Sarcocystis myopathy in a patient with HIV-AIDS.

Sarcocystosis is a zoonotic infection that causes intestinal and muscular illnesses in humans. Sarcocystosis was until recently considered rare in humans. To complete their life cycle, Sarcocystis species require both a definitive and an intermediate host. Humans are the definitive host when infected by one of two species: Sarcocystis hominis (from eating undercooked beef) or Sarcocystis suihominis (from eating uncooked pork). Infection with either of these species results in intestinal sarcocystosis, causing a self-limited disease characterized by nausea, abdominal pain, and diarrhea. Humans act as the intermediate host when infected by Sarcocystis nesbitti, resulting in the markedly different clinical picture of muscular sarcocystosis. Most documented cases of muscular sarcocystosis were assumed to be acquired in Malaysia, in addition to other regions of Southeast Asia and India. Published cases of muscular sarcocystosis from the Middle East, Central and South America, and Africa are all rare. Although the clinical presentation of muscular sarcocystosis remains to be fully characterized, fever, myalgia, and headache are among the most common symptoms. Here, we report a patient from sub-Saharan Africa with chronic Sarcocystis myopathy and well-controlled HIV-AIDS.

Diaphragmatic hydatid disease: a diagnostic challenge for the radiologist.

Primitive hydatid disease of diaphragm is very rare. The preoperative diagnosis of this hydatid location represents a challenge for the radiologist. We reported a case of primitive hydatid cyst of the diaphragm not associated with other hydatid localizations which was diagnosed preoperatively. A 70 year-old woman with no previous medical history, complained of abdominal pain in the right upper quadrant for 7 months. The physical exam and the laboratory tests were unremarkable. Abdominal ultrasound showed multiloculated cystic lesion which appeared to be located in the hepatic dome suggestive of hydatid cyst of the liver.  However, computed tomography showed findings but in favour of the diaphragmatic origin of the cyst which was confirmed peroperatively. Since the exploration of cysts lying between the thorax and the abdomen is difficult by ultrasound, computed tomography with multiplanar reconstruction appears to be indispensable in the preoperative assessment of hydatid cysts in contact with the diaphragm.

Morphological and molecular genetic characterization of two Kudoa spp., K. musculoliquefaciens, and K. pleurogrammi n. sp. (Myxosporea: Multivalvulida), causing myoliquefaction of commercial marine fish.

Genetic characterization of myxosporean species, including members of the genus Kudoa, has advanced dramatically throughout the last decade. This is in stark contrast to those species described further back in time. Kudoa musculoliquefaciens described from the jellied muscle of swordfish, Xiphias gladius, in the western Pacific Ocean off the Sanriku Coast, northern Japan, is one such species. In the present study, multiple pseudocysts (0.66-1.35 mm average length and 0.06-0.10 mm average width) containing K. musculoliquefaciens spores were collected from three host groups: muscle blocks of swordfish caught in the western Pacific Ocean off the Sanriku Coast, or the northern Indian Ocean, and Indo-Pacific sailfish, Istiophorus platypterus, in the western Pacific Ocean off Kochi, western Japan. Subspherical K. musculoliquefaciens spores, 8.0-10.3 µm in width, 7.3-10.0 µm in thickness, 6.4-7.9 µm in sutural thickness, and 5.5-8.1 µm in length, had four subspherical polar capsules, 2.8-4.0 µm in length by 2.2-3.2 µm in width. The kudoid spores found in the different host groups showed morphometric variations to some extent but had essentially identical nucleotide sequences of the ribosomal RNA gene (rDNA), closest to those of Kudoa hemiscylli or Kudoa carcharhini recorded from elasmobranchs in the Indo-Pacific Ocean. Another kudoid species, Kudoa pleurogrammi n. sp., was recorded from the jellied and normal muscles of Atka mackerel, Pleurogrammus monopterygius and Pleurogrammus azonus, fished in the northern Pacific Ocean or northern Sea of Japan. Subquadrate spores found in round-ended pseudocysts (1.15-3.85 mm in length and 0.11-0.26 mm in width) in myofibers were 8.2-9.1 µm in width, 7.1-8.2 µm in thickness, 5.4-7.7 µm in sutural thickness, and 5.6-6.8 µm in length, with four ovoid polar capsules, 2.7-2.9 µm in length by 1.4-2.0 µm in width. Kudoid spores from both jellied and normal muscles or different host fish species had identical 18S or 28S rDNA nucleotide sequences. Thus, molecular genetic characterization of kudoid species with the potential to induce post-mortem myoliquefaction will facilitate the reliable and specific identification of myxosporeans found in either jellied or normal muscles of important commercial fish.

