Location: Animal Parasitic Diseases LaboratoryTitle: Avoid haste in defining human muscular Sarcocystosis Author
|Esposito, Douglas - Centers For Disease Control And Prevention (CDCP) - United States|
|Slesak, Gunter - Tropenklinik|
|Tappe, Dennis - Bernhard-Nocht Institute For Tropical Medicine|
|Bottieau, Emmanuel - Institute Of Tropical Medicine|
|Brown, Clive - Centers For Disease Control And Prevention (CDCP) - United States|
|Grobusch, Martin - University Of Amsterdam|
|Malvy, Denis - Tropical Medicine Research Institute|
|Von Sonnenburg, Frank - Medical Center Of The University Of Munich|
|Sotir, Mark - Centers For Disease Control And Prevention (CDCP) - United States|
|Steiner, Florian - Charite' University Hospital Berlin|
|Zanger, Philipp - Eberhard-Karls University|
|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  interest in our article  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 , 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,  or even strain. In this light, performing serial clinical and laboratory investigations seems warranted when evaluating and managing patients with suspected AMS.