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  IN THIS Article
 ::  Abstract
 ::  Human sarcocystis
 ::  Case History
 ::  Discussion
 ::  Acknowledgements
 ::  References
 ::  Article Figures
 ::  Article Tables

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ARTICLE
Year : 1976  |  Volume : 22  |  Issue : 4  |  Page : 185-190

Human sarcocystis


Department of Pathology, St. John's Medical College, Bangalore-560034, India

Correspondence Address:
J A Thomas
Department of Pathology, St. John's Medical College, Bangalore-560034
India
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Source of Support: None, Conflict of Interest: None


PMID: 829835

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 :: Abstract 

The nineteenth authenticated report of human sarcocpstis is made and all available literature reviewed on the subject.



How to cite this article:
Thomas J A. Human sarcocystis. J Postgrad Med 1976;22:185-90

How to cite this URL:
Thomas J A. Human sarcocystis. J Postgrad Med [serial online] 1976 [cited 2020 Dec 3];22:185-90. Available from: https://www.jpgmonline.com/text.asp?1976/22/4/185/42820



 :: Human sarcocystis Top


Miescher [24] in 1843 for the first time described a peculiar parasite of mouse skeletal muscle, which came to be called "Sarcocystis". [3] These organisms were later, however, not only found to para­sitise mice but also other mammals, birds and reptiles.

The first human case observed, was described by Lindemannl [18] in 1868 and in 1898, this parasite was named "Sarco­cystis lindemanni", by Rivolta, [26] in honour of its discoverer. Several cases were subsequently published by Leue­kart, [17] Koch and Gaffky, [15] Rosenberg [27] and Kartulis. [12] Babudeiere [1] and Kean and Grocott [13] believed that these reports, including that of Lindemann's, were doubt­ful, incorrect or lacked sufficient data for review. Thus, the first authenticated case involving Man and Sarcocystis lin­demanni, was published only in 1894 by Baraban and Saint-Remy. [2] This report was followed by seventeen others, in the next 82 years. [4],[5],[6],[7],[8],[9],[10],[11],[13],[14],[16],[19],[20],[22],[23],[25],[28],[29]

The case presented here is the nine­teenth and differs in some respects from those already published. An evaluation with comparisons of all available data, is presented in [Table 1].


 :: Case History Top


A 54 year old Hindu vegetarian female, belonging to the middle-income-group complained of dull aching pain in both lower limbs of four months duration. She also complained of difficulty in walking and standing up. There was no history of a burning sensation over the lower limbs, no intermittent claudication or hypoasthesia. Her personal and family histories were noncontributory.

General physical examination of the systems showed no significant deviation from normal. Local examination of both lower limbs showed bilateral pedal oedema, with marked tenderness over the bellies of the left gastrocnemius muscle. A hard mass was palpable in the bulk of this muscle mass and measured 2.5 x 3 cms in area. The sensory and motor components of this limb and the other lower limb appeared normal.

Routine laboratory investigations were all within normal limits, The stool examination in particular showed neither ova nor cysts.

A biopsy of the hard mass in the left gastrocnemius muscle was done.

The specimen received by this depart­ment consisted of three pieces of white fibromuscular tissue, the largest piece of which measured 2.5 cms in greatest di­mension.

One of the pieces was felt gritty on cutting.

Several sections from these tissues were examined and showed many skele­tal muscle bundles. These bundles were however, widely dispersed and had inter­posed between them large tracts of col­lagenous tissue which showed evidence of heterotopic ossification See [Figure 1] on page 184B and evidence also of small is­lands of embryonic-type cartilage. A few thick-and-thin-walled blood vessels were scattered here and there. The Alcian-Blue Periodic-Acid Schiff Reac­tion (AB-PAS) showed Alcian Blue positivity in the collagenous tissue, espe­cially around the areas of heterotopic ossification.

Examination of the skeletal muscle fibres of the widely dispersed bundles showed evidence of wide variation in size with evidence of atrophy, fragmentation and vacuolation See [Figure 2] on page 184B. Some of the vacuolated muscle fibres showed PAS-positive granules within which were rounded structures that measured about two microns in greatest dimension. Most of the fibres appeared moderately PAS-positive and showed cross striations with the Phosphotungstic -Acid-Hematoxylin (PTAH) stain. Many of the fragmented and vacuolated skeletal muscle fibres did not show such cross striations, with the PTAH stain.

One skeletal muscle fibre contained a cyst See [Figure 3] on page 184B. This cyst measured, on an average estimation on several consecutive 5 micron sections, 91 x 243 microns in cross-section and exhi­bited a capsule that was 0.5 to one mic­ron in thickness, was pink with the Haematoxylin-Eosin stain, nonstriated with the PTAH stains, PAS-negative and separate from the sacrolemmal sheath of the involved skeletal muscle fibre See [Figure 4] on page 184B. No septae were seen. It was not possible to assess the ,length of the cyst. Within the cyst numerous interweaving bundles of vaguely sickle­shaped organisms were seen, measuring on an average 7.3 x 1.25 microns. These organisms had PAS positive granules, at both poles, which were better visualized with the Iron-Haematoxylin stain. The involved skeletal muscle fibre showed patchy PAS positivity and showed cross­striations with the PTAH stain.

