Diagnosis
There are several other genera of heteroxenous and cyst-forming coccidia including Besnoitia, Cystoisospora, Frenkelia, Hammondia, Neospora and Toxoplasma. Related but monoxenous spore forming genera include Isospora. Differentiating these genera from Sarcocystis in diagnostic material may be difficult without immunochemical stains.
The diagnosis is usually made post mortum by examination of the skeletal muscle. In some species the cysts may be visible to the naked eye (ducks, mice, rabbits and sheep) but in most microscopic examination is required. Ante mortum diagnosis may be made with the use of dermal sensitivity testing or complement fixation tests. Muscle biopsy is also diagnostic but this is much less commonly used.
Oocysts with two sporocysts or individual sporocysts in human feces are diagnostic of intestinal infection. These first appear 14 to 18 days after ingesting beef (S. hominis), and 11 to 13 days after ingesting pork (S. suihominis). Flotation based on high-density solutions incorporating sodium chloride, cesium chloride, zinc sulfate, sucrose, Percoll, Ficoll-Hypaque or other such density gradient media is preferred to formalin-ethyl acetate or other sedimentation methods. Sporocysts of S. hominis average 9.3 by 14.7 micrometres and those of S. suihominis average 10.5 by 13.5 micrometres. Because of the overlap in size, size alone is not reliable as a diagnostic criterion of the species. Confirmatory staining with the periodic acid-Schiff (PAS) can be performed as the walls stain positively. PCR amplification of the rRNA may also be used.
The walls of the sarcocyst may be helpful in species diagnosis with 24 wall types identified in 62 species. S. hominis and S. suihominis both have walls of type 10. The wall of S. hominis is up to 6 micrometres thick and appears radially striated from villar protrusions up to 7 micrometres long. Its bradyzoites are 7 to 9 micrometres long. The wall of S. suihominis is 4 to 9 micrometres thick, with villar protrusions up to 13 micrometres long. Its bradyzoites are 15 micrometres long.
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