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Autochthonous Human Schistosomiasis, Malaysia LETTERS products, Minnesota and Wisconsin, 2002– mekongi and differs genetically from smaller operculated ova typically 2004. Emerg Infect Dis. 2007;13:838–46. the latter by ≈10%. Both species dif- found in feces or bile), and the similar http://dx.doi.org/10.3201/eid1306.061576 6. Overdevest I, Willemsen I, Rijnsburger fer from S. japonicum by 25% (5), and Eurytrema (thick-walled operculated M, Eustace A, Xu L, Hawkey P, et al. adult and ova morphologies are simi- ova in feces). Extended-spectrum β-lactamase genes lar (4). Few transmission sites for this Schistosomiasis is endemic in of Escherichia coli in chicken meat and new S. japonicum–complex schisto- many developing countries and in- humans, the Netherlands. Emerg Infect Dis. 2011;17:1216–22. http://dx.doi.org/ some species were identified in rural fects >207 million persons living in 10.3201/eid1707.110209 areas (4). We report after 30 years the rural agricultural areas (6). In Asia, 7. Dutil L, Irwin R, Finley R, Ng LK, Avery histologic finding of S. malayensis– S. japonicum, S. mekongi, and S. ma- B, Boerlin P, et al. Ceftiofur resistance in like eggs in the liver of a Malay man layensis cause human infection (7), Salmonella enterica serovar Heidelberg from chicken meat and humans, Cana- and discuss public health implications. with S. japonicum being the most da. Emerg Infect Dis. 2010;16:48–54. A 29-year-old male nonaboriginal dangerous. In Malaysia, S. malayen- http://dx.doi.org/10.3201/eid1601.090729 Malay from Subang Jaya in Selangor sis, in addition to S. spindale, S. na- 8. US Food and Drug Administration. State, Peninsular Malaysia, had died sale, S. incognitum, Trichobilhazia Cephalosporin order of prohibition goes into effect. April 6, 2012 [cited 2012 suddenly of an intoxication in 2011. brevis, and Pseudobilharziella lon- Apr 20]. http://www.fda.gov/Animal- According to his mother, he had re- churae, is known to occur in wildlife Veterinary/NewsEvents/CVMUpdates/ ported hematuria and dysuria during (8). The first known case of human ucm299054.htm adolescence. Similar symptoms had schistosomiasis in Malaysia was dis- reoccurred 10 years later, accom- covered in 1973 during an autopsy Address for correspondence: Peter Collignon, panied by constipation. The patient of an aborigine. Schistosoma eggs Infectious Diseases and Microbiology, Canberra had never been outside of Malaysia, resembling those of S. japonicum Hospital, PO Box 11, Woden. ACT 2607, and he had gone bomb fishing for were found in liver tissue (1). A sub- Australia; email: [email protected] many years in Sungai Lepar Utara, a sequent retrospective autopsy study river near his village (Felda Tekam revealed additional cases with these Utara, Jerantut, Pahang; 3°52’30”N, Schistosoma japonicum–like ova in 102°49’2”E). No tests on blood or fe- the rural aboriginal population, re- ces were performed before his death. sulting in an overall prevalence of An autopsy was conducted in Sungai 3.9% (2). Several attempts to recover Autochthonous Buloh Hospital, and gross pathology eggs from feces from the Orang Asli showed a normal heart, kidneys, and population in peninsular Malaysia Human brain. The lungs were edematous and (3), a biopsy-positive Orang Asli (3), Schistosomiasis, congested. The liver also was con- and serologically positive persons Malaysia gested, but no macroscopic lesions (9, and others) were unsuccessful, were seen. Toxicology investigations however, which was attributed to the To the Editor: In Malaysia, the showed methadone and a derivative in zoonotic nature of S. malayensis and only histologically diagnosed autoch- his blood and urine. During a routine thus missing adaptation to the human thonous cases of human schistosomia- histologic examination, several gran- host. Whether hematuria, a typical sis were reported in the 1970s, all in ulomas with intensive lymphocyte, sign of S. haematobium infection, as rural aborigine (Orang Asli) popula- monocyte, and eosinophil infiltration seen in the patient reported here also tions (1–3) (online Technical Appen- surrounding clusters of ovoidal eggs was caused by S. malayensis disease dix Figure 1, wwwnc.cdc.gov/EID/ were found in the liver (Figure; online remains unclear because symptoms article/19/8/12-1710-Techapp1.pdf). Technical Appendix Figure 2). Serial of the latter have not been reported. The fact that the infection had been sectioning showed that the eggs con- Serologic surveys for schistosomia- found only among aborigines had led tained miracidia and had the overall sis in peninsular Malaysia showed to the proposal of a distinct unknown appearance of S. malayensis–like ova prevalences of 4%–25% in selected schistosome with an animal reservoir 50 µm long × 28 µm wide. The ova rural populations (9). Because infect- causing sylvatic infections (2,3). Con- were not operculated and had no bipo- ed Robertsiella snails had been found sequently, during