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Home Eurosurveillance Weekly Release  2007: Volume 12/ Issue 29 Article 3
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Eurosurveillance, Volume 12, Issue 29, 19 July 2007
Articles

Citation style for this article: McHugh G, Kiely D, Low J, Healy ML, Hayes C, Clarke S. Importation of Polish trichinellosis cases to Ireland, June 2007. Euro Surveill. 2007;12(29):pii=3239. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3239

Importation of Polish trichinellosis cases to Ireland, June 2007

G McHugh1, D Kiely2, J Low1, ML Healy1, C Hayes2, S Clarke (sclarke@STJAMES.IE)1

1 GUIDE Clinic, St. James’s Hospital, Dublin, Ireland
2 Department of Public Health, Health Service Executive (HSE) East, Ireland

A Polish national in his late 20s presented in June to the emergency department of a hospital in Dublin. He had suffered from fevers, periorbital swelling, conjunctival injection, myalgia and diarrhoea for the preceding ten days. The patient had been living in Ireland for the past year but returned to north-west Poland for holidays in April 2007. During his stay he purchased and consumed lightly-smoked pork sausages. He first consumed some of the sausages in the beginning of May and returned to Ireland a week later.

By the end of May he began to feel unwell and noticed that his eyes began to swell and he developed conjunctivitis. He attended an ophthalmologist who diagnosed a viral conjunctivitis. The following day he developed a high-grade fever, diarrhoea and pains in his legs. He also complained of a dry cough. His general practitioner treated him with chloromycetin eye drops and co-amoxiclav for three days with no resolution of symptoms. He was then referred to hospital for further investigation.

The patient indicated that the Polish radio had reported an outbreak of trichinellosis in the region of Poland that he had visited [1,2,3]. As a result of this, and based on his clinical presentation and characteristic blood investigations (eosinophilia, elevated muscle enzymes), a presumptive diagnosis of trichinellosis was made. Serum samples were sent for detection of anti-Trichinella antibodies, and treatment was commenced with mebendazole. The patient's Polish fiancée who had travelled to Poland with him and consumed some of the sausages, was also ill with similar symptoms and following appropriate investigations was started on mebendazole. The serology results for both patients were obtained by the end of June and confirmed by an indirect fluorescent antibody test for Trichinella of >512 from the Hospital for Tropical Medicine in London.

Public health investigation
After the first case presentation appropriate contact was made with the relevant authorities within the Health Protection Surveillance Centre (HPSC) and the Department of Public Health in Dublin [4]. HPSC confirmed the outbreak of trichinellosis in north-west Poland with the Polish authorities. Preliminary investigations point towards sausages produced from uncooked pork meat as the source of the outbreak. The product is not for sale in Ireland. However, the index case brought some of the sausages with him on his return to Ireland.

In addition to the index case and his fiancée, there were two female members in the Irish household. However, neither had consumed the sausage and it was not eaten by anyone other than the index case and his fiancée. None of the sausage was available for testing.

All accident and emergency consultants, ophthalmologists and general practitioners in the Health Service Executive Eastern area were alerted to the possibility of similar cases occurring in individuals entering the country from Poland who may have consumed the contaminated product.

An alert was also sent to the Polish community in Ireland through Ireland's Polish language weekly newspaper.

References:
  1. Golab E, Szulc M, Sadkowska-Todys M. Outbreak of trichinellosis in north-western Poland, June 2007. Euro Surveill 2007;12(7):E070712.1. Available from: http://www.eurosurveillance.org/ew/2007/070712.asp#1
  2. Golab E, Szulc M, Wnukowska N, Rozej W, Fell G, Sadkowska-Todys M. Outbreak of trichinellosis in north-western Poland – Update and exported cases, June-July 2007. Euro Surveill 2007;12(7):E070719.2. Available from: http://www.eurosurveillance.org/ew/2007/070719.asp#2
  3. CDC. Fact sheet: trichinellosis. Available from: http://www.cdc.gov/ncidod/dpd/parasites/trichinosis/factsht_trichinosis.htm
  4. Heymann DL. Control of communicable diseases manual. 18th edition. Washington: American Public Health Association, 2004.

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