exudates and Sarcocystosis

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.

Topics: Adult; Chagas Disease; Communicable Diseases, Emerging; Female; Humans; Malaysia; Male; Muscular Diseases; Pregnancy; Pregnancy Complications, Parasitic; Sarcocystosis; Travel; Travel Medicine

Sarcocystosis, an unusual parasitic zoonotic disease, is caused by coccidian/ apicomplexan protozoa in humans and animals. The parasites usually develop in a heteroxenous predator-prey life-cycle involving final (carnivore) and intermediate (omnivore/herbivore) hosts. Besides the intestinal, non-invasive form of the disease in which humans and animals are the definitive hosts for certain Sarcocystis spp., the invasive form has come to recent attention. In the latter, humans and animals serve as intermediate host harbouring sarcocysts in their muscle tissue. Already in 1991 sarcocystosis was seen as a potential emerging food borne zoonosis in Malaysia, and in 2011 and 2012 the largest cluster of symptomatic human muscular sarcocystosis world-wide was reported from Tioman Island, Pahang state. In this review, we focus on invasive sarcocystosis in humans and animals in Malaysia, review the recorded cases and epidemiology, and present hypotheses.

Topics: Animals; Foodborne Diseases; Humans; Malaysia; Sarcocystis; Sarcocystosis; Zoonoses

Food-borne parasitic zoonoses have emerged as a major public health problem in many countries and are posing a medical challenge. They are not only important from the economic point of view but also because of their severe sequelae. In Malaysia, these parasitoses are a tip of an iceberg problem. The article documents all the food-borne parasitic zoonoses reported in Malaysia. An epidemiological assessment of the diseases with research needs is highlighted.

Topics: Animals; Cysticercosis; Documentation; Echinococcosis; Food Parasitology; Humans; Malaysia; Opisthorchiasis; Parasitic Diseases; Prevalence; Public Health; Research; Sarcocystosis; Toxoplasmosis; Zoonoses

Three cases of muscular sarcocystosis from West Malaysia are reported. The morphological features of the parasites from these three cases are similar to the eight cases previously reported from this country. A review of this total of eleven cases of muscular sarcocystosis showed that they were all incidental findings, where man acted as intermediate hosts of as yet unknown Sarcocystis spp. These cases of muscular sarcocystosis were probably zoonotic in origin and associated with close contact with definitive hosts (both domestic and wild animals) thus permitting the contamination of food and drink with sporocysts shed by these definitive hosts. These infections were probably acquired locally as most of the subjects were born in Malaysia and none had ever left the country to stay elsewhere. Eight of the eleven cases reported were associated with malignancies, especially of the tongue and nasopharynx.

Topics: Adult; Aged; Child; Female; Humans; Incidence; Life Style; Malaysia; Male; Middle Aged; Neoplasms; Prevalence; Risk Factors; Sarcocystosis; Zoonoses

Topics: Angiostrongylus; Animals; Arthropods; Food Parasitology; Humans; Malaysia; Nematode Infections; Parasitic Diseases; Sarcocystosis; Toxoplasmosis; Trichinellosis; Zoonoses

Sarcocystis is a tissue coccidian with an obligatory two-host life cycle. The sexual generations of gametogony and sporogony occur in the lamina propria of the small intestine of definitive hosts which shed infective sporocysts in their stools and present with intestinal sarcocystosis. Asexual multiplication occurs in the skeletal and cardiac muscles of intermediate hosts which harbor Sarcocystis cysts in their muscles and present with muscular sarcocystosis. In Malaysia, Sarcocystis cysts have been reported from many domestic and wild animals, including domestic and field rats, moonrats, bandicoots, slow loris, buffalo, and monkey, and man. The known definitive hosts for some species of Sarcocystis are the domestic cat, dog and the reticulated python. Human muscular sarcocystosis in Malaysia is a zoonotic infection acquired by contamination of food or drink with sporocysts shed by definitive hosts. The cysts reported in human muscle resembled those seen in the moonrat, Echinosorex gymnurus, and the long-tailed monkey, Macaca fascicularis. While human intestinal sarcocystosis has not been reported in Malaysia so far, it can be assumed that such cases may not be infrequent in view of the occurrence of Sarcocystis cysts in meat animals, such as buffalo. The overall seroprevalence of 19.8% reported among the main racial groups in Malaysia indicates that sarcocystosis (both the intestinal and muscular forms) may be emerging as a significant food-borne zoonotic infection in the country.