Isolated Myocysticercosis.

Cysticercosis, a parasitic disease caused by larval form of Taenia solium, is a major health concern in the developing world. The encysted larval stage can affect any part of the body, but are most frequently detected in brain, eye, skeletal muscle and subcutaneous tissue. Most muscular cysticercosis are almost always associated with central nervous system involvement or with multiple intramuscular cysts or both. Here we report an unusual case of cysticercosis in right rectus muscle which was an isolated muscle involvement without any other systemic manifestation.

Myopathy in a patient with systemic AA amyloidosis possibly induced by psoriasis vulgaris: An autopsy case.

INTRODUCTION: Amyloid myopathy is a rare manifestation of primary systemic amyloid light-chain (AL) amyloidosis, but it has not been reported to occur in secondary amyloid A (AA) amyloidosis. METHODS: We describe a 46-year-old man with psoriasis vulgaris who presented with idiopathic upper and lower limb weakness and was eventually diagnosed with hypertrophic cardiomyopathy. Muscle biopsy findings were compatible with mild inflammatory myopathy. He died of cardiopulmonary arrest, and an autopsy was performed. RESULTS: The autopsy revealed amyloid plaques immunopositive for AA (but not AL or transthyretin) in the perimysial, perivascular, and endomysial regions of the iliopsoas muscle. The final diagnosis was systemic AA amyloidosis with muscle amyloid angiopathy, possibly induced by psoriasis vulgaris. CONCLUSION: This is an extremely rare autopsy case of myopathy in a patient with systemic AA amyloidosis. The reason for the unusually large amount of amyloid deposition in muscle blood vessel walls remains unclear.

KUDOA SP. (Myxozoa: Multivalvulida) in skeletal muscle of captive bullnose eagle rays, Myliobatis freminvillei (Rajiformes: Myliobatidae).

Kudoa spp. (Myxozoa: Multivalvulida) are of significant concern in marine and estuarine teleosts because of trophozoites and spores in the skeletal muscle reducing the marketability of wild and cultured fish. Kudoa spp. have rarely been reported from elasmobranchs. Spores of a Kudoa sp. were identified in two captive, mature bullnose eagle rays (Myliobatisfreminvillei) (Rajiformes: Myliobatidae). The male bullnose eagle ray (case 1) showed intractable weight loss, muscle wasting, and hyperkalemia, and was euthanized. The skeletal muscle showed myofiber degeneration, vacuolation, and necrosis, and spores of a Kudoa sp. were present multifocally through the muscle. The female bullnose eagle ray (case 2) had a severe, rapidly progressive, erosive lesion extending through the pectoral fin and was euthanized. Spores of a Kudoa sp. were not found in the lesion but were present in two disparate sections of skeletal muscle. There was no inflammation or degeneration associated with the infected myofibers in case 2. From case 1, morphometrics of 15 spores in histologic section were apical width 6.5-8.0 µm, apical thickness 5.0-7.0 µm, lateral width 5.5-6.5 µm, length 4.5-6.5 µm; the equal-sized polar capsules were spherical, 1.5-2.5 µm in diameter; there was a clear halo 2 µm thick around the spores, considered to be a mucous envelope. Spores from case 2 were indistinguishable from those in case 1. This appears to be the first report of Kudoa sp. in bullnose eagle rays.

[Emerging parasitic diseases]. / Maladies parasitaires émergentes.

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.

Intramuscular cysticercosis of the forearm mimicking a soft tissue tumour.

A man in his 20s presented with a painless, slow-growing firm swelling in the anterolateral aspect of his left forearm. The swelling had been present for 1 year and measured 10×12 cm. Clinically, a differential diagnosis of soft tissue sarcoma, lipoma, neurofibroma, dermoid cyst and hydatid cyst of the extremity was considered. MRI suggested a primary intramuscular hydatid cyst. However, fine-needle aspiration was inconclusive, and ELISA for immunoglobulin G antibodies to echinococcal antigen in serum was negative. A wide-local complete surgical excision of the lesion was planned. Intraoperatively, a well-defined, tense cystic swelling with surrounding dense adhesions was found within the intramuscular plane. Histopathological examination of the cyst wall revealed cysticercosis. The patient recovered uneventfully. This case highlights that solitary intramuscular cysticercosis, although rare, should be included in the differential diagnosis of an isolated soft tissue mass, particularly in endemic areas.

