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  1. Fulltext 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
    Italiano CM, Wong KT, AbuBakar S, Lau YL, Ramli N, Syed Omar SF, et al.
    PLoS Negl Trop Dis, 2014 May;8(5):e2876.
    PMID: 24854350 DOI: 10.1371/journal.pntd.0002876
    From the 17th to 19th January 2012, a group of 92 college students and teachers attended a retreat in a hotel located on Pangkor Island, off the west coast of Peninsular Malaysia. Following the onset of symptoms in many participants who presented to our institute, an investigation was undertaken which ultimately identified Sarcocystis nesbitti as the cause of this outbreak.
    Matched MeSH terms: Sarcocystosis/diagnosis
  2. Muscular sarcocystosis: an index case in a native Malaysian
    Mohammad N, Besari AM, Nair PK, Wan Ghazali WS
    BMJ Case Rep, 2017 Jul 26;2017.
    PMID: 28747414 DOI: 10.1136/bcr-2017-220490
    A previously healthy 20-year-old man presented with prolonged intermittent low grade fever and cough for 6months. He had bilateral calf pain and lower limb weakness 2days prior to admission. Physical examination revealed multiple enlarged lymph nodes with hepatomegaly. There was bilateral calf tenderness with evidence of proximal myopathy. Full blood picture showed lymphocytosis with reactive lymphocytes and eosinophilia. Creatine kinase and lactate dehydrogenase were markedly elevated. Over 2 weeks of admission, patient was treated symptomatically until the muscle biopsy of right calf revealed eosinophilic myositis with muscular sarcocystosis. He was treated with albendazole and high-dose corticosteroids. Symptoms subsided on reviewed at 2weeks and the dose of corticosteroid was tapered down slowly over a month. Due to poor compliance, he was readmitted 1month later because of relapsed. High-dose corticosteroid was restarted and duration for albendazole was prolonged for 1month. His symptom finally resolved over 2weeks.
    Matched MeSH terms: Sarcocystosis/diagnosis*
  3. 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: Sarcocystosis/diagnosis
  4. 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: Sarcocystosis/diagnosis*
  5. Fulltext Detection of sarcocystosis in goats in Malaysia by light microscopy, histology, and PCR
    Kutty MK, Latif B, Muslim A, Hussaini J, Daher AM, Heo CC, et al.
    Trop Anim Health Prod, 2015 Apr;47(4):751-6.
    PMID: 25740651 DOI: 10.1007/s11250-015-0789-4
    A number of methods have been used for the detection of the presence of microsarcocysts in animals, but little information exists on the value between the various methods. This study therefore examined for Sarcocystis spp. using three different methods in 105 samples of skeletal muscle collected from goats slaughtered in an abattoir in Selangor, Malaysia from January to February 2014. Three methods were used, direct light microscopy of squashed fresh muscle tissues; histological examination of fixed, sectioned, and hematoxylin and eosin (H&E)-stained samples of muscle; and molecular identification by polymerase chain reaction (PCR). Of the 105 tissue samples, 55 (52.38 %) were positive by light microscopy (LM), 46 (43.8 %) by histology, and 95 (90.48 %) by PCR. Only 29 (27.6 %) and 5 (4.76 %) samples were positive and negative, respectively, by all three methods. The cysts were elongated to a spindle shape with a mean size of 393.30 × 81.6 μm and containing banana-shaped bradyzoites of size 12.32 × 2.08 μm. The wall of the cyst was radially striated with a thickness of 2.83 μm. Samples were tested for the presence of Sarcocystis-specific 18S rRNA and were identified as Sarcocystis capracanis. Of the three methods used, the PCR test appears to be the most useful method for the diagnosis of sarcocystosis especially for species identification.
    Matched MeSH terms: Sarcocystosis/diagnosis
  6. [Emerging parasitic diseases]
    Weibel Galluzzo C, Wagner N, Michel Y, Jackson Y, Chappuis F
    Rev Med Suisse, 2014 May 7;10(429):1008-13.
    PMID: 24908745
    Travels, migration and circulation of goods facilitate the emergence of new infectious diseases often unrecognized outside endemic areas. Most of emerging infections are of viral origin. Muscular Sarcocystis infection, an acute illness acquired during short trips to Malaysia, and Chagas disease, a chronic illness with long incubation period found among Latin American migrants, are two very different examples of emerging parasitic diseases. The former requires a preventive approach for travelers going to Malaysia and must be brought forth when they return with fever, myalgia and eosinophilia, while the latter requires a proactive attitude to screen Latin American migrant populations that may face difficulties in accessing care.
    Matched MeSH terms: Sarcocystosis/diagnosis*
  7. Fulltext From 18S to 28S rRNA Gene: An Improved Targeted Sarcocystidae PCR Amplification, Species Identification with Long DNA Sequences
    Lee FCH, Muthu V
    Am J Trop Med Hyg, 2021 02 22;104(4):1388-1393.