Topics: Animals; Antibodies, Protozoan; Food Parasitology; Humans; Intestinal Diseases, Parasitic; Malaysia; Muscular Diseases; Prevalence; Sarcocystis; Sarcocystosis; Zoonoses

The intake of food and water containing the Sarcocystis parasite has been linked to a number of outbreaks worldwide, including Malaysia. Nevertheless, the lack of surveys and epidemiological data on Sarcocystis infections in Malaysia makes it difficult to estimate its occurrence in humans and animals. A cross-sectional study was conducted to determine the prevalence of Sarcocystis and the risk factors associated with infection among village chickens and pigs reared under different farm managements in Peninsular Malaysia. Phylogenetic trees were constructed using partial fragments of the 18S rRNA gene and ITS1 sequences. In the present study, 680 sera samples were collected from village chickens (n=250) and commercial pigs (n=433) and anti-Sarcocystis antibodies were screened using the enzymelinked immunosorbent assays (ELISA) kit. At the animal level, the prevalence of Sarcocystis was 9.2% (95% CI: 5.92-13.48) and at the farm level, it was 64.0% (95% CI: 42.52-82.03) in village chickens. The animal-level seroprevalence of Sarcocystis for pigs was 3.7% (95% CI: 2.13-5.93) and 36.8% (95% CI: 16.29-61.64) at the farm-level. Polymerase Chain Reaction (PCR) was conducted on meat samples from various parts of village chickens (n=250) consisting of brain, heart, lung, and pectoralis muscle tissues, and pork (n=121) consisting of intercostal muscle, diaphragm, and tongue. Sarcocystis DNA was detected in 6.4% (95% CI: 4.60-11.60) of village chicken samples but zero in pork samples. A total of 11 unique Sarcocystis haplotypes were isolated from these tissue samples. Multivariable logistic regression analysis of the putative risk factors showed a statistically significant association between Sarcocystis infection in pigs and uncovered storage of feed. Although no zoonotic Sarcocystis was isolated in this study, we reported the first discovery of S. wenzeli in Malaysia.

Topics: Animals; Chickens; Cross-Sectional Studies; Humans; Malaysia; Phylogeny; Risk Factors; Sarcocystis; Sarcocystosis; Seroepidemiologic Studies; Swine

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.

Topics: Base Sequence; DNA, Protozoan; Genetic Variation; Humans; Malaysia; Phylogeny; Polymerase Chain Reaction; RNA, Ribosomal, 18S; RNA, Ribosomal, 28S; Sarcocystidae; Sarcocystosis; Sensitivity and Specificity; Sequence Analysis, DNA; Soil Microbiology; Water Microbiology

Sarcocystosis was diagnosed worldwide by serodiagnostic tests utilising the whole parasite, for which the protozoa were maintained in vitro are more costly. In this study, antigenicity of Sarcocystis falcatula recombinant protein (rSfSAG4) was investigated towards the local communities of Pangkor and Tioman Islands and its seroprevalence was surveyed in these islands. A total of 348 human sera were tested using rSfSAG4 by Western blot and ELISA. High prevalence of sarcocystosis was observed in Tioman Island (80.6%) than in Pangkor Island (50.0%) by Western blot. In ELISA, the seroprevalence observed in Tioman Island was 45.9%, whereas in Pangkor Island 63.0%. In other parasitic infections, the prevalence was 34.0% by Western blot and 46.0% by ELISA. In healthy control group, 7% by Western blot and 8% by ELISA showed positivity to rSfSAG4. It is suggested SfSAG4 is a candidate antigen to measure seroprevalence of sarcocystosis.