Although scattered aggregates of lym­phocytes and plasma cells were seen around small blood vessels, no inflamma­tion was seen involving the affected ske­letal muscle fibre.

Precipitin reactions were attempted using the patient's serum and homogena­tes of animal sarcocystis. They were not positive.

The patient was discharged, on the fourth postoperative day, her condition remaining unchanged.


 :: Discussion Top


Markus, Killick-Kendrick and Garn­ham [21] have attempted to establish the life cycle of Sarcocystis. These authors believed that two vertebrate hosts were required by the parasite and was essen­tial for the completion of its life cycle. The sporocysts were excreted by Man, dog, or cat ("predators") in the faeces which when ingested by a bovine ("prey") developed asexually into merozoites that later became sarcocysts con­taining cystozoites. The "predators", on ingesting the infected bovine meat, deve­loped male and female gametocytes in the intestinal epithelium. By the fifth day, isosporon oocysts were formed and escap­ed into the faeces, but being fragile, rup­tured giving rise to sporocysts.

In the nineteen reports documenting human infections, in the last 82 years, Man has acted as the "prey". It is, there­fore, possible that autoinfection or inha­lation of infected material from unhygie­nic surroundings may play a part in the pathogenesis of these lesions. The latter possibility is further underlined by the fact that the patient reported here was a vegetarian Hindu, who, due to religious precepts was not likely to have consum­ed bovine meat.

On reviewing the nineteen authenticat­ed reports of "sarcocystis", the cysts were located at the following sites:-upper limb-1 case, pectoral region-4 cases, leg and foot-5 cases, abdomen-1 case, mouth and tongue-2 cases, heart-6 cases, larynx-1 case, undetermined site in muscle-1 case. This distribution sug­gests that the parasite was predelected to locating itself in the more active mus­cles of the body.

The morphology of "Sarcocystis linde­manni" has been described, based on histological observations. It is to be there­fore, expected that wide variations in descriptions would exist due to tissue shrinkage during processing. This fact is highlighted in the measurements cited in the various reports. The cysts varied in size from 10 to 53000 microns and have been shown to have a cyst wall in 4 ins­tances which showed striations and varied in thickness from 0.5 to 16.1 microns. These striations in the cyst wall may have been due to skeletal. muscle fibre cytoplasm condensation. The organisms con­tained within the cysts were always des­cribed as slightly curved with lengths upto 14 microns and a width of 1.2 to 1.75 microns.

The presence of septae partitioning the cyst were noted in 5 cysts, were not seen in 7 cysts and not mentioned in 7 reports. Naidu [25] in 1929 suggested that such par­titions tended to occur in only older cysts. This appears possible as seen in the reports of Baraban and Saint-Remy, [2] Vasudevan [28] and McGill and Goodbody [23] where the cysts with such septae measur­ed over 1000 microns.

Bonne and Soewandi [4] and Feng [8] de­scribed a vascular host-stroma in rela­tion to the parasite whereas Kean and Grocott, [13] Koberle, [14] Liu and Roberts, [19] Gupta et al [10] and the present author have seen atrophy of skeletal muscle fibres with degeneration and fibrosis with the occurrence of lymphacytes and poly­morphs, in varying numbers in the con­nective tissue stroma. The present report, in addition, showed heterotopic ossifica­tion and embryonal cartilage formation. Whereas it would be difficult to discard these tissue reactions as just incidental findings, the relative paucity of parasites in the skeletal muscle fibres with no tissue reactions around would suggest just such a possibility. The vacuolation in some of the skeletal muscle fibres with a few PAS positive granules within were intriguing. Could this observation sug­gest that this parasite was capable of spreading from muscle fibre to muscle fibre? If this possibility were to exist the local tissue response could be ex­plained. Another possible explanation for these host tissue responses could lie in the fact that the parasitised muscle fibre may have ruptured, resulting in the re­lease of toxic products like "sarcocystin" [3] ,which may have not only produced the extensive tissue reactions but may have also been implicated in including weak­ness, and pain in the affected part.


 :: Acknowledgements Top


The author thanks Dr. C. M. Francis;, M.B.B.S., Ph.D,, Dean of this Institution for permission to publish this report.

He further wishes to express his grati­tude to the late Dr. Syed Mohideen, Pro­fessor of Veterinary Pathology, Veteri­nary College, University of Agricultural Science,Bangalore. Dr. S. J. Seshadri, Associate Professor of Veterinary Pathology and Dr. S. Sastry of that College for confirming his impression on the tissue sections.

