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Editor's Correspondence |

Trichinellosis Is Unlikely to Be Responsible for Mozart's Death

Jean Dupouy-Camet, MD, PhD
Arch Intern Med. 2002;162(8):946. doi:.
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Hirschmann,1 in his stimulating and fascinating article "What Killed Mozart," suggests that trichinellosis (trichinosis) could explain the death of this eminent composer. This parasitic disease, though unrecognized, was certainly common in central Europe at the end of the 18th century. The parasite was identified in London in 18352 (and not in 1825 as stated by Hirschmann ...) but its clinical relevance was only assessed in 1860 in Dresden. As a matter of fact, more than 80 outbreaks of trichinellosis were reported between 1858 and 1882 in this area3(p130) and, particularly, 2 outbreaks were described in Vienna in 1881 and 1882. Interestingly, this parasitosis is still prevalent in central European countries (Poland, Romania, Balkans, Baltic republics, Russia) where outbreaks are reported among pork eaters.4 As mentioned by Hirschmann, many medical causes could have explained Mozart's death but, in my opinion, the major features reported in his article are not particularly suggestive of trichinellosis. I was involved with 3 major outbreaks in France that included 1611 patients5,6 and the most prominent clinical features of the acute phase of the disease were myalgias (82%-93%), fever (81%-90%), and facial and eyelid edema (58%-84%). Cutaneous rash was reported in 11% to 44% of the cases and limb edema in 6% to 8%. Severe forms were characterized by the occurrence of neurologic complications (encephalitis), which were observed in 1.4% to 9% of the patients. Five patients died of thromboembolic complications or encephalitis. If Mozart had been affected by a severe course of trichinellosis, he certainly would have presented myalgia, probably a facial edema, and may have experienced neurologic complications preventing him to compose his Requiem mass. These important symptoms are not reported by Hirschmann. Myalgia, sometimes excruciating, is one of the most frequent symptoms of trichinellosis and affects preferentially the masseters, the tongue, the muscles of the neck, the flexor muscles of the extremities, and the muscles of the back. Walking and speaking can be difficult. Myalgia is absent only in very mild cases with an excellent prognosis. Myalgias were also prominent features in the first human observation described by Zenker in 1860,1 which was at first mistaken for typhoid fever. In addition, if limb edema can be seen, inflammation of extremities including hands and feet is not a sign of trichinellosis. Finally, it is true that trichinellosis is an "epidemic disorder characterized in the past by a substantial mortality rate" but this disease does not have a predictable course, as in our experience the 5 deaths we reported in 1985 were relatively sudden and unexpected. Moreover, in Mozart's time, trichinellosis was not recognized as a specific entity, so how could physicians have predicted a fatal outcome to an unknown condition? Present criteria to define a case of trichinellosis include biological criteria (a positive serologic or muscular biopsy result, high eosinophil counts) associated with at least 1 of the following symptoms: fever, facial edema, and myalgias. By these criteria, it is unlikely that Mozart was affected by trichinellosis.

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trichinosis

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