Topics: Antigens, Protozoan; Antigens, Surface; Blotting, Western; Enzyme-Linked Immunosorbent Assay; Humans; Malaysia; Recombinant Proteins; Sarcocystis; Sarcocystosis; Seroepidemiologic Studies

To investigate the seroprevalence of Sarcocystosis in the local communities of Pangkor and Tioman islands, Malaysia, by using antigenic recombinant surface antigens 2 and 3 from Sarcocystis falcatula (rSfSAG2 and rSfSAG3) as the target proteins via Western blot and ELISA assays.. SfSAG2 and SfSAG3 genes were isolated from S. falcatula and expressed in Escherichia coli expression system. A total of 348 serum samples [volunteers from both islands (n = 100), non-Sarcocystis parasitic infections patients (n = 50) and healthy donors (n = 100)] were collected and tested with purified SfSAGs in Western blot and ELISA assays to measure the seroprevalence of human sarcocystosis.. None of the sera in this study reacted with rSfSAG2 by Western blot and ELISA. For rSfSAG3, relatively high prevalence of sarcocystosis was observed in Tioman Island (75.5%) than in Pangkor Island (34%) by Western blot. In ELISA, the different prevalence rate was observed between Tioman Island (43.8%) and Pangkor Island (37%). The prevalence rate in other parasitic infections (amoebiasis, cysticercosis, filariasis, malaria, toxocariasis and toxoplasmosis) was 30% by Western blot and 26% by ELISA. Only 8% (by Western blot) and 10% (by ELISA) of healthy donors showed reactivity towards rSfSAG3.. This is the first study reporting a seroprevalence of sarcocystosis in Pangkor and Tioman Islands, Malaysia. The combination of Western blot and ELISA is suitable to be used for serodiagnosis of sarcocystosis. With further evaluations, SfSAG3 can potentially be used to confirm infection, asymptomatic screening, surveillance and epidemiological studies.

Topics: Antigens, Surface; Blotting, Western; Enzyme-Linked Immunosorbent Assay; Humans; Malaysia; Sarcocystis; Sarcocystosis; Seroepidemiologic Studies

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.

Topics: Adrenal Cortex Hormones; Albendazole; Biopsy; Hepatomegaly; Humans; Lymphadenopathy; Malaysia; Male; Sarcocystosis; Treatment Outcome; Young Adult

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.

Topics: Abattoirs; Animals; Goat Diseases; Goats; Malaysia; Microscopy; Muscle, Skeletal; Polymerase Chain Reaction; Sarcocystis; Sarcocystosis; Sensitivity and Specificity

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.

Topics: Adolescent; Adult; Child; Cytokines; Female; Humans; Immune Tolerance; Malaysia; Male; Sarcocystis; Sarcocystosis; Th2 Cells; Travel; Young Adult

Sarcocystis species are pathogenic parasites that infect a wide range of animals, including cattle. A high prevalence of cattle sarcocystosis has been reported worldwide, but its status is unknown in Malaysia. This study focused on utilizing 18S rDNA to identify Sarcocystis species in Malaysian cattle and to determine their genetic variants. In this study, only Sarcocystis cruzi was detected in Malaysian cattle. The intra-species S. cruzi phylogenetic tree analysis and principal coordinate analysis (PCoA), respectively displayed two minor groups among the parasite isolates. This finding was supported by high Wright FST value (FST=0.647). The definitive hosts (dogs) may play a fundamental role in the development of S. cruzi genetic variants. Additionally, the existence of microheterogeneity within the S. cruzi merozoites and/or distinct genetic variants arisen from independent merozoites in mature sarcocysts, possibly contributed to the existence of intra-species variations within the population.

Topics: Animals; Cattle; Cattle Diseases; DNA, Protozoan; Genetic Variation; Malaysia; Molecular Sequence Data; Phylogeny; RNA, Ribosomal, 18S; Sarcocystis; Sarcocystosis; Sequence Analysis, DNA

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.

