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PAPER • OPEN ACCESS
View the article online for updates and enhancements.
-
-
-
This content was downloaded from IP address 27.79.75.39 on 13/02/2023 at 03:35
Published under licence by IOP Publishing Ltd
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
Tatyana Lipilkina1,*, Igor Popov1, Pavel Lipilkin1, and Alexey Ermakov1
1 Don state technical university, Gagarin Square, 1, Rostov-on-Don, 344003, Russia
E-mail: [email protected]
Abstract In the Russian Federation, cases of infection with trichinosis in a population of
people or animals are annually recorded. Trichinosis is intestinal and tissue helminthiasis of
humans and a number of mammals, caused all over the world by nematodes. A person becomes
infected with the parasite by eating meat containing live encapsulated Trichinella larvae.
Mating takes place in the gastrointestinal tract, fertilized females are introduced into the
intestinal mucosa with their anterior thinned ends. The clinical picture of trichinosis is
accompanied by the development of myositis, degeneration of muscle fibers, and multiple
edema. Deaths are not uncommon due to necrotic ulcerative lesions of the intestine and internal
bleeding.
1. Introduction
Trichinosis is a natural focal parasitic invasion; the causative agent is nematodes of the genus
Trichinella [1]. The most common species is Trichinella spiralis. Until 2011, 65818 cases of
trichinosis were registered in the world, of which 42 were fatal [2, 3]. According to the data of
Rospotrebnadzor [4], from 30 to 200 cases of trichinosis are registered annually in Russia. Wild
animals remain the natural reservoir of infection. Trichinella infection rarely causes clinical signs in
natural hosts of the parasite, unless they are infected with very large numbers of larvae, although it can
be fatal to humans. Climate warming with milder winters and less snow allows Trichinella spiralis to
spread and become more abundant [5]. Also, the possible relationship of foodborne zoonoses between
wild boars, domestic animals, and humans is of growing interest among researchers [6].
In economically developed countries, in the context of ensuring biological safety when raising pigs
on farms, in most cases, human infection with trichinosis occurs as a result of the consumption of
insufficiently thermally processed meat of wild animals [7, 8, 9]. This occurs as a result of the
consumption of raw or undercooked meat, mainly from infected pigs, and more and more cases occur
from the consumption of game [10, 11].
The incidence of zoonotic meat-borne parasitic infections is underestimated and ignored, so they
are becoming more common in many parts of the world, mainly due to inadequate methods that are
used for routine diagnosis, monitoring, and reporting for many zoonotic parasites [12, 13, 14, 15].
Meat inspection, although often insensitive and often not practiced in many regions, is the main
method used to diagnose meat parasites.
2. The aim of the study
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
2
To evaluate the incidence of trichinosis among Rostov Oblast residents and the risk of infection when
eating infected meat according to the data of the Rostov Oblast veterinary service, as well as to
determine the most important risk factors and predict the severity of the course of trichinosis.
3. Materials and methods
Analyzed the data of the Center for Hygiene and Epidemiology in the Rostov region and the number
of registered cases of trichinosis in 1994-2019. The results of the examination of meat of farm animals
by the services and branches of the Rostov regional veterinary laboratory and the Rostov regional
station for combating animal diseases for the above period have been studied.
The analysis of 158 archival case histories of patients with trichinosis, who in the period from 1994 to
2019 were inpatient treatment in the infectious ward No. 5 of the City Hospital 1 named after N.A.
Semashko, Rostov-on-Don. The diagnosis in all patients was confirmed in accordance with the criteria
of the Food and Agriculture Organization of the United Nations (FAO), World Health Organization
(WHO), World Organization for Animal Health (OIE), and in each case, it was confirmed
serologically in humans.
For serological studies, indirect hemagglutination was used. All patients were divided into two groups.
The first group - 54 (34%) patients with a "mild" form of the disease (normal temperature or below
38.0 ° C, or abortive, moderate myalgia of certain muscle groups, limited edema, and transient
manifestations of an allergic reaction). The second group - 104 (66%) patients with a "severe" course
(prolonged fever over 38.0 ° C, generalized myalgia, persistent and widespread edema, vomiting, eye
damage, signs of myocardial and nervous system damage). All patients received therapy with standard
dosage mebendazole, dexamethasone, in severe cases, as well as symptomatic therapy.
For statistical processing of the data, the χ2-distribution test and relative risk (RR) were used with a
95% confidence interval (CI), with a significance level of p <0.05.
