Neurotrichinellosis

Trichinellosis is a parasitic zoonosis caused by the nematode Trichinella spp. Neurotrichinellosis represents one of the most important complications of severe trichinellosis in humans and is sometimes fatal, especially when Trichinella spiralis is involved. There are numerous mechanisms responsible for the involvement of the nervous system through direct or indirect involvement of the parasite. In the latter, inflammatory cells, especially eosinophils, appear to play a crucial role. Encephalopathy, neuromuscular disturbances, and ocular involvement represent the most frequent presentations of neurotrichinellosis, with the first being the most responsible for fatalities. The diagnosis is based on imaging (CT or MRI), which shows nodular multifocal hypodensities in serologically positive individuals with relevant epidemiological factors (e.g., consumption of raw pork). However, only direct diagnosis by muscle biopsy can give the absolute certainty of infection. Albendazole and mebendazole are the anthelminthic of choice and should be used with corticosteroids to prevent allergic manifestations.