Topics: Animal Structures; Animals; Cattle; Cattle Diseases; DNA, Protozoan; DNA, Ribosomal; Goat Diseases; Goats; Malaysia; Meat; Microscopy; Molecular Diagnostic Techniques; Polymerase Chain Reaction; RNA, Ribosomal, 18S; Sarcocystis; Sarcocystosis; Sheep; Sheep Diseases; Specimen Handling

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.. Systematic case series.. The 26 cases of 5 centers for tropical medicine in Germany showed a characteristic biphasic development: symptoms began in general 2 weeks after mid-holidays (min. 7.5, max. 22 days) with unspecific fever and headaches lasting for almost 1 week. After an asymptomatic period of 2 weeks, severe myalgia (6.5, scale 0-10) and fever developed and lasted for about 6 weeks (min. 7, max. 207 days), accompanied by creatin-phosphokinase(CK)-elevation (up to 3.5 times), and eosinophilia (2.9 times). One out of two muscle biopsies revealed a cyst typical for sarcocystosis. In 6 out of 7 patients an increase in Sarcocystis-specific antibody concentration could be demonstrated by ELISA. Treatment with systemic steroids and albendazole, or ivermectin resulted in significant symptomatic improvement in most of the patients. One patient was treated early with cotrimoxazole and subsequently did not develop a second phase of the disease. All patients had stayed in the North-West of the island Tioman.. Muscular sarcocystosis develops in a biphasic pattern with initial fever and later prolonged myalgia, eosinophilia, and CK-elevation. Steroids achieve symptomatic relief in the late phase. Early cotrimoxazole-therapy could possibly prevent parasitic muscle invasion. In fever after travel to Malaysia differential diagnosis should include sarcocystosis. The source of infection appears to be located in North-West of Tioman. Further studies are needed, including addressing early diagnosis and treatment.

Topics: Adolescent; Adult; Antibodies, Protozoan; Biopsy; Child; Developing Countries; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; Fever of Unknown Origin; Germany; Humans; Infectious Disease Incubation Period; Malaysia; Male; Middle Aged; Muscle, Skeletal; Myalgia; Sarcocystis; Sarcocystosis; Travel; Young Adult

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.. All retreat participants were identified, and clinical and epidemiological information was obtained via clinical review and self-reported answers to a structured questionnaire. Laboratory, imaging and muscle biopsy results were evaluated and possible sources of exposure, in particular water supply, were investigated. At an average of 9-11 days upon return from the retreat, 89 (97%) of the participants became ill. A vast majority of 94% had fever with 57% of these persons experiencing relapsing fever. Myalgia was present in 91% of patients. Facial swelling from myositis of jaw muscles occurred in 9 (10%) patients. The median duration of symptoms was 17 days (IQR 7 to 30 days; range 3 to 112). Out of 4 muscle biopsies, sarcocysts were identified in 3. S. nesbitti was identified by PCR in 3 of the 4 biopsies including one biopsy without observed sarcocyst. Non-Malaysians had a median duration of symptoms longer than that of Malaysians (27.5 days vs. 14 days, p = 0.001) and were more likely to experience moderate or severe myalgia compared to mild myalgia (83.3% vs. 40.0%, p = 0.002).. The similarity of the symptoms and clustered time of onset suggests that all affected persons had muscular sarcocystosis. This is the largest human outbreak of sarcocystosis ever reported, with the specific Sarcocystis species identified. The largely non-specific clinical features of this illness suggest that S. nesbitti may be an under diagnosed infection in the tropics.

Topics: Adolescent; Adult; Child; Child, Preschool; Disease Outbreaks; Female; Fever; Humans; Magnetic Resonance Imaging; Malaysia; Male; Middle Aged; Myositis; Recurrence; Sarcocystis; Sarcocystosis; Young Adult

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.

Topics: Adolescent; Anti-Infective Agents; Child; Female; Fever; Germany; Headache; Humans; Infant; Malaysia; Male; Myalgia; Prednisolone; Sarcocystis; Sarcocystosis; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

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.. 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.. 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.. 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.

Topics: Adolescent; Adult; Aged; Biopsy; Child; Child, Preschool; Disease Outbreaks; Eosinophils; Female; Geography; Humans; Islands; Leukocyte Count; Malaysia; Male; Middle Aged; Muscles; Public Health Surveillance; Risk Factors; Sarcocystis; Sarcocystosis; Travel; Young Adult