4. Results
According to the results of the monitoring carried out by the Center for Hygiene and Epidemiology in
the Rostov Region of Rospotrebnadzor for the period from 1994 to 2019, 224 cases of human
trichinosis were registered in the territory of the Rostov Region.
The highest incidence rate was observed between 1995 and 2000, with a peak in 1997 and 1999. An
increase in the incidence was also noted in 2004-2008. The epidemic process in trichinosis directly
depends on the epizootic. According to the study of pig meat by the veterinary services of the Rostov
region, in the period from 1994 to 2019, Trichinella larvae in pig meat were detected in 247 animals.
Figure 1. Dynamics of detection of cases of trichinosis in animals and humans in the Rostov region
(from 1994 to 2019)
0
10
20
30
40
50
60
70
80
1994 1996 1998 2000 2002 2004 2006 20082 0102012 2014 2016 2018
Humans
Farm
Pigs
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
3
Noteworthy is the similarity of both curves and the coincidence of the peaks in the detection of
contaminated meat and human disease. The largest number of animals with invasion was found in
Zernogradskiy (149 individuals, 61%) and Salskiy districts (86 individuals, 35%). This indicates the
presence of an established epizootic reservoir. In this regard, the curve of farm animals (Figure 1) is
rather an indirect characteristic of the dynamics of the epizootic process. Epizootic activity is
determined in comprehensive studies of the problem of trichinosis with the study of complex
interactions between humans and their economic activities with synanthropic and wild fauna in each
specific region.
Analyzed 158 archival case histories of patients with trichinosis. Among them, 82 (52%) are men, 76
(48%) are women. At the age of 10 - 75 years inclusive. The most numerous age groups are 30-39
years old (n = 59, 37%) and 40 - 49 years old (n = 32, 20%). Groups 20 - 29 years old and 11 - 19
years old accounted for 18% and 16%, respectively. In the majority of patients (n = 153), the cause of
infection was the consumption of pork meat products purchased outside the veterinary control zones,
as well as bear meat (n = 5), i.e. insufficient heat-treated wild animal meat (figure 2).
Figure 2. The vast majority of human infections with trichinosis occur as a result of eating pork meat
from households.
The incubation period ranged from 4 to 36 days, 23 days on average. There was no statistically
significant relationship between the duration of incubation and the severity of clinical manifestations.
Repeated consumption of contaminated meat was one of the risk factors for severe disease. Of the
54 mildly ill, only 20 (37%) people re-consumed contaminated pork, and among the seriously ill 60
(58%) out of 104 patients reported this (RR = 1,558; CI 1,06 - 2,29; p = 0,024).
When analyzing the laboratory data obtained, it was found that leukocytosis above 11,0 × 109/L
was observed in 24 (44%) patients of the first group and in 65 (63%) patients in the second, that is, it
was another factor in the prognosis of severe trichinosis (RR = 1,406; CI 1,007 - 1,963; p = 0,045).
Another factor in the prognosis of severity was the increased content of eosinophils in the blood -
more than 10%, found in 17 (31%) and 53 (51%) patients of the 1st and 2nd groups, respectively (RR
= 1,306; CI 1,046 - 1,631; p = 0,018).
Eosinophilia over 50% was observed in 15 (27%) patients and was accompanied by especially
pronounced manifestations of edema syndrome (RR = 0,29; CI 0,124 - 0,678; p = 0,004).
Additionally, in patients with eosinophil levels of 50% and above, the highest titers of antibodies to
Trichinella were observed (χ2-distribution = 4,81; p = 0,029).
0
20
40
60
80
100
120
140
160
pork meat bushmeat
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
factor/presenc
relative risk
Severe clinical
Severe clinical
Severe clinical
5. Conclusions
Thus, in the course of the study, it was found that repeated consumption of infected meat increases the
risk of developing severe forms of trichinosis by 1,6 times, the level of leukocytes in the peripheral
blood exceeds 11,0×109/L – 1.4 times and eosinophilia – 1,3 times.
Returning to the dynamics of detecting patients with trichinosis and a similar dynamics of detecting
invasive pig meat, it should be noted that over the past 10 years, the incidence of human diseases and
the detection of infected meat have decreased. In our opinion, this is due to the improvement of the
technology for the production of pork meat, the conditions for keeping animals and the strengthening
of the preventive component of veterinary supervision. But the findings do not mean that solving the
problem of trichinosis associated with the consumption of meat from domestic pigs eliminates the
possibility of new cases in humans. Especially when eating wild boar meat.
