Laboratory Diagnosis

For intestinal sarcocystosis caused by S. hominis and S. suihominis, diagnosis i

s made by the observation of oocysts or sporocysts in stool. They are easily ove
rlooked as they are often shed in small numbers. Also, the two species cannot be
separated by oocyst or sporocyst morphology. When humans serve as dead-end host
s for non-human Sarcocystis spp., diagnosis is made by the finding of sarcocysts
in tissue specimens.
Treatment Information
Currently, there is no proven prophylaxis or therapeutic treatment for either in
testinal or tissue sarcocystosis. Albendazole was reported to be efficacious in
one case
Causal Agents
Sarcocystis hominis and S. suihominis use humans as definitive hosts and are res
ponsible for intestinal sarcocystosis in the human host. Humans may also become
dead-end hosts for non-human Sarcocystis spp. after the accidental ingestion of
oocysts.
Both sporulated oocysts (containing two sporocysts) and individual sporocysts ca
n be passed in stool The number 1. Sporocysts contain four sporozoites and a ref
ractile residual body. Sporocysts ingested by the intermediate host (cattle for
S. hominis and pigs for S. suihominis) rupture, releasing sporozoites. Sporozoit
es enter endothelial cells of blood vessels and undergo schizogony, resulting in
first-generation schizonts. Merozoites derived from the first-generation invade
small capillaries and blood vessels, becoming second-generation schizonts. The
second generation merozoites invade muscle cells and develop into sarcocysts con
taining bradyzoites, which are the infective stage for the definitive host The n
umber 2. Humans become infected when they eat undercooked meat containing these
sarcocysts. Bradyzoites are released from ruptured cysts in the small intestine
The number 3 and invade the lamina propria of the intestinal epithelium The numb
er 4. There, they differentiate into macro- and microgametocytes. Fusion of male
and female gametes The number 5 results in the formation of oocysts The number
6. Oocysts sporulate in the intestinal epithelium and are shed from the host in
feces The number 7. Due to the fragile nature of the oocyst wall, individual spo
rocysts may also be detected in feces.
Geographic Distribution
Worldwide, but more common in areas where livestock is raised.
Clinical Presentation
In cases of intestinal sarcocystosis, when humans serve as the definitive hosts,
infections are often asymptomatic and clear spontaneously. Occasionally, mild f
ever, diarrhea, chills, vomiting and respiratory problems may occur. When humans
become infected with sarcocysts of non-human species, the infections are not in
testinal but rather result in muscle cysts; symptoms such as myalgia, muscle wea
kness and transitory edema may occur. In these cases, humans are dead-end interm
ediate hosts.
Sarcocystosis is an important food-borne parasitosis in humans and various anima
ls. Sarcocystis miescheriana and Sarcocystis suihominis are pathogenic to pigs;
S. suihominis is also distinctly pathogenic to humans. Intermediate and final ho
sts can harbor more than one Sarcocystis species, so the exact identification fo
r Sarcocystis infection in various hosts is essential to control sarcocystosis i
n humans and important economic animals including pigs. In this study, four isol
ates of sarcocysts from slaughtered pigs (SmJY1-SmJY4) in the central region of
China, in Henan province, were collected and examined by transmission electron m
icroscopy and 18S rRNA sequence analysis to identify the Sarcocystis species in
pigs in China. The results showed that cysts in the diaphragm muscles have a thi
ck cyst wall with a number of palisade-like protrusions up to 4.38 m in length. I
nside these protrusions, there were 13-16 fibrils per protrusion. Bradyzoites in
cysts showed typical characteristics of Apicomplexa including a conoid, many mi
cronemes, dense bodies, one big nucleus, and a number of amylopectin granules. T
hese ultrastructural results suggest that characteristics of tissue cysts of the
isolates SmJY1-SmJY4 were similar to those of S. miescheriana. The sequence sim
ilarities of SmJY1-SmJY4 with S. miescheriana were 99-99.5 %, and the sequence s

imilarities of SmJY1-SmJY4 with S. suihominis were much lower. Results of the ul

trastructural observation in combination with molecular characterization based o
n the 18S rRNA sequence represent the first demonstration of S. miescheriana in
pigs in China. In addition, results of the histological examination showed that
the cysts of S. miescheriana had two types of cyst wall, a palisade-like thick w
all and another smoothly thin wall, and could cause obvious atrophy, degeneratio
n, and necrosis of muscle fibers in the diaphragm of naturally infected pigs. Th
ese findings will provide an important reference for the examination of Sarcocys
tis species in the slaughter quarantine of live pigs and in the control of sarco
cystosis in pigs.