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  1. Fulltext Human Invasive Muscular Sarcocystosis Induces Th2 Cytokine Polarization and Biphasic Cytokine Changes, Based on an Investigation among Travelers Returning from Tioman Island, Malaysia
    Tappe D, Slesak G, Pérez-Girón JV, Schäfer J, Langeheinecke A, Just-Nübling G, et al.
    Clin Vaccine Immunol, 2015 Jun;22(6):674-7.
    PMID: 25903356 DOI: 10.1128/CVI.00042-15
    Sarcocystis nesbitti is a parasite responsible for a biphasic eosinophilic febrile myositis syndrome in two recent outbreaks in Malaysia. We demonstrate Th2 cytokine polarization in infected travelers, an overall cytokine production decrease in the early phase of the disease suggestive of initial immunosuppression, and elevated levels of proinflammatory and chemotactic cytokines in the later myositic phase.
    Matched MeSH terms: Sarcocystis/immunology*
  2. Fulltext Acute muscular sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011-2012
    Esposito DH, Stich A, Epelboin L, Malvy D, Han PV, Bottieau E, et al.
    Clin Infect Dis, 2014 Nov 15;59(10):1401-10.
    PMID: 25091309 DOI: 10.1093/cid/ciu622
    BACKGROUND: Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012.

    METHODS: Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy.

    RESULTS: Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy.

    CONCLUSIONS: Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.

    Matched MeSH terms: Sarcocystis/genetics; Sarcocystis/isolation & purification
  3. Fulltext Human infections with Sarcocystis species
    Fayer R, Esposito DH, Dubey JP
    Clin Microbiol Rev, 2015 Apr;28(2):295-311.
    PMID: 25715644 DOI: 10.1128/CMR.00113-14
    Recurrent outbreaks of muscular sarcocystosis among tourists visiting islands in Malaysia have focused international attention on sarcocystosis, a disease once considered rare in humans. Sarcocystis species require two hosts, definitive and intermediate, to complete their life cycle. Humans can serve as definitive hosts, with intestinal sarcocystosis for two species acquired from eating undercooked meat: Sarcocystis hominis, from beef, and Sarcocystis suihominis, from pork. Symptoms such as nausea, stomachache, and diarrhea vary widely depending on the number of cysts ingested but appear more severe with pork than with beef. Humans serve as intermediate hosts for Sarcocystis nesbitti, a species with a reptilian definitive host, and possibly other unidentified species, acquired by ingesting sporocysts from feces-contaminated food or water and the environment; infections have an early phase of development in vascular endothelium, with illness that is difficult to diagnose; clinical signs include fever, headache, and myalgia. Subsequent development of intramuscular cysts is characterized by myositis. Presumptive diagnosis based on travel history to tropical regions, elevated serum enzyme levels, and eosinophilia is confirmed by finding sarcocysts in muscle biopsy specimens. There is no vaccine or confirmed effective antiparasitic drug for muscular sarcocystosis, but anti-inflammatory drugs may reduce symptoms. Prevention strategies are also discussed.
    Matched MeSH terms: Sarcocystis/physiology*
  4. Eosinophilia and musculoskeletal disease
    Watts RA
    Curr Opin Rheumatol, 2001 Jan;13(1):57-61.
    PMID: 11148716
    Eosinophilia is occasionally a feature of rheumatic disease. The differential diagnosis of eosinophilia includes parasitic infection, systemic vasculitides, eosinophilic arthritis, and myopathies, together with the idiopathic hypereosinophilic syndrome and malignancy. Careful evaluation of the patient should enable an accurate diagnosis to be made. Parasitic infection is the commonest cause of eosinophilia worldwide and can cause systemic disease, as illustrated by the report of Sarcocystis myositis in a group of military personnel in Malaysia. A persistent arthropathy associated with eosinophilia, but not with parasitic infection, has been reported from the far East. Drugs may also cause eosinophilia, and there has recently been much discussion of the relation between Churg-Strauss syndrome and the leukotriene antagonist zafirlukast. The present view is that reduction of steroid dose allows unmasking of previously undiagnosed Churg-Strauss syndrome. The idiopathic hypereosinophilic syndrome may represent a lymphoproliferative process; evidence for this comes from the demonstration that many patients have a clonally expanded population of aberrant T cells.
    Matched MeSH terms: Sarcocystis
  5. [Muscular sarcocystosis after travel to Malaysia: a case series from Germany]
    Slesak G, Tappe D, Keller C, Cramer J, Güthoff W, Zanger P, et al.