There is an urgent need for interdisciplinary collaboration between governmental and
nongovernmental health, agricultural and environmental organizations in all Arab countries to
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
establish an information system for monitoring and controlling meat-borne zoonotic infections. This
should also include national and international surveillance schemes for detecting zoonotic infections,
as well as detecting changes in trends or distribution in order to initiate preventive and control
measures.
References [1] N. O. Wilson, R. L. Hall, S.P. Montgomery, 2015 Trichinellosis surveillance-United States 2008-2012,
MMWR Surveill Summ., 64, 1-8
[2] R. Neghina, R. Moldovan, I. Marincu I, et al., 2013 The roots of evil: the amazing history of
trichinellosis and trichinella parasites, Parasitol Res, 110, 503-508 doi:10.1007/s00436-011-2672-1
[3] K. D. Murrell, E. Pozio, 2015 Worldwide occurrence and impact of human trichinellosis 1986-2009,
Emerg. Infect. Dis., 17, 194-202 doi:10.3201/eid1712.110896
[4] Rospotrebnadzor 2017. About situation with the incidence of trichinellosis in the Russian Federation.
Accessed June 02, 2021 URL:
http://rospotrebnadzor.ru/about/info/news/news_details.php?ELEMENT_ID=9116&sphrase_id=117476
3
[5] N. Markov, N. Pankova, K. Morelle, 2019Where winter rules: Modeling wild boar distribution in its
north-eastern range, Science of the Total Environment, 687, 1055-1064
doi:10.1016/j.scitotenv.2019.06.157
[6] S. Bonardi, L. Bolzoni, R. G. Zanoni et al., 2019 Limited exchange of Salmonella among domestic pigs
and wild boars in Italy, EcoHealth, 16, 420-428 doi:10.1007/s10393-019-01418-2
[7] M. Serrano-Moliner et al., 2018 Epidemiology and management of foodborne nematodiasis in the
European Union, systematic review 2000-2016, Pathogens and global health, 112, 249-258,
doi:10.1080/20477724.2018.1487663
[8] N. Vu Thi, E. Pozio, N. Van De et al., 2014 Anti-Trichinella IgG in ethnic minorities living in
Trichinella-endemic areas in northwest Vietnam: study of the predictive value of selected clinical signs
and symptoms for the diagnosis of trichinellosis. Acta Trop, 139, 93-98
doi:10.1016/j.actatropica.2014.07.012
[9] A. Rostami, H.R. Gamble, J. Dupouy-Camet et al., 2017 Meat sources of infection for outbreaks of
human trichinellosis 17. Food Microbiol, 64, 65-71 doi:10.1016/j.fm.2016.12.012
[10] CDC (Centers for Disease Control and Prevention) 2017. Sarcocystosis. Global Health, Division of
Parasitic Diseases and Malaria. Accessed June 02, 2021 URL:
https://www.cdc.gov/dpdx/sarcocystosis/index.html
[11] E.H. Abdel-Hafeez, A.M. Kamal, N.H. Abdelgelil, M. Abdel-Fatah, 2015 Parasites transmitted to
human by ingestion of different types of meat, El-Minia city, El-Minia governorate, Egypt. J Egypt Soc
Parasitol, 45, 671–680 doi:10.12816/0017935
[12] WHO (World Health Organization) 2020 Neglected zoonotic diseases. Geneva, Accessed June 02, 2021
URL: https://www.who.int/neglected_diseases/zoonoses/infections_more/en/
[13] J. H. Diaz et al., 2020 The Disease Ecology, Epidemiology, Clinical Manifestations, and Management
of Trichinellosis Linked to Consumption of Wild Animal Meat, Wilderness & environmental medicine,
31, 235-244 doi:10.1016/j.wem.2019.12.003
[14] M. M. Ribicich et al., 2020 A review on Trichinella infection in South America, Veterinary
parasitology, 285 doi:10.1016/j.vetpar.2020.109234
[15] L. J. La Grange, S. Mukaratirwa, 2020 Epidemiology and hypothetical transmission cycles of
Trichinella infections in the Greater Kruger National Park of South Africa: an example of host-parasite
interactions in an environment with minimal human interactions, Parasite, 27, 13
doi:10.1051/parasite/2020010
View the article online for updates and enhancements.
