Prolonged clinical course of muscular sarcocystosis and effectiveness of cotrimoxazole among travelers to Tioman Island, Malaysia, 2011-2014

Sarcocystosis among buffaloes from slaughterhouses in Nile Delta, Egypt: morphologic assessment and molecular confirmation

Background

Sarcocystis species are coccidian protozoan zoonotic parasites of the phylum Apicomplexa. There is a large diversity of Sarcocystis species. Some of them are pathogenic and dangerous to humans, domestic, and wild animals. Cattle are common intermediate hosts. The infection of meat with different species of Sarcocystis can be serious for public health.

Aims

The current study aimed to determine the prevalence of sarcocystosis in slaughtered buffaloes in Tanta city abattoirs, Nile Delta, Egypt.

Methods

Morphological and histological examinations and a molecular study were undertaken. A total of 517 locally bred buffaloes were slaughtered in Tanta city, Egypt. Each buffalo carcass was visually inspected for the presence of Sarcocystis macrocysts. Fifty tissue samples containing suspected cysts were examined by using different techniques including histology, transmission electron microscope (TEM), and PCR.

Results

By visual inspection, the overall prevalence of suspected sarcocystosis was 26.5%. The highest infection rate was detected visually from the esophagus followed by skeletal muscles and diaphragm whereas the least was recorded in the tongue. Histological and TEM examination showed that the cysts were packed with bradyzoites separated by multiple septa. 100% of the sarcocysts diagnosed visually in the esophagus and muscles were confirmed by PCR, compared to only 25% of those detected in the tongue.

Conclusion

These results highlight the high prevalence of sarcocystosis among buffaloes in Egypt, possibly due to widespread environmental contamination by Sarcocystis oocysts. The use of molecular methods should be encouraged to confirm the identity of the suspected cysts.

M. Bulla-Castañeda DMBC, López Buitrago HA, Díaz Anaya AM, Madeira de Carvalho LM, Pulido-Medellín MO. Sarcocystis spp., a parasite with zoonotic potential

Sarcocystosis infection is caused by protozoan cysts of genus Sarcocystis spp. where S. hominis, S. heydorni (bovines) and S. suihominis (porcine) are the most relevant for humans because of their zoonotic potential. S. cruzi, S. suihominis and S. ovicanis represent the most pathogenic species for cattle, pigs and sheep respectively. This infection has a worldwide importance due to its high transmission; besides to represent a zoonosis, it generates great economics losses. The main diagnostic methods for this disease are artificial digestion, PCR, indirect ELISA, and compression analysis. It’s important to highlight few studies on Sarcocystis spp., especially the ones involving the pursuit of effective treatments to control the infection for both humans and animals, however, some studies have reported that treatments such as cotrimoxazole and albendazole with or without prednisone are effective in counteracting symptoms in humans, considering the lack of reports about Sarcocystis spp. prevalence in Colombia.

SARCOCYSTOSIS IN A CAPTIVE FLOCK OF THICK-BILLED PARROTS (RHYNCHOPSITTA PACHYRHYNCHA) FROM 2005 TO 2016: MORBIDITY, MORTALITY, DIAGNOSTICS, AND MANAGEMENT STRATEGIES

Sarcocystosis was diagnosed in a captive flock of thick-billed parrots (Rhynchopsitta pachyrhyncha) at the Wildlife Conservation Society's Queens Zoo. Since the index case in 2005, 45% of mortalities in birds over 30 days of age were due to sarcocystosis. Sarcocystis falcatula was repeatedly identified as the causative agent. The disease predominantly affected younger adult parrots. Administration of antiparasitic medications prior to development of respiratory signs prolonged life in infected birds, but disease was fatal until utilization of a three-drug combination (pyrimethamine, trimethoprim-sulfamethoxazole, and ponazuril). This protocol may require in excess of 6 mo of therapy to achieve clinical resolution of active disease. Plasma creatine kinase activity was found to be the most useful test in diagnosing infection and monitoring response to therapy. Polymerase chain reaction (PCR) for apicomplexan organisms on antemortem whole blood, blood smears, or dried blood spots helped confirm suspected cases, but due to the poor sensitivity was sometimes misleading when assessing response to therapy or resolution of clinical disease. Preventive measures, focusing on exclusion and removal of Virginia opossums (Didelphis virginiana) from zoo grounds failed to curtail the occurrence of sarcocystosis in the flock. Other preventative steps, such as modification of feeding stations to exclude potential arthropod paratenic hosts and prophylaxis trials with diclazuril, appeared to successfully mitigate new infections. Given the diagnostic and therapeutic challenges, prevention of exposure to S. falcatula is essential to ex-situ conservation efforts for thick-billed parrots.

Zoonotic Sarcocystis

Apicomplexan species in the genus Sarcocystis form tissue cysts, in their intermediate hosts, similar to those established in chronic toxoplasmosis. More than 200 species are known, but just a few are known to threaten human health owing to infection in livestock species. Intestinal sarcocystosis occurs when people consume raw or undercooked beef contaminated with Sarcocystis hominis or S. heydorni or undercooked pork contaminated with S. suihominis. Those infections may cause mild enteritis, but most infections are thought to be asymptomatic. People also become dead-end (intermediate) hosts for non-human Sarcocystis spp. after accidentally ingesting sporocysts, leading to extraintestinal sarcocystosis. The clinical spectrum may range from asymptomatic muscle cysts to a severe, acute, eosinophilic myositis associated with systemic symptoms with peripheral eosinophilia. Most human cases have been described from Southeast Asia, but Sarcocystis parasites have a worldwide distribution, especially where livestock is raised, and human infections in other areas have been described but may be underrecognized.

Sarcocystis myopathy in a patient with HIV-AIDS

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.

Human Invasive Muscular Sarcocystosis Induces Th2 Cytokine Polarization and Biphasic Cytokine Changes, Based on an Investigation among Travelers Returning from Tioman Island, Malaysia

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.

Human infections with Sarcocystis species

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.