    Dtsch. Med. Wochenschr., 2014 May;139(19):990-5.
    PMID: 24782151 DOI: 10.1055/s-0034-1370004
    Since 2011, about 100 travellers to the island of Tioman, Malaysia, have been diagnosed worldwide with suspected muscular sarcocystosis, a previously only sporadically observed parasitic disease. Source of infection and therapy remain unclear. Final diagnosis requires microscopic identification of cysts in muscle biopsies. The study objective was a systematic description of characteristic symptoms, laboratory investigations and treatment response.
    Matched MeSH terms: Sarcocystis/immunology
  6. Fulltext Outbreak of human infection with Sarcocystis nesbitti, Malaysia, 2012
    Abubakar S, Teoh BT, Sam SS, Chang LY, Johari J, Hooi PS, et al.
    Emerg Infect Dis, 2013 Dec;19(12):1989-91.
    PMID: 24274071 DOI: 10.3201/eid1912.120530
    An outbreak of fever associated with myalgia and myositis occurred in 2012 among 89 of 92 college students and teachers who visited Pangkor Island, Malaysia. The Sarcocystis nesbitti 18S rRNA gene and sarcocysts were obtained from muscle tissues of 2 students. Our findings indicate emergence of S. nesbitti infections in humans in Malaysia.
    Matched MeSH terms: Sarcocystis/classification*; Sarcocystis/genetics; Sarcocystis/isolation & purification
  7. Ongoing outbreak of an acute muscular Sarcocystis-like illness among travellers returning from Tioman Island, Malaysia, 2011-2012
    Esposito DH, Freedman DO, Neumayr A, Parola P
    Euro Surveill, 2012 Nov 08;17(45).
    PMID: 23153473
    As of 4 November, 2012, 100 patients with an acute muscular Sarcocystis-like illness associated with travel to Tioman Island, Malaysia, have been identified. Thirty-five travelled there mostly during July and August 2011 and 65 mostly during July and August 2012, suggesting an ongoing outbreak. Epidemiological investigations are ongoing. Public health agencies and practicing clinicians should be aware of this rarely-reported disease in humans and consider it as differential diagnosis in travellers returning from Tioman Island.
    Matched MeSH terms: Sarcocystis/cytology; Sarcocystis/isolation & purification
  8. Suspected new wave of muscular sarcocystosis in travellers returning from Tioman Island, Malaysia, May 2014
    Tappe D, Stich A, Langeheinecke A, von Sonnenburg F, Muntau B, Schäfer J, et al.
    Euro Surveill, 2014 May 29;19(21).
    PMID: 24906376
    In May 2014, six patients presented in Germany with a Sarcocystis-associated febrile myositis syndrome after returning from Tioman Island, Malaysia. During two earlier waves of infections, in 2011 and 2012, about 100 travellers returning to various European countries from the island were affected. While the first two waves were associated with travel to Tioman Island mostly during the summer months, this current series of infections is associated with travel in early spring, possibly indicating an upcoming new epidemic.
    Matched MeSH terms: Sarcocystis/isolation & purification*
  9. Fulltext Phylogenetic analysis and identification of Sarcocystis spp. found in rodents in Peninsular Malaysia
    Jenn Haw Fong, Kenny Voon, Stephen Ambu, Joon Wah Mak
    International e-Journal of Science, Medicine & Education, 2014;8(2):12-17.
    MyJurnal
    Background: The tissue specimens used for extraction of DNA in this study were from rodents trapped in four states in Peninsular Malaysia, namely Kedah, Kelantan, Selangor and Johor. Methods: Histological sections of these rodent muscle tissues stained with hematoxylin and eos in showed infection with Sarcocystis spp. Based on these results, the current study was carried out to determine the phylogenetic relationship among the identified Sarcocystis spp. in these rodents.The formalin fixed paraffin embedded (FFPE) rodent muscle blocks were subjected to DNA extraction and followed with semi nested PCR targeting 5’ and 3’ regions of 18S rRNA of Sarcocystis spp. Results: Phylogenetic analysis showed two distinct groups of Sarcocystis spp. among the rodents in Peninsular Malaysia. Most of the identified Sarcocystis spp. were genetically closely related to Sarcocystis rodentifelis and Sarcocystis muris and were also observed to be genetically closely related to Sarcocystis sp. ex Columba livia and Sarcocystis sp. cyst type I ex Anser albifrons. Conclusion: Further classification to confirm these Sarcocystis spp. was not possible as only partial sequences of 18S rRNA was available and this was insufficient for
    optimal differentiation.