-
-
-
This content was downloaded from IP address 27.79.75.39 on 13/02/2023 at 03:35
Published under licence by IOP Publishing Ltd
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
Tatyana Lipilkina1,*, Igor Popov1, Pavel Lipilkin1, and Alexey Ermakov1
1 Don state technical university, Gagarin Square, 1, Rostov-on-Don, 344003, Russia
E-mail: [email protected]
Abstract In the Russian Federation, cases of infection with trichinosis in a population of
people or animals are annually recorded. Trichinosis is intestinal and tissue helminthiasis of
humans and a number of mammals, caused all over the world by nematodes. A person becomes
infected with the parasite by eating meat containing live encapsulated Trichinella larvae.
Mating takes place in the gastrointestinal tract, fertilized females are introduced into the
intestinal mucosa with their anterior thinned ends. The clinical picture of trichinosis is
accompanied by the development of myositis, degeneration of muscle fibers, and multiple
edema. Deaths are not uncommon due to necrotic ulcerative lesions of the intestine and internal
bleeding.
1. Introduction
Trichinosis is a natural focal parasitic invasion; the causative agent is nematodes of the genus
Trichinella [1]. The most common species is Trichinella spiralis. Until 2011, 65818 cases of
trichinosis were registered in the world, of which 42 were fatal [2, 3]. According to the data of
Rospotrebnadzor [4], from 30 to 200 cases of trichinosis are registered annually in Russia. Wild
animals remain the natural reservoir of infection. Trichinella infection rarely causes clinical signs in
natural hosts of the parasite, unless they are infected with very large numbers of larvae, although it can
be fatal to humans. Climate warming with milder winters and less snow allows Trichinella spiralis to
spread and become more abundant [5]. Also, the possible relationship of foodborne zoonoses between
wild boars, domestic animals, and humans is of growing interest among researchers [6].
In economically developed countries, in the context of ensuring biological safety when raising pigs
on farms, in most cases, human infection with trichinosis occurs as a result of the consumption of
insufficiently thermally processed meat of wild animals [7, 8, 9]. This occurs as a result of the
consumption of raw or undercooked meat, mainly from infected pigs, and more and more cases occur
from the consumption of game [10, 11].
The incidence of zoonotic meat-borne parasitic infections is underestimated and ignored, so they
are becoming more common in many parts of the world, mainly due to inadequate methods that are
used for routine diagnosis, monitoring, and reporting for many zoonotic parasites [12, 13, 14, 15].
Meat inspection, although often insensitive and often not practiced in many regions, is the main
method used to diagnose meat parasites.
2. The aim of the study
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
2
To evaluate the incidence of trichinosis among Rostov Oblast residents and the risk of infection when
eating infected meat according to the data of the Rostov Oblast veterinary service, as well as to
determine the most important risk factors and predict the severity of the course of trichinosis.
3. Materials and methods
Analyzed the data of the Center for Hygiene and Epidemiology in the Rostov region and the number
of registered cases of trichinosis in 1994-2019. The results of the examination of meat of farm animals
by the services and branches of the Rostov regional veterinary laboratory and the Rostov regional
station for combating animal diseases for the above period have been studied.
The analysis of 158 archival case histories of patients with trichinosis, who in the period from 1994 to
2019 were inpatient treatment in the infectious ward No. 5 of the City Hospital 1 named after N.A.
Semashko, Rostov-on-Don. The diagnosis in all patients was confirmed in accordance with the criteria
of the Food and Agriculture Organization of the United Nations (FAO), World Health Organization
(WHO), World Organization for Animal Health (OIE), and in each case, it was confirmed
serologically in humans.
For serological studies, indirect hemagglutination was used. All patients were divided into two groups.
The first group - 54 (34%) patients with a "mild" form of the disease (normal temperature or below
38.0 ° C, or abortive, moderate myalgia of certain muscle groups, limited edema, and transient
manifestations of an allergic reaction). The second group - 104 (66%) patients with a "severe" course
(prolonged fever over 38.0 ° C, generalized myalgia, persistent and widespread edema, vomiting, eye
damage, signs of myocardial and nervous system damage). All patients received therapy with standard
dosage mebendazole, dexamethasone, in severe cases, as well as symptomatic therapy.
For statistical processing of the data, the χ2-distribution test and relative risk (RR) were used with a
95% confidence interval (CI), with a significance level of p <0.05.
