequelae were maintained in the follow-up period, and control imaging techniques revealed residual changes in the brain. This case emphasizes the importance of the strict application of all foreseen preventive measures in the control of trichinellosis, and primarily, mandatory trichinoscopic examination of all meat intended for human consumption.