    Matched MeSH terms: Sarcocystis
  10. Fulltext Prevalence of Sarcocystis spp. in rodents in Peninsular Malaysia
    Ambu, Stephen, Yin, Evelyn Synn Yeoh, Joon, Wah Mak, Chakravarthi, Srikumar
    International e-Journal of Science, Medicine & Education, 2011;5(2):29-38.
    MyJurnal
    The aim of the study was to assess the prevalence of Sarcocystis infection in wild and peri-urban rodents in some states in Peninsular Malaysia. The thigh muscle from these rodents were formalin preserved, sectioned and stained with hematoxylin and eosin and examined under light microscopy. Of the 146 muscle tissue examined only 73 were positive for Sarcocystis infection.
    Morphological identification showed the presence of some new morphological types to be present. Different species of Sarcocystis were seen in the sections but more extensive studies are needed to identify them to species level.
    Matched MeSH terms: Sarcocystis
  11. Ultrastructure of the cyst wall of Sarcocystis spp. from some rodents in Malaysia
    Kan SP
    Int J Parasitol, 1979 Oct;9(5):475-80.
    PMID: 118943
    Matched MeSH terms: Sarcocystis/ultrastructure*
  12. Ultrastructure of Sarcocystis booliati Dissanaike and Poopalachelvam, 1975 from the moonrat, echinosorex gymnurus, in Malaysia
    Kan SP, Dissanaike AS
    Int J Parasitol, 1976 Aug;6(4):321-6.
    PMID: 821875
    Matched MeSH terms: Sarcocystis/ultrastructure*
  13. Fulltext Description of Sarcocystis scandentiborneensis sp. nov. from treeshrews (Tupaia minor, T. tana) in northern Borneo with annotations on the utility of COI and 18S rDNA sequences for species delineation
    Ortega Pérez P, Wibbelt G, Brinkmann A, Galindo Puentes JA, Tuh FYY, Lakim MB, et al.
    Int J Parasitol Parasites Wildl, 2020 Aug;12:220-231.
    PMID: 32695576 DOI: 10.1016/j.ijppaw.2020.07.003
    Sarcocystis scandentiborneensis sp. nov. was discovered in histological sections of striated musculature of treeshrews (Tupaia minor, T. tana) from Northern Borneo. Sarcocysts were cigar-shaped, 102 μm-545 μm long, and on average 53 μm in diameter. The striated cyst wall varied in thickness (2-10 μm), depending on whether the finger-like, villous protrusions (VP) were bent. Ultrastructurally, sarcocysts were similar to wall type 12 but basal microtubules extended into VPs that tapered off with a unique U-shaped, electron-dense apical structure. In phylogenetic trees of the nuclear 18S rRNA gene, S. scandentiborneensis formed a distinct branch within a monophyletic subclade of Sarcocystis spp. with (colubrid) snake-rodent life cycle. We mapped all intraspecific (two haplotypes) and interspecific nucleotide substitutions to the secondary structure of the 18S rRNA gene: in both cases, the highest variability occurred within helices V2 and V4 but intraspecific variability mostly related to transitions, while transition/transversion ratios between S. scandentiborneensis, S. zuoi, and S. clethrionomyelaphis were skewed towards transversions. Lack of relevant sequences restricted phylogenetic analysis of the mitochondrial Cytochrome C oxidase subunit I (COI) gene to include only one species of Sarcocystis recovered from a snake host (S. pantherophisi) with which the new species formed a sister relationship. We confirm the presence of the functionally important elements of the COI barcode amino acid sequence of S. scandentiborneensis, whereby the frequency of functionally important amino acids (Alanine, Serine) was markedly different to other taxa of the Sarcocystidae. We regard S. scandentiborneensis a new species, highlighting that structurally or functionally important aspects of the 18S rRNA and COI could expand their utility for delineation of species. We also address the question why treeshrews, believed to be close to primates, carry a parasite that is genetically close to a Sarcocystis lineage preferably developing in the Rodentia as intermediate hosts.
