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ARS Home » Northeast Area » Beltsville, Maryland (BARC) » Beltsville Agricultural Research Center » Animal Parasitic Diseases Laboratory » Research » Publications at this Location » Publication #312914
Title: Avoid haste in defining human muscular Sarcocystosis

Author
item ESPOSITO, DOUGLAS - Centers For Disease Control And Prevention (CDC) - United States
item Rosenthal, Benjamin
item SLESAK, GUNTER - Tropenklinik
item TAPPE, DENNIS - Bernhard-Nocht Institute For Tropical Medicine
item Fayer, Ronald
item BOTTIEAU, EMMANUEL - Institute Of Tropical Medicine
item BROWN, CLIVE - Centers For Disease Control And Prevention (CDC) - United States
item GROBUSCH, MARTIN - University Of Amsterdam
item MALVY, DENIS - Tropical Medicine Research Institute
item VON SONNENBURG, FRANK - Medical Center Of The University Of Munich
item SOTIR, MARK - Centers For Disease Control And Prevention (CDC) - United States
item STEINER, FLORIAN - Charite' University Hospital Berlin
item ZANGER, PHILIPP - Eberhard-Karls University
item KOZARSKY, PHYLLIS - Emory University, School Of Medicine

Submitted to: Clinical Infectious Diseases
Publication Type: Other
Publication Acceptance Date: 12/23/2014
Publication Date: 12/23/2014
Publication URL: http://10.1093/cid/ciu1163
Citation: Esposito, D.H., Rosenthal, B.M., Slesak, G., Tappe, D., Fayer, R., Bottieau, E., Brown, C., Grobusch, M.P., Malvy, D., Von Sonnenburg, F., Sotir, M.J., Steiner, F., Zanger, P., Kozarsky, P.E. 2014. Avoid Haste in Defining Human Muscular Sarcocystosis. Clinical Infectious Diseases. 60: 1134.

Interpretive Summary: There are many species of Sarcocystis that cause parasitic infections in animal hosts, and two well-characterized species that people can acquire by eating infected pork or beef. ARS researchers assisted a team of clinicians investigating an ongoing outbreak of a newly recognized zoononic species. The current report discusses clinical signs and symptoms that can assist in the diagnosis of human patients infected with this enigmatic, emerging infection.

Technical Abstract: We appreciate Dr. Italiano’s [1] interest in our article [2] and agree that our case definition, described in our methods as ‘intentionally specific,’ may have resulted in the exclusion of some travelers infected with Sarcocystis nesbitti. Nevertheless, we believe published data from outbreak investigations in Malaysia offer ample evidence that peripheral eosinophilia and myositis are important distinguishing components of human acute muscular sarcocystosis (AMS) [2–8]. Surely, some patients would not have these findings at any given point in their illness. Indeed, our Figure 4 shows sub-threshold laboratory values during the late phase of disease [2], a finding corroborated elsewhere [3–6]. We concur that some ill patients will not develop detectable eosinophilia or myositis at all. As in all infectious diseases, variations in the clinical manifestations, laboratory testing results, and the courses of illness should be expected. Such variation may stem from host factors, the infectious load, and/or the infecting Sarcocystis species, [9] or even strain. In this light, performing serial clinical and laboratory investigations seems warranted when evaluating and managing patients with suspected AMS.