Hydatid cyst of the gluteal muscle: a case report and literature review.

INTRODUCTION: Echinococcosis is a relatively widespread anthropozoonosis in endemic regions, preferentially affecting the liver and lungs. Although rare, it can sometimes be localized in the muscles. The clinical symptoms are insidious and not very indicative, often leading to a delayed diagnosis. We reported a case of a hydatid cyst located in the gluteal muscle. OBSERVATION: This was a 52-year-old female patient admitted for the appearance of a swelling in the left buttock region, progressively increasing in size. The radiological exam, revealed a large simple cyst originating from the gluteal muscle with purely liquid content. A surgical excision was performed, and the parasitological examination of the hydatid fluid confirmed the diagnosis. CONCLUSION: Hydatid cysts in soft tissues are rare, slow-developing tumors with local extension. This diagnosis should be considered, especially in individuals from endemic countries. The treatment is primarily surgical, but the best way to combat hydatid disease, regardless of its location, remains prevention.

Solitary hydatid cyst in thigh without any detectable primary site.

Echinococcus granulosus causes a zoonotic infection called Cystic Echinococcosis (CE). Surgeons meet with hydatid cysts of the liver and lungs with reasonable frequency. However hydatid cyst may also appear in other parts of the body. A 30 years old lady presented with a smooth slow-growing subcutaneous nodule on the anteromedial side of the right thigh with no detectable primary site in the liver or lung. The case was subsequently diagnosed as hydatid cyst of muscle and radical surgery was done under coverage of anihelminthic drug. The common practice in this type of case is to do fine needle aspiration cytology (FNAC) taking the lesion to be a soft tissue neoplasm. The aim of this case presentation is to be aware of that in case of a diffuse non-tender swelling with history of gradual increase in size, hydatid cyst should be considered in the differential diagnosis.

Primary solitary hydatid cyst in paraspinal cervical muscles: a case report and review of the literature.

Hydatid disease caused by Echinococcus granulosus and Echinococcus multilocularis commonly presents with pulmonary and hepatic cysts. Primary paraspinal muscle cysts are a rare presentation. We report a case of hydatid cyst within paraspinal muscles presenting with cervical mass and associated pain. The hydatid disease serological test was negative. Neither hepatic nor pulmonary cystic lesions were found. Radiographic findings were unspecific for hydatid cysts. Surgical resection was planned due to the provisional diagnosis of muscular cystic neoplasm. During surgery, a cyst containing a clear liquid was found. The cyst wall was excised and the surgical field was irrigated with hypertonic saline. The patient's symptoms resolved by discharge day. Postoperative pathological examinations revealed a muscular hydatid cyst.

Systematic examination of the cardiopulmonary, urogenital, muscular and gastrointestinal parasites of the Eurasian otters (Lutra lutra) in Denmark, a protected species recovering from a dramatic decline.

The Eurasian otter (Lutra lutra) is a protected species in Denmark and at present, the population is recovering due to conservation efforts. The Danish otters are mainly found in the continental part of Denmark (Jutland), but establishment in the main islands (Fyn and Zealand) has been observed. While there is a lack of systematic studies on the parasite fauna of otters in Denmark, this study aims to screen otters for their parasite fauna, especially those of zoonotic and/or veterinary importance. Thirty-three otter carcasses, road-killed (n = 30), found dead (n = 2) and shot (n = 1), were collected between June 2013 and May 2014 and examined for cardiopulmonary, urogenital, gastrointestinal, and muscle helminths by post mortem examination. Faecal samples were analysed by modified concentration McMaster technique and direct immunofluorescence test for Giardia and Cryptosporidium. At least one parasite was found in 75.8% of animals. The parasite fauna included 13 species, consisting of five nematodes: Molineus patens (30.3%), Aonchotheca putorii (27.3%), Strongyloides sp. (24.2%), Physaloptera sp. (12.1%), Eucoleus aerophilus (10.0%); one cestode: Schistocephalus solidius (6.1%); four trematodes: Metorchis bilis (33.3%), Isthimiophora melis (15.2%), Cryptocotyle sp. (3.0%), Plagiorchis sp. (3.0%); one acanthocephalan: Acanthocephalus ranae (18.2%); and two protozoans: Giardia spp. (3.1%), and Eimeria spp. (3.1%). The study showed that otters carry parasites of zoonotic and veterinary importance. Many of these parasites can also infect native carnivores and birds, and the distribution of these parasites may be affected if the otter population continue to increase in Denmark.