4. Results
According to the results of the monitoring carried out by the Center for Hygiene and Epidemiology in
the Rostov Region of Rospotrebnadzor for the period from 1994 to 2019, 224 cases of human
trichinosis were registered in the territory of the Rostov Region.
The highest incidence rate was observed between 1995 and 2000, with a peak in 1997 and 1999. An
increase in the incidence was also noted in 2004-2008. The epidemic process in trichinosis directly
depends on the epizootic. According to the study of pig meat by the veterinary services of the Rostov
region, in the period from 1994 to 2019, Trichinella larvae in pig meat were detected in 247 animals.
Figure 1. Dynamics of detection of cases of trichinosis in animals and humans in the Rostov region
(from 1994 to 2019)
0
10
20
30
40
50
60
70
80
1994 1996 1998 2000 2002 2004 2006 20082 0102012 2014 2016 2018
Humans
Farm
Pigs
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
3
Noteworthy is the similarity of both curves and the coincidence of the peaks in the detection of
contaminated meat and human disease. The largest number of animals with invasion was found in
Zernogradskiy (149 individuals, 61%) and Salskiy districts (86 individuals, 35%). This indicates the
presence of an established epizootic reservoir. In this regard, the curve of farm animals (Figure 1) is
rather an indirect characteristic of the dynamics of the epizootic process. Epizootic activity is
determined in comprehensive studies of the problem of trichinosis with the study of complex
interactions between humans and their economic activities with synanthropic and wild fauna in each
specific region.
Analyzed 158 archival case histories of patients with trichinosis. Among them, 82 (52%) are men, 76
(48%) are women. At the age of 10 - 75 years inclusive. The most numerous age groups are 30-39
years old (n = 59, 37%) and 40 - 49 years old (n = 32, 20%). Groups 20 - 29 years old and 11 - 19
years old accounted for 18% and 16%, respectively. In the majority of patients (n = 153), the cause of
infection was the consumption of pork meat products purchased outside the veterinary control zones,
as well as bear meat (n = 5), i.e. insufficient heat-treated wild animal meat (figure 2).
Figure 2. The vast majority of human infections with trichinosis occur as a result of eating pork meat
from households.
The incubation period ranged from 4 to 36 days, 23 days on average. There was no statistically
significant relationship between the duration of incubation and the severity of clinical manifestations.
Repeated consumption of contaminated meat was one of the risk factors for severe disease. Of the
54 mildly ill, only 20 (37%) people re-consumed contaminated pork, and among the seriously ill 60
(58%) out of 104 patients reported this (RR = 1,558; CI 1,06 - 2,29; p = 0,024).
When analyzing the laboratory data obtained, it was found that leukocytosis above 11,0 × 109/L
was observed in 24 (44%) patients of the first group and in 65 (63%) patients in the second, that is, it
was another factor in the prognosis of severe trichinosis (RR = 1,406; CI 1,007 - 1,963; p = 0,045).
Another factor in the prognosis of severity was the increased content of eosinophils in the blood -
more than 10%, found in 17 (31%) and 53 (51%) patients of the 1st and 2nd groups, respectively (RR
= 1,306; CI 1,046 - 1,631; p = 0,018).
Eosinophilia over 50% was observed in 15 (27%) patients and was accompanied by especially
pronounced manifestations of edema syndrome (RR = 0,29; CI 0,124 - 0,678; p = 0,004).
Additionally, in patients with eosinophil levels of 50% and above, the highest titers of antibodies to
Trichinella were observed (χ2-distribution = 4,81; p = 0,029).
0
20
40
60
80
100
120
140
160
pork meat bushmeat
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
factor/presenc
relative risk
Severe clinical
Severe clinical
Severe clinical
5. Conclusions
Thus, in the course of the study, it was found that repeated consumption of infected meat increases the
risk of developing severe forms of trichinosis by 1,6 times, the level of leukocytes in the peripheral
blood exceeds 11,0×109/L – 1.4 times and eosinophilia – 1,3 times.
Returning to the dynamics of detecting patients with trichinosis and a similar dynamics of detecting
invasive pig meat, it should be noted that over the past 10 years, the incidence of human diseases and
the detection of infected meat have decreased. In our opinion, this is due to the improvement of the
technology for the production of pork meat, the conditions for keeping animals and the strengthening
of the preventive component of veterinary supervision. But the findings do not mean that solving the
problem of trichinosis associated with the consumption of meat from domestic pigs eliminates the
possibility of new cases in humans. Especially when eating wild boar meat.
