An Outbreak of Human Trichinellosis in the Village of Subotinac near the Town of Aleksinac

An outbreak of trichinellosis affecting 13 individuals, of whom 8 with severe form presented as myocarditis, occurred in the village of Subotinac near the town of Aleksinac in Serbia. The source of this epidemic was smoked pork from a domestic pig that had not undergone meat inspection procedures. The most striking clinical features among all the 13 patients were muscular pain (84.6%), malaise (69.2%), upper eyelid edema (61.5%), and difficulty in chewing (53.9%). These symptoms and signs were associated with significant elevations of creatine phosphokinase and lactate dehydrogenase levels. As high as 61.5% of the patients with trichinellosis were diagnosed with myocarditis (determined by means of electrocardiography, echocardiography, troponin I and creatine kinase-MB measurements). The patients had Trichinella-specific IgG antibodies in an enzyme-linked immunosorbent assay and positive indirect immunofluorescence test results. Patients seemed to respond well to treatment with mebendazole. Corticosteroid therapy was administered to patients with myocarditis. Since high percentage of our patients presented with myocarditis, an infectious diseases specialist should always keep in mind doing cardiac biomarkers analyses, echocardiography and electrocardiography.