    Matched MeSH terms: Sarcocystis
  14. Fulltext Detection of Sarcocyst in meat from local markets in Selangor: highlighting the use of Crude sample in PCR
    Azdayanti Muslim, Putri Shafinaz Sharudin, Atiqah Yunus, Norhabsah Omar, Alieya Zakaria, Norshafiqah Mohamad
    Journal of Clinical and Health Sciences, 2016;1:18-21.
    Sarcocystis spp. are obligate intracellular protozoan parasites which cause meat-borne parasitic disease. In Malaysia, sarcocystosis is seen as a potential emerging food-borne zoonosis after a series of large outbreak of human infections. Humans acquire infection either by ingestion of cyst in raw or undercooked infected meat or from sporocysts in contaminated food and water. The goal of this study is to identify the presence of sarcocystis parasites in meat of cattle, buffaloes, sheep and goats collected from local markets in Selangor, Malaysia. Methods: A total of 64 skeletal muscles samples (57 cattle, 2 buffaloes, 4 goats and 1 sheep) were collected from local markets. The samples were cut randomly into three pieces, squashed firmly between two glass slides and then examined microscopically for the presence of cysts. Results: Three samples of meat (4.69 %) from cattle (1), buffalo (1) and sheep (1) were found to be positive for cysts. The cysts were confirmed by PCR as sarcocystis sp. Conclusion: The results showed low prevalence of Sarcocystis infection in meat collected from local markets. However, since there is a transmission among the livestock, extra precaution should be taken in consideration to prevent the spreading of sarcocystosis from animals to human.
    Matched MeSH terms: Sarcocystis
  15. Fulltext Detection of Sarcocyst in meat from local markets in Selangor: highlighting the use of Crude sample in PCR
    Azdayanti Muslim, Putri Shafinaz Sharudin, Atiqah Yunus, Norhabsah Omar, Alieya Zakaria, Norshafiqah Mohamad
    Journal of Clinical and Health Sciences, 2016;1(2):18-21.
    MyJurnal
    Sarcocystis spp. are obligate intracellular protozoan parasites which cause meat-borne parasitic disease. In Malaysia, sarcocystosis is seen as a potential emerging food-borne zoonosis after a series of large outbreak of human infections. Humans acquire infection either by ingestion of cyst in raw or undercooked infected meat or from sporocysts in contaminated food and water. The goal of this study is to identify the presence of sarcocystis parasites in meat of cattle, buffaloes, sheep and goats collected from local markets in Selangor, Malaysia. Methods: A total of 64 skeletal muscles samples (57 cattle, 2 buffaloes, 4 goats and 1 sheep) were collected from local markets. The samples were cut randomly into three pieces, squashed firmly between two glass slides and then examined microscopically for the presence of cysts. Results: Three samples of meat (4.69 %) from cattle (1), buffalo (1) and sheep (1) were found to be positive for cysts. The cysts were confirmed by PCR as sarcocystis sp. Conclusion: The results showed low prevalence of Sarcocystis infection in meat collected from local markets. However, since there is a transmission among the livestock, extra precaution should be taken in consideration to prevent the spreading of sarcocystosis from animals to human.
    Matched MeSH terms: Sarcocystis
  16. Fulltext Initial patient cluster and first positive biopsy findings in an outbreak of acute muscular Sarcocystis-like infection in travelers returning from Tioman island, Peninsular Malaysia, in 2011
    Tappe D, Ernestus K, Rauthe S, Schoen C, Frosch M, Müller A, et al.
    J Clin Microbiol, 2013 Feb;51(2):725-6.
    PMID: 23224083 DOI: 10.1128/JCM.03063-12
    Matched MeSH terms: Sarcocystis
  17. Sarcocystis myopathy in a patient with HIV-AIDS
    Anderson D, Nathoo N, Lu JQ, Kowalewska-Grochowska KT, Power C
    J Neurovirol, 2018 06;24(3):376-378.
    PMID: 29508303 DOI: 10.1007/s13365-018-0620-x
    Sarcocystosis is a zoonotic infection that causes intestinal and muscular illnesses in humans. Sarcocystosis was until recently considered rare in humans. To complete their life cycle, Sarcocystis species require both a definitive and an intermediate host. Humans are the definitive host when infected by one of two species: Sarcocystis hominis (from eating undercooked beef) or Sarcocystis suihominis (from eating uncooked pork). Infection with either of these species results in intestinal sarcocystosis, causing a self-limited disease characterized by nausea, abdominal pain, and diarrhea. Humans act as the intermediate host when infected by Sarcocystis nesbitti, resulting in the markedly different clinical picture of muscular sarcocystosis. Most documented cases of muscular sarcocystosis were assumed to be acquired in Malaysia, in addition to other regions of Southeast Asia and India. Published cases of muscular sarcocystosis from the Middle East, Central and South America, and Africa are all rare. Although the clinical presentation of muscular sarcocystosis remains to be fully characterized, fever, myalgia, and headache are among the most common symptoms. Here, we report a patient from sub-Saharan Africa with chronic Sarcocystis myopathy and well-controlled HIV-AIDS.