    PMID: 33617472 DOI: 10.4269/ajtmh.20-0767
    Sarcocystosis outbreaks in Tioman and Pangkor islands of Malaysia between 2011 and 2014 have raised the need to improve Sarcocystis species detection from environmental samples. In-house works found that published primers amplifying the 18S rRNA gene of Sarcocystis either could not produce the target from environmental samples or produced Sarcocystis DNA sequence that was insufficient for species identification. Using the primer pair of 18S S5 F (published) and 28S R6 R (new), this study improved the PCR amplification of Sarcocystidae to overcome these two difficulties. The PCR product spanned from the 18S to 28S rRNA genes, providing more information for species identification. The long DNA sequence allowed comparison between the "Ident" and "Query Cover" sorting in GenBank identity matching. This revealed the ambiguity in identity matching caused by different lengths of reference DNA sequences, which is seldom discussed in the literature. Using the disparity index test, a measurement of homogeneity in nucleotide substitution pattern, it is shown that the internal transcribed spacer (ITS)1-5.8S-ITS2 and 28S genes are better than the 18S gene in indicating nucleotide variations, implying better potentials for species identification. The example given by the handful of Sarcocystidae long DNA sequences reported herein calls for the need to report DNA sequence from the 18S to the 28S rRNA genes for species identification, especially among emerging pathogens. DNA sequence reporting should include the hypervariable 5.8S and ITS2 regions where applicable, and not be limited to single gene, per the current general trend.
    Matched MeSH terms: Sarcocystosis/diagnosis*
  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: Sarcocystosis/diagnosis*
  9. 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: Sarcocystosis/diagnosis
  10. 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: Sarcocystosis/diagnosis
  11. [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: Sarcocystosis/diagnosis*
  12. 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: Sarcocystosis/diagnosis
  13. Imported eosinophilic fever with myositis: A diagnostic challenge
    Camprubí D, Rodriguez-Valero N, Losada I, Grau-Junyent JM, Muñoz J
    Travel Med Infect Dis, 2018 05 23;24:16.
    PMID: 29802894 DOI: 10.1016/j.tmaid.2018.05.009
    Matched MeSH terms: Sarcocystosis/diagnosis*
  14. Fulltext Light microscopy and molecular identification of Sarcocystis spp. in meat producing animals in Selangor, Malaysia
    Latif B, Kannan Kutty M, Muslim A, Hussaini J, Omar E, Heo CC, et al.
    Trop Biomed, 2015 Sep;32(3):444-52.
    PMID: 26695204 MyJurnal
    One thousand and forty-five tissue samples of skeletal muscles, tongue, heart, diaphragm and esophagus were collected from 209 animals (43 sheep, 89 goats and 77 cattle) from an abattoir in Selangor between February and October, 2013. Each sample was divided into three pieces with each piece measuring 2-3 mm3. Each piece was then squeezed between two glass slides and examined microscopically at x 10 magnification for the presence of sarcocystosis. Three positive samples from each animal species were then fixed in 10% formalin for histological processing. Seven positive samples collected from each animal species were preserved at -80°C or 90% ethanol for gene expression studies. Microsarcocysts were detected in 114 (54.5%) animals by light microscopy (LM). The infection rates in sheep, goat and cattle were 86, 61.8 and 28.6% respectively. The highest rate of infection was in the skeletal muscles of sheep (64.9%) and goats (63.6%) and in the heart of cattle (63.6%). The cysts were spindle to oval in shape and two stages were recognized, the peripheral metrocytes and centrally located banana-shaped bradyzoites. 18S rRNA gene expression studies confirmed the isolates from the sheep as S. ovicanis, goats as S. capracanis and cattle as S. bovicanis. This, to the best of our knowledge, is the first molecular identification of an isolate of S. ovicanis and S. capracanis in Malaysia. Further studies with electron microscopy (EM) are required in the future to compare the features of different types of Sarcocysts spp.
    Matched MeSH terms: Sarcocystosis/diagnosis
  15. Phosphorylated neurofilament H (pNF-H) as a potential diagnostic marker for neurological disorders in horses
    Intan-Shameha AR, Divers TJ, Morrow JK, Graves A, Olsen E, Johnson AL, et al.
    Res Vet Sci, 2017 Oct;114:401-405.
    PMID: 28750210 DOI: 10.1016/j.rvsc.2017.07.020
    The current study aimed at the investigating the potential use of phosphorylated neurofilament H (pNF-H) as a diagnostic biomarker for neurologic disorders in the horse. Paired serum and cerebrospinal fluid (CSF) samples (n=88) and serum only (n=30) were obtained from horses diagnosed with neurologic disorders and clinically healthy horses as control. The neurologic horses consisted of equine protozoal myeloencephalitis (EPM) (38 cases) and cervical vertebral malformation (CVM) (23 cases). Levels of pNF-H were determined using an ELISA. The correlation between CSF and serum concentrations of pNF-H was evaluated using Spearman's Rank test and the significance of the difference among the groups was assessed using a nonparametric test. Horses had higher pNF-H levels in the CSF than serum. Horses afflicted with EPM had significantly higher serum pNF-H levels in comparison to controls or CVM cases. The correlation between CSF and serum pNF-H levels was poor in both the whole study population and among subgroups of horses included in the study. There was significant association between the likelihood of EPM and the concentrations of pNF-H in either the serum or CSF. These data suggest that pNF-H could be detected in serum and CSF samples from neurologic and control horses. This study demonstrated that pNF-H levels in serum and CSF have the potential to provide objective information to help in the early diagnosis of horses afflicted with neurologic disorders.
    Matched MeSH terms: Sarcocystosis/diagnosis
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