- Claire Italiano, MBBS, FRACP, DTMH, MPHTM
Claire Italiano, MBBS, FRACP, DTMH, MPHTM
- Infectious Diseases Physician
- Royal Perth Hospital, Australia
- David Freedman, MD
David Freedman, MD
- Professor of Medicine
- University of Alabama at Birmingham
Sarcocystosis is a zoonotic infection caused by a protozoan parasite of the genus Sarcocystis, of which there are more than 200 known species [1-4]. Depending on the infecting species and nature of the ingested material, two distinct clinical syndromes may occur in humans: intestinal sarcocystosis or muscular sarcocystosis.
Three species of Sarcocystis have been identified in human infection [5,6]. Sarcocystis hominis and Sarcocystis suihominis cause gastrointestinal disease; humans serve in the natural infection cycle . Sarcocystis nesbitti, a snake species, has been recognized as a cause of human muscular sarcocystosis in Malaysia; humans are accidental, dead-end intermediate hosts .
Livestock universally harbor Sarcocystis infection worldwide. Symptomatic and asymptomatic gastrointestinal infection has been reported with the highest prevalence in Europe; cases have also been reported from many Asian countries, with less frequent occurrences in Australia and North and South America [5,7-11].
Of the approximately 190 cases of symptomatic human muscular sarcocystosis reported in the literature, the majority have occurred as part of outbreaks or case series originating from rural Malaysia [7,10-17]. The best description of the natural history of sarcocystosis is reflected in a report of 89 cases that occurred during a definitive point-source outbreak in early 2012 on Pangkor Island off the west coast of Malaysia . Subsequently, 68 cases presenting late in the clinical evolution of disease were attributed retrospectively to exposures on Tioman Island off the east coast of Malaysia in 2011 and 2012 . Other countries with reported exposure include India and Thailand [18-21]; only one symptomatic case has been described with no evident exposure in Asia .
Tissue sarcocysts of unknown species have been observed in asymptomatic individuals from countries including Singapore, Malaysia, Thailand, India, and Uganda; the human pathogenicity of these organisms is not known [21,23-25].
- Odening K. The present state of species-systematics in Sarcocystis Lankester, 1882 (Protista, Sporozoa, Coccidia). Syst Parasitol 1998; 41:209.
- Heckeroth AR, Tenter AM. Sarcocystiosis. In: Protozoal abortion in farm ruminants: guidelines for diagnosis and control, Gottstein B, Conraths F, Buxton D (Eds), Cab International, Cambridge, MA 2007. p.172.
- Harris VC, van Vugt M, Aronica E, et al. Human Extraintestinal Sarcocystosis: What We Know, and What We don't Know. Curr Infect Dis Rep 2015; 17:495.
- Dubey JP. Foodborne and waterborne zoonotic sarcocystosis. Food Waterborne Parasitol 2015; 1:2.
- Fayer R. Sarcocystis spp. in human infections. Clin Microbiol Rev 2004; 17:894.
- Abubakar S, Teoh BT, Sam SS, et al. Outbreak of human infection with Sarcocystis nesbitti, Malaysia, 2012. Emerg Infect Dis 2013; 19:1989.
- Dubey JP, Calero-Bernal R, Rosenthal BM, et al. Sarcocystosis of animals and humans, 2nd ed, CRC Press Inc, Boca Raton, FL 2016.
- Yu S. [Field survey of sarcocystis infection in the Tibet autonomous region]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 1991; 13:29.
- Nimri L. Unusual case presentation of intestinal Sarcocystis hominis infection in a healthy adult. J Med Microbiol Case Reports 2014.
- Wilairatana P, Radomyos P, Radomyos B, et al. Intestinal sarcocystosis in Thai laborers. Southeast Asian J Trop Med Public Health 1996; 27:43.
- Fayer R, Esposito DH, Dubey JP. Human infections with Sarcocystis species. Clin Microbiol Rev 2015; 28:295.