Soil-transmitted helminth (STH) infections have been documented among these minority groups since 1938. However the prevalence of STH is still high among these communities. Most studies tend to consider the Orang Asli (indigenous) as a homogenous group. In contrary, different subtribes have their own cultural practices. To understand this variation better, we studied the prevalence and associated factors of STH and other gut parasitic infections among two common subtribes (i.e. Temuan and Temiar). Results showed that the prevalence of the overall STH infections was higher in the Temuan subtribe (53.2% of 171) compared to the Temiar subtribe (52.7% of 98). Trichuris trichiura (46.2%) was the most prevalent parasite in the Temuan subtribe, followed by Ascaris spp. (25.7%) and hookworm (4.1%). In contrast, Ascaris spp. (39.8%) was more prevalent among the Temiar subtribe, preceded by T. trichiura (35.7%) and finally hookworm (8.3%). There were also co-infections of helminthiasis and intestinal protozoa among both Temuan and Temiar subtribes with rates being three times higher among the Temiar compared to Temuan. The most common co-infection was with Entamoeba histolytica/dispar/moshkovskii (n = 24; 24.5%, 16.0-33.0), followed by Giardia spp. (n = 3; 3.1%, -0.3-6.5). In Temuan, STH infection individuals were also infected with Entamoeba histolytica/dispar/moshkovskii (n = 11; 6.4%, 5.0-13.8), Cryptosporidium spp. (n = 3, 1.8%, -0.2-3.8) and Giardia spp. (n = 2, 1.2%, -0.4-2.8). In comparison, there was no Cryptosporidium spp. detected among the Temiar. However, it was interesting to note that there was an occurrence of co-infection of intestinal helminthiasis and sarcocystosis (intestinal) in a Temiar individual. The last report of sarcocystosis (muscular) among the Orang Asli was in 1978. The present study highlighted the importance of understanding the variation of infections amongst the different Orang Asli subtribes. It is vital to note these differences and use this knowledge to customise effective control measures for the various subtribes.

Topics: Adolescent; Adult; Aged; Animals; Asian People; Child; Child, Preschool; Coinfection; Cross-Sectional Studies; Female; Helminthiasis; Helminths; Humans; Infant; Intestinal Diseases, Parasitic; Malaysia; Male; Middle Aged; Neglected Diseases; Sarcocystis; Sarcocystosis; Young Adult

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.

Topics: Disease Outbreaks; Genes, Protozoan; Humans; Malaysia; Molecular Sequence Data; Phylogeny; RNA, Ribosomal, 18S; Sarcocystis; Sarcocystosis

The prevalence of sarcocystosis in cattle and water buffaloes from peninsular Malaysia was investigated in abattoirs in Selangor state, February, 2011, to March, 2012. Fresh muscle samples were collected from the tongue, heart, oesophagus, diaphragm and skeletal muscles of 102 cattle and 18 water buffaloes. Each sample was initially screened by light microscopy and then fixed for further histopathological analysis. Out of 120 animals examined, 49 (40.8%) harboured the microscopic type of Sarcocystis spp. The positivity rate for cattle was 36.2% and for water buffaloes 66.7%. In cattle, the organs highly infected were the skeletal muscles and diaphragm (27% each), followed by tongue and esophagus (24.3% each), and the heart (8%). In water buffaloes, the heart was most often infected (66.7%), followed by the oesophagus (50%) and skeletal muscle (33.3%); no sarcocysts were detected in the tongue and diaphragm. The shape of the sarcocyst was fusiform to oval with a mean cyst size of 151.66 x 75.83 μm and wall thickness of 2.47 μm in cattle, and 114 x 50.81 μm cyst size and the wall thickness of 1.11 μm in water buffaloes, consistent with Sarcocystis cruzi and Sarcocystis levinei, respectively. Remaining tissue from cattle was subjected to parasite specific 18S rRNA gene PCR and Sarcocystis cruzi was confirmed, at least exemplarily. The peripheral metrocytes and the banana-shaped bradyzoites (15.23 x 2.2 μm in cattle and 11.49 x 2.45 μm in water buffalo hosts) were easily recognized. In conclusion, a high positivity rate was found in Malaysian meat-producing animals with possible implications for meat consumption and human health.

