Between 15 and 18 November 2002, two women (aged 47 and 55) and one 52 year old man in Frankfurt am Main, presented with trichinosis (1). Clinical features were fever, headache, myalgia, diarrhoea, periorbital oedema, general weakness, and eosinophilia. The diagnosis in two of them was later confirmed by serology and the third case had a clear epidemiological link.
In early November, the index case, the 55 year old woman (the first of the three to be taken ill) had travelled to Romania. It is suspected that she became infected with Trichinella spiralis through consumption of smoked sausage made with meat from wild boar and domestic pig at a private party on 4 November. Sausage portions brought back from Romania led to infection in the other two patients.
In recent years several cases of trichinosis, linked to insufficiently cooked meat from wild and domestic pigs, have been documented in various Balkan countries (Croatia, the former Yugoslavia, and Romania) and eastern European countries, especially the Ukraine. Several imported cases have been reported in Germany.
Trichinella larvae can be destroyed by cooking cuts of meat that are up to 15cm thick at a temperature of at least 65°C, or by freezing it for at least 20 days at -15°C, or for at least 10 days at -23°C.
Cases of trichinosis should prompt enquiries about patients' exposure to smoked or undercooked meat, particularly pork, or 'home-made' sausages imported from Balkan and east European countries.