- ProMed Mail: Sarcocystosis, human - Malaysia: Tioman Island. http://www.promedmail.org/direct.php?id=20111031.3240 (Accessed on December 04, 2014).
- Arness MK, Brown JD, Dubey JP, et al. An outbreak of acute eosinophilic myositis attributed to human Sarcocystis parasitism. Am J Trop Med Hyg 1999; 61:548.
- Italiano CM, Wong KT, AbuBakar S, et al. Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012. PLoS Negl Trop Dis 2014; 8:e2876.
- Esposito DH, Stich A, Epelboin L, et al. Acute muscular sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011-2012. Clin Infect Dis 2014; 59:1401.
- Centers for Disease Control and Prevention (CDC). Notes from the field: acute muscular sarcocystosis among returning travelers - Tioman Island, Malaysia, 2011. MMWR Morb Mortal Wkly Rep 2012; 61:37.
- Esposito DH, Freedman DO, Neumayr A, Parola P. Ongoing outbreak of an acute muscular Sarcocystis-like illness among travellers returning from Tioman Island, Malaysia, 2011-2012. Euro Surveill 2012; 17.
- Mehrotra R, Bisht D, Singh PA, et al. Diagnosis of human sarcocystis infection from biopsies of the skeletal muscle. Pathology 1996; 28:281.
- Thomas JA. Human sarcocystis. J Postgrad Med 1976; 22:185.
- Pamphlett R, O'Donoghue P. Sarcocystis infection of human muscle. Aust N Z J Med 1990; 20:705.
- Beaver PC, Gadgil K, Morera P. Sarcocystis in man: a review and report of five cases. Am J Trop Med Hyg 1979; 28:819.
- Van den Enden E, Praet M, Joos R, et al. Eosinophilic myositis resulting from sarcocystosis. J Trop Med Hyg 1995; 98:273.
- Wong KT, Pathmanathan R. High prevalence of human skeletal muscle sarcocystosis in south-east Asia. Trans R Soc Trop Med Hyg 1992; 86:631.
- Larbcharoensub N, Cheewaruangroj W, Nitiyanant P. Laryngeal sarcocystosis accompanying laryngeal squamous cell carcinoma: case report and literature review. Southeast Asian J Trop Med Public Health 2011; 42:1072.
- Makhija M. Histological identification of muscular sarcocystis: a report of two cases. Indian J Pathol Microbiol 2012; 55:552.
- Tian M, Chen Y, Wu L, et al. Phylogenetic analysis of Sarcocystis nesbitti (Coccidia: Sarcocystidae) suggests a snake as its probable definitive host. Vet Parasitol 2012; 183:373.
- Lau YL, Chang PY, Subramaniam V, et al. Genetic assemblage of Sarcocystis spp. in Malaysian snakes. Parasit Vectors 2013; 6:257.
- Lau YL, Chang PY, Tan CT, et al. Sarcocystis nesbitti infection in human skeletal muscle: possible transmission from snakes. Am J Trop Med Hyg 2014; 90:361.
- Slesak G, Schäfer J, Langeheinecke A, Tappe D. Prolonged clinical course of muscular sarcocystosis and effectiveness of cotrimoxazole among travelers to Tioman Island, Malaysia, 2011-2014. Clin Infect Dis 2015; 60:329.
- Chin CC, Wong S, Tan CT. Sarcocystis nesbitti related autoimmune diffuse alopecia. Neurol Asia 2016; 21:261.
- Poulsen CS, Stensvold CR. Current status of epidemiology and diagnosis of human sarcocystosis. J Clin Microbiol 2014; 52:3524.
- Wong KT, Pathmanathan R. Ultrastructure of the human skeletal muscle sarcocyst. J Parasitol 1994; 80:327.
- Wong KT, Yusoff M. Scanning electron microscopy of the human muscular sarcocyst. Parasitol Res 1995; 81:359.