An ultrasonographic evaluation of solitary muscular and soft tissue cysticercosis.

BACKGROUND: Cysticercosis in humans is infection with the larval form (cysticercus cellulosae) of the pork tapeworm T. solium. Encystment of larvae can occur in almost any tissue. The location of cysts in order of frequency is the central nervous system, subcutaneous tissue and striated muscle, vitreous humour of the eye and, rarely, other tissues. High resolution ultrasound can be used in the diagnosis of muscular and soft tissue cysticercosis. OBJECTIVE: The aim of this study is to evaluate the ultrasonographic findings in cases of muscular and soft tissue cysticercosis. MATERIALS AND METHODS: It was a retrospective review of the cases of muscular and soft tissue cysticercosis which were diagnosed by ultrasound during June 2007 to May 2009 in the department of Radiology and Imaging, Nepalgunj Medical College Teaching Hospital. A total of six patients were evaluated. RESULT: There were four males and two females. Age of the patient ranged from 18 to 50 years. All of the patients presented with a swelling with pain in fi ve of them. There was a wide variation in the location of the cysts. In all cases ultrasound revealed a cystic lesion with an echogenic eccentric pedunculated nodule attached to the wall. The mean diameter of the cyst was 6mm. Smooth wall was present in fi ve cases whereas one of the cysts revealed irregular wall. Pericystic inflammatory changes were seen in the adjacent muscles. CONCLUSION: Ultrasound is a safe and non-invasive method that can be used in the diagnosis of muscular and soft tissue cysticercosis.

Primary hydatid disease of the transverse abdominal muscle A case report.

INTRODUCTION: Echinococcus is a parasitic disease that affects all organs and tissues. The most commonly affected are liver (70-80%) and lungs (10-25%), while very rarely, in about 5% of cases, it can be found in the spleen, kidneys, brain, heart, pancreas, muscles and skeleton. CASE REPORT: Although localization of hydatid cyst in muscle is rare, it is important to consideredPORT it in the differential diagnosis of a cystic mass in the muscle. Clinical diagnosis of cystic echinococcosis is based on general ultrasound imaging, CT, MRI, differentiation of Echinococcus-Ag, ELISA testing, immunoelectrophoresis (IEP), counterimmunoelectrophoresis (CIE). DISCUSSION: Surgery is the primary treatment for muscle hydatidosis. We present our experience in treating the case of an infected hydatid cyst on transverse abdominal muscle, with infection extending to the right diaphragm and subcutaneous tissue of abdomen and thorax between the transverse abdominal and internal sternal abdominal muscles. CONCLUSION: The goal of the surgical treatment is total evacuation of the parasite, "sterilization" of the residual cavity and handling of intraoperartive complications. The post-operative course was normal and the patient was discharged to home care ten days after surgery in good general and local condition. KEY WORDS: Abscess, Echinococcus, Infection, Muscle.

[Isolated echinococcosis of the flexor digitorum profondus: a case report]. / Echinococcose isolée du muscle flexor digitorum profondus : à propos d'un cas.

Echinococcosis is a widespread zoonosis which is endemic in most sheep-raising countries. Primary isolated muscular localisation is uncommon even in these endemic areas. The authors report a rare case of primary hydatid cyst localized in the myotendinous junction of the flexor digitorum profundus. According to our review of the medical literature, there are no reports of a similar case, making ours the first such report.

Evaluation of radiologic diagnostic criteria and treatment options in skeletal muscle hydatid cysts.

AIM: To investigate the diagnosis and treatment methods of soft tissue involvement of hydatid cysts (HCs). MATERIALS AND METHODS: Eleven patients who were diagnosed as having HC with muscular tissue (soft tissue) involvement between 2010 and 2016 were evaluated retrospectively. Seven patients had typical HC magnetic resonance imaging (MRI) and four patients had cysts with an unusual appearance. We evaluated how to diagnose the cysts using imaging methods, their characteristic radiologic images, and treatment alternatives against the disease. The patients were treated with antihelminthic chemotherapy preoperatively and postoperatively. RESULTS: Of the 11 patients who underwent treatment, 7 were diagnosed using MRI and 4 were diagnosed with histopathologic examinations. The mean follow-up period was 16 (range, 6-24) months, and the mean age was 39.4 (range, 24-56) years. In seven patients, multivesicular appearance with specific MRI findings, T2-hypointense rim appearance, double-rim sign, membrane dissociation, and appearance of daughter cysts were identified as diagnostic criteria. Two patients underwent ultrasound assisted percutaneous aspiration-injection-reaspiration (PAIR) treatment. Seven patients underwent total pericystectomy, and two patients underwent subtotal pericystectomy with serum saline injection into the cyst. Two patients showed signs of mild anaphylaxis, one during the diagnosis and one during treatment. CONCLUSION: There may be difficulties in the diagnosis and treatment of HCs of the musculoskeletal system. It should be known that there are alternative methods in the treatment (cyst excision and PAIR treatment). Clinical, serologic, and radiologic findings should be used in the diagnosis. To avoid complications during the histopathologic diagnosis, MRI should be examined in detail. It is thought that atypical cysts can be diagnosed (double-layer appearance and peripheral rim sign) in addition to typical cysts (detached membrane and multivesicular appearance), and diagnosis and treatment can be planned without anaphylactic complications.

