ORIGINAL STUDIES Acute Trichinellosis in Children Compared With Adults Durgul Ozdemir, MD,* Hasan Ozkan, MD,* Nurullah Akkoc, MD,† Fatos Onen, MD,† Oguz Gurler, MD,† Ismail Sari, MD,† Servet Akar, MD,† Merih Birlik, MD,† Aydanur Kargi, MD,‡ Erdener Ozer, MD,‡ and Edoardo Pozio, PhD§ Objectives: Trichinellosis is a cosmopolitan parasite infection caused by Trichinella nematodes that is acquired from consumption of raw meat from several animal species. Knowledge of the clinical pattern and laboratory features of the disease in childhood is limited. The purpose is to study the clinical pattern of trichinellosis caused by Trichinella britovi in children and to compare it in household adults. Methods: We evaluated all children up to 17 years of age and their adult householders exposed to the consumption of infected meat during an outbreak of trichinellosis. A questionnaire was developed to record clinical data. The blood sample was collected for blood count, muscle enzymes, serum electrolytes, albumin and serology. All exposed children were treated with mebendazole, and severe symptomatic patients received prednisolone. Clinical and laboratory presentations and outcome were recorded. To evaluate the clinical picture of trichinellosis in childhood, clinical and laboratory findings were compared between children and household adults with a confirmed diagnosis who consumed the same amount of infected meat. Results: In 47 (62%) of 76 children with suspected trichinellosis, the diagnosis was serologically confirmed. The main clinical and laboratory findings in children were fever, abdominal pain, myalgia, facial and/or eyelid edema, rash, eosinophilia and increased muscu- lar enzymes. The incubation period was similar in children and adults, but myalgia (66% versus 96%, P  0.01), facial and/or eyelid edema (57% versus 86%, P  0.05), eosinophilia (52% versus 96%, P  0.01) and increased serum creatine kinase (38% versus 79%, P  0.01) were less common in children than in adults. Seroconversion occurred in fewer children than adults, but the difference was not statistically significant. Conclusions: T. britovi infection shows a benign course and a milder clinical picture in children than in adults who consumed the same amount of infected meat. Key Words: trichinellosis, children, Trichinella britovi, myalgia (Pediatr Infect Dis J 2005;24: 897–900) T richinellosis occurs throughout the world from consump- tion of raw infected meat of animal origin (eg, pork, horsemeat and game). 1 In recent years, an increase in the occurrence of this infection has been documented in Eastern Europe, Asia and Central and South America. 1–3 The first symptoms and signs of trichinellosis are abdominal pain and diarrhea, but they occur only in a small percentage of infected persons during an outbreak. 4 The main and more pathogno- monic syndrome, including eyelid and/or facial edema, fever and myalgia, occurs when larvae migrate from the lymphatic intestinal vessels to the blood, reaching the muscle cells, between the 2nd and the 3rd week after infection. 4,5 An early diagnosis of trichinellosis based on the clinical pattern is difficult, particularly in nonendemic countries, because the symptoms are not pathognomonic and it can mimic viral or bacterial infections, food intoxication and allergic reactions. 4 Between December 2003 and January 2004, a large outbreak of trichinellosis involving more than 600 persons occurred in Izmir, Turkey, because of consumption of in- fected raw meat balls. The purpose of this study was to describe the clinical and laboratory features of acute trichinellosis in childhood and to compare them with those detected in adult households. MATERIALS AND METHODS All children up to 17 years of age and their adult householders exposed to the consumption of the implicated food were admitted to the Hospital of the Dokuz Eylul University in Izmir, Turkey, from January 16 to 23, 2004. All exposed individuals had eaten cig kofte from a restaurant; the food a local delicacy usually made with uncooked veal but in this case was made with pork. Children with at least 1 key symptom for acute trichinellosis such as high fever, facial and/or eyelid edema and myalgia, or who were asymptomatic but 2 and more people in the same household met the case definition for trichinellosis, were enrolled for this study. A questionnaire was developed to record demographic, clinical and epidemiologic data. Blood samples were collected for white blood cells and eosinophil counts, muscle enzymes, serum electrolytes, albumin and serology. The serologic test to detect anti-Trichinella IgG was performed at the Interna- tional Trichinella Reference Center of Rome, Italy with an in-house enzyme-linked immunosorbent assay and the use of an excretory/secretory antigen obtained from muscle larvae according to a previously published protocol. 6 Positive re- sults were confirmed by Western blot. 6 Muscle biopsy was performed from the deltoid muscle of 4 children and their householders under local anesthesia. The algorithm proposed Accepted for publication May 10, 2005. From the Departments of *Pediatrics, †Internal Medicine and ‡Pathology, Dokuz Eylul University, School of Medicine, Izmir, Turkey; and the §Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanita `, Rome, Italy. E-mail hasan.ozkan@deu.edu.tr. Reprints not available. Copyright © 2005 by Lippincott Williams & Wilkins ISSN: 0891-3668/05/2410-0897 DOI: 10.1097/01.inf.0000180514.46871.65 The Pediatric Infectious Disease Journal • Volume 24, Number 10, October 2005 897