Topics: Animals; Buffaloes; Cattle; Cattle Diseases; DNA, Protozoan; DNA, Ribosomal; Genes, rRNA; Histocytochemistry; Malaysia; Muscles; Parasitology; Prevalence; RNA, Protozoan; RNA, Ribosomal, 18S; Sarcocystis; Sarcocystosis; Sequence Analysis, DNA

Topics: Adult; Biopsy; Disease Outbreaks; Female; Germany; Humans; Malaysia; Male; Muscles; Sarcocystis; Sarcocystosis; Travel

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.

Topics: Acute Disease; Biopsy; Disease Outbreaks; Fever; Food Contamination; Humans; Malaysia; Muscle, Skeletal; Musculoskeletal Pain; Sarcocystis; Sarcocystosis; Sentinel Surveillance; Travel; Water Supply

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.

Topics: Blotting, Western; Creatine Kinase; Disease Outbreaks; Eosinophils; Fever; Humans; Malaysia; Muscle, Skeletal; Musculoskeletal Pain; Sarcocystis; Sarcocystosis; Sentinel Surveillance; Serologic Tests; Travel

Sarcocystis sp. infection was investigated in 20 necropsied captive wild mammals and 20 birds in 2 petting zoos in Malaysia. The gross post-mortem lesions in mammals showed marbling of the liver with uniform congestion of the intestine, and for birds, there was atrophy of the sternal muscles with hemorrhage and edema of the lungs in 2 birds. Naked eye examination was used for detection of macroscopic sarcocysts, and muscle squash for microscopic type. Only microscopically visible cysts were detected in 8 animals and species identification was not possible. Histological examination of the sections of infected skeletal muscles showed more than 5 sarcocysts in each specimen. No leukocytic infiltration was seen in affected organs. The shape of the cysts was elongated or circular, and the mean size reached 254 x 24.5 µm and the thickness of the wall up to 2.5 µm. Two stages were recognized in the cysts, the peripheral metrocytes and large numbers of crescent shaped merozoites. Out of 40 animals examined, 3 mammals and 5 birds were positive (20%). The infection rate was 15% and 25% in mammals and birds, respectively. Regarding the organs, the infection rate was 50% in the skeletal muscles followed by tongue and heart (37.5%), diaphragm (25%), and esophagus (12.5%). Further ultrastructural studies are required to identify the species of Sarcocystis that infect captive wild animals and their possible role in zoonosis.

Topics: Animals; Animals, Wild; Animals, Zoo; Cell Size; Malaysia; Muscle, Skeletal; Sarcocystis; Sarcocystosis

Seven members of a 15-man U.S. military team that had operated in rural Malaysia developed an acute illness consisting of fever, myalgias, bronchospasm, fleeting pruritic rashes, transient lymphadenopathy, and subcutaneous nodules associated with eosinophilia, elevated erythrocyte sedimentation rate, and elevated levels of muscle creatinine kinase. Sarcocysts of an unidentified Sarcocystis species were found in skeletal muscle biopsies of the index case. Albendazole ameliorated symptoms in the index case; however, his symptoms persisted for more than 5 years. Symptoms in 5 other men were mild to moderate and self-limited, and 1 team member with laboratory abnormalities was asymptomatic. Of 8 team members tested for antibody to Sarcocystis, 6 were positive; of 4 with the eosinophilic myositis syndrome who were tested, all were positive. We attribute this outbreak of eosinophilic myositis to accidental tissue parasitism by Sarcocystis.

Topics: Acute Disease; Adult; Alanine Transaminase; Animals; Aspartate Aminotransferases; Biopsy; Cohort Studies; Disease Outbreaks; Eosinophilia; Erythrocyte Count; Humans; L-Lactate Dehydrogenase; Malaysia; Male; Military Personnel; Muscle, Skeletal; Myositis; Parasitemia; Recurrence; Rural Health; Sarcocystis; Sarcocystosis; United States

Topics: Humans; Malaysia; Muscular Diseases; Neoplasms; Sarcocystosis; Urban Health

Topics: Carcinoma; Humans; Malaysia; Male; Middle Aged; Nasopharyngeal Neoplasms; Sarcocystosis

