Trichinella spiralis infection during human pregnancy. A case report.

SARACINO P., CALCAGNO M., BILEN BEAUCHE E., GENTILINI V., TAUS R., VENTURIELLO SM.

Conferencia; XIII International Conference on Trichinellosis; 2011

Infection by Trichinella spp. during pregnancy still arises many questions. Argentina, where trichinellosis is endemic, an important number of outbreaks have occurred over time where pregnant women might be involved. The aim of this work was to study the clinical, laboratory and inmunoserological (IS) features of trichinellosis in an infected pregnant woman and her newborn. The patient was a 24-year-old infected woman in her second trimester of pregnancy (P). The patient acquired the infection through the ingestion of pork salami from a commercial source. After the first week post-infection (pi) she presented a strong periorbitary oedema without conjunctival injection, mild myalgia, nauseas and vomits. Hospitalization was not necessary. At the time of serological testing, day 30 pi, slightly elevated muscle enzymes were observed (CPK: 180 UI/l, LDH: 397 UI/l, total leukocytes count 8300/mm3 and eosinophilia 19%. The IS diagnosis by indirect immunofluorescence (IIF) and ELISA detected specific antibodies (Abs). The patient gave birth to a healthy newborn at through full-term P. Serum samples from the infected mother at day 30 pi (MoP) and at delivery; 169 days pi (MoD), newborn and cord blood samples were collected. Detection of specific Abs against excretory-secretory products of muscle larvae of T. spiralis (ML-ESP) was carried out in all serum samples by ELISA. Anti ESP-LM-total immunogammaglobulins (Ig), IgG and IgE were detected in all sera analyzed, IgM and IgG4 in Mo samples and IgA only in MoP serum. Total Ig and IgE antibodies against newborn larvae surface (NBLS) were detected by IIF in all samples serum. All sera samples analyzed showed helminthotoxic activity against NBLS by in vitro Dependent Cell Cytotoxicity (ADCC) assay (MoP 33%, MoD 27%, Cord 32%, Infant 24%, cytotoxic serum 60% and normal serum 0%) The parasite burden of swine product samples (artificial digestion) was 1 ML/g. The isolated ML was Trichinella spiralis, as determined by multiplex PCR assays at the International Trichinella Reference Centre. The mild symptoms and signs presented by the patient might be associated to the low parasite burden of the ingested product and pregnancy status. The presence of helminthocytotoxic Abs against NBLS in the patient’s serum, together with the increase in eosinophils in blood suggest a decrease in muscle parasite burden and might reduce the possibility of infecting the fetus in case of transplacental passage of the larvae. The detection of IgE in the cord serum and in the newborn suggests the existence of IgE trans-placental passage.