 
 :: References Top

1.Babudeieri, B.: Sarcosporidi e le' Sarco­sporidiosi (Studio Monographico), Arch. f. Protistank., 76: 421-580, 1932 as quoted by Kean and Grocott.  Back to cited text no. 1    
2.Baraban. M Le and Saint-Remy, M. G.: Sur un cas de tubes psorospermiques ob­serves chez 1' homme. Compt. Rend. Soc. de Biol., 46: 231-203, 1894.  Back to cited text no. 2    
3.Belding, D. L.: In "Text Book of Para­sitology," Edn. 3, Appleton-Century­Crofts, New York, pp. 237-240, 1965.  Back to cited text no. 3    
4.Bonne, C. and Soewandi, R.: Een geval. van. Sarcosporidiasis bij den mensch, Genes Tijdschr. v. Ned-Indie, 69: 1104­-1106, 1929.  Back to cited text no. 4    
5.Darling, S. T.: Sarcosporidiasis with a report of a case in man. Arch. Inst. Med., 3: 183-192, 1909.  Back to cited text no. 5    
6.Darling, S. T.: Sarcosporidiasis in an East Indian, J. Parasitol., 6: 98-101, 1919.   Back to cited text no. 6    
7.Faust, E. C. and Russell, P. F.: In"Clinical Parasitology" by Craig and Faust, Seventh Edition, Lea and Febiger,Philadelphia, p. 282, 1964.   Back to cited text no. 7    
8.Feng, L. C. Barcosporidiasis in man, Chinese Med. J., 46: 976-981, 1932.  Back to cited text no. 8    
9.Gilmore, H. R., Kean, B. H. and Posey, F. M.: Sarcosporidiasis with parasites found in heart, Am. J. Trop. Med., 22: 121-125, 1942.  Back to cited text no. 9    
10.Gupta, 0. K., Nath, P., Bhatia, K. B. and Mehrotra, M. L.: Sarcocystis infec­tion in man-a case report, Indian J. Path. Bact., 16: 73-75, 1973.  Back to cited text no. 10    
11.Hewitt, J. A.: Sarcosporidiasis in human cardiac muscle, J. Path. Bact., 36: 133­-139, 1934.  Back to cited text no. 11    
12.Kartulis: As quoted by Babudeieri [1] .   Back to cited text no. 12    
13.Kean, B. H. and Grocott, R. G.: Sarcosporidiasis or toxoplasmosis in man and guinea-pig, Am. J. Path., 21: 467-479, 1945.  Back to cited text no. 13    
14.Koberle, F.: Uber Sarkosporidiose beim Menschen. Zschr, Tropenmed. u. Para­sitol., 9: 1-6, 1958.  Back to cited text no. 14    
15.Koch and Gaffy: As quoted by Babu­deieri [1] .  Back to cited text no. 15    
16.Lambert, S. W. Jr.: Sarcosporidial in­fection of the myocardium in man, Am. J. Path., 3: 663-668, 1927.  Back to cited text no. 16    
17.Leuckart: as quoted by Babudeieril.  Back to cited text no. 17    
18.Lindemann: as quoted by Faust and Russell  Back to cited text no. 18    
19.Liu, C. T. and Roberts, L. M.: Sarco­sporidiasis in a Bantu woman, Am. J. Clin. Path., 44: 639-641, 1965.  Back to cited text no. 19    
20.Mackinnon, J. E. and Abbott, P.: A Sudanese case of Sarcosporidiasis, Ann. Trop. Med. Parasit., 49: 308-310, 1965.  Back to cited text no. 20    
21.Markus, M. B., Killick-Kendrick, R. and Garnham, P. C. C.: The coccidial nature and life cycle of Sarcocystis, J. Trop. Med. Hyg., 77: 248-259, 1974.  Back to cited text no. 21    
22.Manifold, J. A.: Report on a case of sarcosporidiasis in a human heart, J. Roy. Army Med. Corps., 42: 275-277, 1924.  Back to cited text no. 22    
23.McGill., R. J. and Goodbody, R. A.: Sarcosporidiasis in man with periarteritis nodosa, Brit. Med. J., 2: 333-334, 1957.  Back to cited text no. 23    
24.Miescher, F.: Ueber eigenthiimliche Schlauche in den Muskeln einer ­Hausmaus. Ber. u.d. Verhandl. Naturf. Ges. Basel ., 5: 198-202, 1843. Quoted by Faust and Russe11 [7] and Belding. [3]  Back to cited text no. 24    
25. Naidu, A. J.: A case of Sarcosporidiasis, Lancet, 214: 549-550, 1928.  Back to cited text no. 25    
26.Rivolta: Quoted by Faust and Russell7.  Back to cited text no. 26    
27.Rosenberg: Quoted by Babudeieril1.  Back to cited text no. 27    
28.Vasudevan, A.: A case of sarcosporidial infection in man, Indian J. Med. Res., 15: 141-142, 1927.  Back to cited text no. 28    
29.Vuilemin, P.: Le Sarcocystis Tenella parasite de 1' home. Compt. Rend. Acad. Sci. (Paris), 134: 1152-1154, 1902.  Back to cited text no. 29    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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