There is an urgent need for interdisciplinary collaboration between governmental and
nongovernmental health, agricultural and environmental organizations in all Arab countries to
AFE 2021 IOP Conf. Series: Earth and Environmental Science 937 (2021) 022013
IOP Publishing doi:10.1088/1755-1315/937/2/022013
establish an information system for monitoring and controlling meat-borne zoonotic infections. This
should also include national and international surveillance schemes for detecting zoonotic infections,
as well as detecting changes in trends or distribution in order to initiate preventive and control
measures.
References [1] N. O. Wilson, R. L. Hall, S.P. Montgomery, 2015 Trichinellosis surveillance-United States 2008-2012,
MMWR Surveill Summ., 64, 1-8
[2] R. Neghina, R. Moldovan, I. Marincu I, et al., 2013 The roots of evil: the amazing history of
trichinellosis and trichinella parasites, Parasitol Res, 110, 503-508 doi:10.1007/s00436-011-2672-1
[3] K. D. Murrell, E. Pozio, 2015 Worldwide occurrence and impact of human trichinellosis 1986-2009,
Emerg. Infect. Dis., 17, 194-202 doi:10.3201/eid1712.110896
[4] Rospotrebnadzor 2017. About situation with the incidence of trichinellosis in the Russian Federation.
Accessed June 02, 2021 URL:
http://rospotrebnadzor.ru/about/info/news/news_details.php?ELEMENT_ID=9116&sphrase_id=117476
3
[5] N. Markov, N. Pankova, K. Morelle, 2019Where winter rules: Modeling wild boar distribution in its
north-eastern range, Science of the Total Environment, 687, 1055-1064
doi:10.1016/j.scitotenv.2019.06.157
[6] S. Bonardi, L. Bolzoni, R. G. Zanoni et al., 2019 Limited exchange of Salmonella among domestic pigs
and wild boars in Italy, EcoHealth, 16, 420-428 doi:10.1007/s10393-019-01418-2
[7] M. Serrano-Moliner et al., 2018 Epidemiology and management of foodborne nematodiasis in the
European Union, systematic review 2000-2016, Pathogens and global health, 112, 249-258,
doi:10.1080/20477724.2018.1487663
[8] N. Vu Thi, E. Pozio, N. Van De et al., 2014 Anti-Trichinella IgG in ethnic minorities living in
Trichinella-endemic areas in northwest Vietnam: study of the predictive value of selected clinical signs
and symptoms for the diagnosis of trichinellosis. Acta Trop, 139, 93-98
doi:10.1016/j.actatropica.2014.07.012
[9] A. Rostami, H.R. Gamble, J. Dupouy-Camet et al., 2017 Meat sources of infection for outbreaks of
human trichinellosis 17. Food Microbiol, 64, 65-71 doi:10.1016/j.fm.2016.12.012
[10] CDC (Centers for Disease Control and Prevention) 2017. Sarcocystosis. Global Health, Division of
Parasitic Diseases and Malaria. Accessed June 02, 2021 URL:
https://www.cdc.gov/dpdx/sarcocystosis/index.html
[11] E.H. Abdel-Hafeez, A.M. Kamal, N.H. Abdelgelil, M. Abdel-Fatah, 2015 Parasites transmitted to
human by ingestion of different types of meat, El-Minia city, El-Minia governorate, Egypt. J Egypt Soc
Parasitol, 45, 671–680 doi:10.12816/0017935
[12] WHO (World Health Organization) 2020 Neglected zoonotic diseases. Geneva, Accessed June 02, 2021
URL: https://www.who.int/neglected_diseases/zoonoses/infections_more/en/
[13] J. H. Diaz et al., 2020 The Disease Ecology, Epidemiology, Clinical Manifestations, and Management
of Trichinellosis Linked to Consumption of Wild Animal Meat, Wilderness & environmental medicine,
31, 235-244 doi:10.1016/j.wem.2019.12.003
[14] M. M. Ribicich et al., 2020 A review on Trichinella infection in South America, Veterinary
parasitology, 285 doi:10.1016/j.vetpar.2020.109234
[15] L. J. La Grange, S. Mukaratirwa, 2020 Epidemiology and hypothetical transmission cycles of
Trichinella infections in the Greater Kruger National Park of South Africa: an example of host-parasite
interactions in an environment with minimal human interactions, Parasite, 27, 13
doi:10.1051/parasite/2020010
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