the 1980s, Schisto- lar plugs; the thin yellowish shell was almost exclusively in small rivers soma malayensis n. sp. was described not striated, but a knob-like structure (4,9–habitats like the Sungai Lepar from intermediate snail (Robertsiella was seen laterally. Morphologic dif- Utara River in our current report–we sp.) and final mammalian hosts (Rat- ferential diagnoses included eggs of suspect that the patient most likely tus muelleri and R. tiomanicus [4]). Capillaria hepatica (bipolar striated became infected while fishing. The S. malayensis is closely related to S. ova in liver), Dicrocoelium (slightly travel history may not be accurate 1340 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 8, August 2013 LETTERS japonicum–complex schistosome from Peninsular Malaysia. J Parasitol. 1988;74: 471–80. http://dx.doi.org/10.2307/ 3282058 5. Le TH, Blair D, McManus DP. Revisit- ing the question of limited genetic varia- tion within Schistosoma japonicum. Ann Trop Med Parasitol. 2002;96:155–64. http://dx.doi.org/10.1179/0003498 02125000268 6. Oliveira G, Rodrigues NB, Romanha AJ, Bahia D. Genome and genomics of schistosomes. Can J Zool. 2004;82:375– 90. http://dx.doi.org/10.1139/z03-220 7. Leshem E, Meltzer E, Marva E, Schwartz E. Travel-related schistoso- miasis acquired in Laos. Emerg Infect Dis. 2009;15:1823–6. http://dx.doi. org/10.3201/eid1511.090611 8. Krishnasamy M, Chong NL, Ambu S, Jeffery J, Oothuman P, Edariah AB. Schistosomiasis in Malaysia, with special reference to Schistosoma spindale, the causative agent of cercarial dermatitis. Trop Biomed. 2001;18:51–64. 9. Greer GJ, Anuar H. Serological evidence Figure. Close-up of liver granuloma with section through 3 Schistosoma malayensis-–like of schistosomiasis among Orang Asli from ova embedded in dense fibrous tissue. The thin-walled, nonstriated helminth ova are not three areas of Peninsular Malaysia. South- operculated and contain nonvital miracidial cells. Hematoxylin and eosin stain; original east Asian J Trop Med Public Health. magnification ×100. 1984;15:303–12. 10. Sejvar J, Bancroft E, Winthrop K, Bettinger J, Bajani M, Bragg S, because it was obtained from a rela- Baha Latif, Chong Chin Heo, et al. Leptospirosis in “Eco-Challenge” tive, and possible unreported drug- Rahimi Razuin, athletes, Malaysian Borneo, 2000. Emerg related travel by the patient to neigh- Devi V. Shamalaa, Infect Dis. 2003;9:702–7. http://dx.doi. org/10.3201/eid0906.020751 boring countries cannot be fully and Dennis Tappe Author affiliations: Universiti Teknologi excluded. R. muelleri, the jungle rat Address for correspondence: Baha Latif, Faculty MARA, Shah Alam, Malaysia (B. Latif, C.C. and definitive host for S. malayensis, of Medicine, Universiti Teknologi, MARA, Heo); Hospital Sungai Buloh, Sungai Buloh, is often seen at river banks (4), and Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia (R. Razuin, D.V. Shamalaa); and rodent feces could have contaminated Malaysia; email: [email protected] the water with schistosome eggs. University of Würzburg, Wuerzburg, Ger- Future field studies are needed many (D. Tappe) to identify focal hot spots of sylvatic DOI: http://dx.doi.org/10.3201/eid1908.121710 transmission by snail examination and seroprevalence studies of persons living References in rural areas, especially the Orang Asli Asian Musk Shrew population. Moreover, in light of grow- 1. Murugasu R, Dissanaike AS. First case of as a Reservoir of ing ecotourism, which also encompass- schistosomiasis in Malaysia. Trans R Soc Trop Med Hyg. 1973;67:880. http://dx.doi. Rat Hepatitis E es stays at remote Orang Asli villages org/10.1016/0035-9203(73)90017-5 and canoeing on small streams (10), ap- 2. Leong SH, Murugasu R, Chong KC. Virus, China propriate public health measures, such Schistosomiasis in the Orang Asli (report To the Editor: Rat hepatitis E vi- as rodent and snail control near tourist of 9 cases). In: Proceeeding of the 10th Malaysian–Singapore Congress of Medi- rus (HEV), a member of genus Hepevi- sites, should be implemented. cine. Singapore: Stamford College Press; rus in the family Hepeviridae, was first 1975; p.184–6. 3. Murugasu R, Wang F, Dissanaike AS. detected in Norway rats in Germany in Acknowledgements Schistosoma japonicum–type infection in 2010 (1, 2). Since then, this rat HEVhas We express our gratitude to Khalid Malaysia—report of the first living case. been detected in multiple wild rat spe- Yusoff for his support in providing the Trans R Soc Trop Med Hyg. 1978;72:389– cies in the United States, Vietnam, research facilities. We also thank the Hos- 91. http://dx.doi.org/10.1016/0035-9203 (78)90133-5 Germany, and Indonesia (3–7). Stud- pital Sungai Buloh for the cooperation in 4. Greer GJ, Ow-Yang CK, Yong HS. ies have shown that rat HEV failed preparing the slides and specimens. Schistosoma malayensis n. sp.: a Schistosoma to infect rhesus monkeys and pigs, Emerging Infectious Diseases • www.cdc.gov/eid • Vol.
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