Primary hydatid disease in adductor muscles.

Primary muscular Echinococcus infection is very rare without involvement of thoracic and abdominal organs. In this case a 31-year-old man who had a growing mass in the postero-medial part of his right thigh was examined. The mass was diagnosed as hydatid cyst using ultrasound, magnetic resonance imaging (MRI) and serological tests. It was removed surgically and there has been no recurrence one year after the surgery. The MRI imaging characteristics may differ depending on the life cycle stage of the parasite. In this case report, we discuss the imaging characteristics of the muscular hydatid cyst with special emphasis on the MRI findings. In regions where hydatidosis is endemic, a mass found in body muscles should be considered as a muscular hydatid cyst.

Clinical presentation and pathology of sarcocystosis in psittaciform birds: 11 cases.

Sarcocystosis in psittaciform birds occurs in several different presentations, making ante-mortem diagnosis challenging without specific laboratory tests. This study followed the course of 11 birds diagnosed with sarcocystosis by serologic analysis and/or post-mortem examinations during a 10-month period in 2006-07. The disease presented in three different clinical forms: an acute pulmonary disease (three birds), muscular disease (five), and neurological disease (three). Early diagnosis of sarcocystosis was possible through the combined used of plasma protein electrophoresis and indirect fluorescent antibody serology in birds presented with the neurological and muscular forms of the disease. In three of these birds the plasma electrophoretic patterns revealed marked hypergammaglobulinemia. All of the birds that presented with the acute pulmonary form developed similar gross and microscopic lesions. Definitive diagnosis was ultimately made by microscopic observation of intravascular pulmonary schizonts containing merozoites. Schizonts were identified in the cerebellum and brainstem in two birds with the neurological form of disease. Those birds that initially presented with severe lethargy and weakness were considered to suffer from the muscular form of disease if they had extreme elevations of muscle enzyme activities (creatine phosphokinase, aspartate aminotransferase) and beta and gamma globulins concentrations, and were seropositive for antibodies to Sarcocystis falcatula. In this group the progression of the disease varied. Two birds recovered completely, and secondary aspergillosis was diagnosed in three birds. The histopathological lesions observed are discussed and interpreted in light of earlier findings from experimental infections in budgerigars, which provide insights into the natural course of sarcocystosis in psittaciform birds.

Molecular and morphological analysis of Myxobolus spp. of salmonid fishes with the description of a new Myxobolus species.

While investigating the parasite fauna of wild coho salmon. Oncorhynchus kisutch (Walbaum, 1792), histological examination provided evidence of a new species of Myxobolus (Myxozoa: Myxosporea) infecting nerves of skeletal muscle. Spores were morphologically similar to those of the intramuscular Myxobolus insidiosus Wyatt and Pratt, 1963, both having pyriform spores with clavate polar capsules. However, the former developed exclusively in the nerves of skeletal muscle rather than in myocytes. We examined both species of Myxobolus derived from coho salmon; Chinook salmon, Oncorhynchus tshawytscha (Walbaum, 1792); cutthroat trout, Oncorhynchus clarkii (Richardson, 1836); and rainbow trout Oncorhynchus mykiss (Walbaum, 1792) from freshwater in Oregon. Spore morphology, small subunit ribosomal RNA gene (rDNA) sequences, and site of infection were compared. Myxobolus arcticus Pugachev and Khokhlov, 1979 has pyriform spores, infects the central nervous system of many salmonids, and is found in the Pacific Northwest. It was therefore included in the analyses to rule out conspecificity with the new species. Together, these data show that the Myxobolus sp. from peripheral nerves in the skeletal musculature of coho salmon, rainbow trout, and cutthroat trout is a new species, described herein as Myxobolus fryeri n. sp.