- Claire Italiano, MBBS, FRACP, DTMH, MPHTM
Claire Italiano, MBBS, FRACP, DTMH, MPHTM
- Infectious Diseases Physician
- Royal Perth Hospital, Australia
- David O Freedman, MD
David O Freedman, MD
- Professor of Medicine, Division of Infectious Diseases
- 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].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- 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.
- Shahari S, Tengku-Idris TI, Fong MY, Lau YL. Molecular evidence of Sarcocystis nesbitti in water samples of Tioman Island, Malaysia. Parasit Vectors 2016; 9:598.
- 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.