The ultrastructure of the cyst wall and zoites of a species of Sarcocystis from the skeletal muscles of a naturally-infected Malaysian long-tailed monkey, Macaca fascicularis, is described in detail. The wavy, electron-dense primary cyst wall is thin (55 nm) and invaginated. Cytophaneres are absent. The ground substance contains electron-dense granules and bundles of parallel, fibrillar elements in some areas. Thin trabeculae are present. The zoites measure 1.2 X 4.7 microns and have an interior conoid, 22 subpellicular microtubules, 50-60 micronemes, 4-6 rhoptries, and a posteriorly situated nucleus. Some ultrastructural aspects of the cyst wall and the zoites of this parasite resemble those of Sarcocystis species of the moonrat, rhesus monkey, tamarin, and baboon. The light microscopic appearance of this species from M. fascicularis also bears some resemblance to that of parasites from the four cases of human Sarcocystis reported in Malaysia. The cyst in all these human cases were thin-walled, with no cytophaners. Although the final hosts of these species of Sarcocystis are not known, it is quite possible that man, monkeys, and perhaps the moonrat (an insectivore) may serve as common intermediate hosts for one or several species of Sarcocystis.

Topics: Animals; Haplorhini; Macaca fascicularis; Malaysia; Male; Monkey Diseases; Muscles; Sarcocystis; Sarcocystosis

The two species of Sarcocystis--S. levinei and S. fusiformis from the water buffalo, Bubalus bubalis, show some ultrastructural similarities in their cyst wall and zoites. The zoites of both species are of about the same size, banana-shaped and have 22 subpellicular microtubules, numerous micronemes, eight rhoptries, a micropore in the region of the micronemes, an elongated mitochondrion, and a nucleus. S. levinei has 200--300 micronemes and S. fusiformis has about 400. The sarcocysts of both species are trabeculated and their cyst walls have cytophaneres containing annulated fibrils and coarse, electron dense granules. The cytophaneres of S. levinei are sloping, with irregular, wavy outlines, whereas S. fusiformis has the cauliflower-type of cytophaneres. This difference in the appearance of the cytophaneres, together with the difference in size of the sarcocysts and their definitive hosts, further confirms that S. levinei and S. fusiformis are two distinct species in the water buffalo.

Topics: Animals; Buffaloes; Cell Wall; Esophagus; Malaysia; Sarcocystis; Sarcocystosis; Species Specificity

Topics: Adult; Humans; Malaysia; Male; Neck Muscles; Sarcocystis; Sarcocystosis

Topics: Adult; Humans; Malaysia; Male; Sarcocystis; Sarcocystosis

Sarcocystis booliati n.sp. is described from the moonrat Echinosorex gymnurus (Mammalia, Insectivora) from West Malaysia. The cysts are very thin-walled, not visible to the naked eye, and have no trabeculae or cytophaneres. They are found in skeletal but not heart muscle. The zoites are small, 5-8 by 2-3 mum with a mean of 6.5 by 2.2 mum, in dry fixed smears. Octoplasma garnhami n.gen. n.sp., a parasite of undetermined taxonomic status but belonging to the Coccidiasina, Apicomplexa, is also described from the same host. Only schizononts and pseudocysts with typically 8 zoites, have so far been seen in monocytes of the spleen and liver. The zoites are large, 15 by 3 mum and have a distinct nucleolus even in dry-fixed smears.

Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Eukaryota; Eulipotyphla; Malaysia; Muscles; Muscular Diseases; Protozoan Infections; Protozoan Infections, Animal; Sarcocystis; Sarcocystosis

The second case of Sarcocystis infection in man is reported from an aborigine girl. It was an incidental finding at autopsy and two cysts were seen in the muscle of the oropharyngeal region. The cysts and zoites were similar to those in the previous case reported from Malaysia.

Topics: Brain Neoplasms; Child; Female; Humans; Malaysia; Melanoma; Nasopharynx; Pharynx; Sarcocystis; Sarcocystosis

Topics: Animals; Malaysia; Rats; Sarcocystis; Sarcocystosis; Singapore; Snakes

The first case of Sarcocystis infection is reported from West Malaysia. A cyst was seen as an incidental finding in a biopsy specimen from the larynx of the patient. The cyst and the cystozoites were of the small size with no evidence of cytophaneres or compartments.

Topics: Adult; Humans; Laryngeal Diseases; Larynx; Malaysia; Male; Muscles; Sarcocystis; Sarcocystosis