    Matched MeSH terms: Sarcocystis
  18. Finding Sarcocystis spp. on the Tioman Island: 28S rRNA gene next-generation sequencing reveals nine new Sarcocystis species
    Lee FCH
    J Water Health, 2019 Jun;17(3):416-427.
    PMID: 31095517 DOI: 10.2166/wh.2019.124
    The Tioman Island of Malaysia experienced acute muscular sarcocystosis outbreaks from 2011 to 2014. So far, a previous study based on the 18S rRNA gene sequencing has reported S. singaporensis, S. nesbitti and Sarcocystis sp. YLL-2013 in water samples acquired from the island, thus confirming the waterborne nature of this emerging parasitic disease. This study aimed to improve the detection methods for Sarcocystis, in order to have a clearer picture of the true diversity of Sarcocystis species in Tioman. A new primer set (28S R7F-28S R8 Deg R) was designed to amplify the 28S rRNA gene of Sarcocystis. Subsequently, Sarcocystidae was detected in 65.6% (21/32) of water samples and 28% (7/25) of soil samples acquired between 2014 and 2015 from Tioman. Next-generation sequencing (NGS) on 18 of the positive samples was then performed using amplicons generated from the same primer set. This yielded 53 potentially unique Sarcocystidae sequences (290 bp), of which nine of the most abundant, prevalent and unique sequences were named herein. In contrast, NGS of the 18S rRNA gene V9 hypervariable region of 10 selected samples detected only two Sarcocystis species (160 bp). S. mantioni was the most ubiquitous sequence found in this study.
    Matched MeSH terms: Sarcocystis*
  19. Notes from the field: acute muscular sarcocystosis among returning travelers - Tioman Island, Malaysia, 2011
    Centers for Disease Control and Prevention (CDC)
    MMWR Morb Mortal Wkly Rep, 2012 Jan 20;61(2):37-8.
    PMID: 22258418
    GeoSentinel (the surveillance program of the International Society of Travel Medicine and CDC) has identified 32 cases of suspected acute muscular sarcocystosis in travelers returning from Tioman Island off the east coast of peninsular Malaysia. All the patients traveled to Tioman Island during the summer of 2011. Within days or weeks of returning home, all experienced fever and muscle pain, often severe and prolonged. All had peripheral eosinophilia, and most had elevated serum creatinine phosphokinase levels. Most were tested for acute trichinosis and toxoplasmosis by serology, and all of these tests were negative. Approximately half of the patients were identified in Germany; others were reported elsewhere in Europe, and in North America and Asia. Muscle biopsy from two patients demonstrated organisms consistent with sarcocystosis, one from a group of five ill travelers and one from a group of three.
    Matched MeSH terms: Sarcocystis/isolation & purification*
  20. Cryptosporidium infection: epidemiology, clinical, diagnosis and management
    Sinniah, B., Sinniah, D.
    Malaysian Journal of Child Health, 1992;4(1):27-32.
    MyJurnal
    Cryptosporidium is an intestinal protozoan parasite which causes diarrhoea in animals and has recently been reported to cause similar symptoms in man. Cryptosporidiosis is a zoonotic infection and the first human case was reported in 1976.2 Since then the number of cases has increased by the hundreds especially among patients with acquired immuno-deficiency syndrome (AIDS), as a result of the severe symptoms that they cause in the im-munosuppressed patients and also due to the better screening techniques which have been developed resulting in the detection of cases.3 To date 20 species of Cryptosporidium have been reported but these cannot be differentiated morphologically. The differences are based mainly on the host from which the parasites were recovered. The species responsible for causing infection in man is Cryptosporidium parvum.4 Of the 20 species reported several are invalid because the oocysts of some of them were found to be the same as the sporocyst of Sarcocystis. It is now concluded that there are only two species that infect mammals (C. Muris and C. parvum). (Copied from article).
    Matched MeSH terms: Sarcocystis
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