TY - JOUR
T1 - Acute muscular sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011-2012
AU - Esposito, Douglas H.
AU - Stich, August
AU - Epelboin, Loïc
AU - Malvy, Denis
AU - Han, Pauline V.
AU - Bottieau, Emmanuel
AU - da Silva, Alexandre
AU - Zanger, Philipp
AU - Slesak, Günther
AU - van Genderen, Perry J. J.
AU - Rosenthal, Benjamin M.
AU - Cramer, Jakob P.
AU - Visser, Leo G.
AU - Muñoz, José
AU - Drew, Clifton P.
AU - Goldsmith, Cynthia S.
AU - Steiner, Florian
AU - Wagner, Noémie
AU - Grobusch, Martin P.
AU - Plier, D. Adam
AU - Tappe, Dennis
AU - Sotir, Mark J.
AU - Brown, Clive
AU - Brunette, Gary W.
AU - Fayer, Ronald
AU - von Sonnenburg, Frank
AU - Neumayr, Andreas
AU - Kozarsky, Phyllis E.
AU - AUTHOR GROUP
AU - van den Enden, Erwin
AU - van Esbroeck, Marjan
AU - Ghesquiere, Wayne
AU - Nguyen, Duc
AU - Receveur, Marie-Catherine
AU - Peyron, François
AU - Parola, Philippe
AU - Savini, Hélène
AU - Caumes, Eric
AU - Perignon, Alice
AU - Develoux, Michel
AU - Rapp, Christophe
AU - Keller, Christian A.
AU - Haditsch, Martin
AU - Güthoff, Wolfgang
AU - Liebold, Ines
AU - Schäfer, Johannes
AU - Gobbi, Federico
AU - Goorhuis, Abraham
AU - van Vugt, Michèle
AU - Stijnis, Kees
AU - Aronica, Eleonora
PY - 2014
Y1 - 2014
N2 - Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012. Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses
AB - Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012. Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses
U2 - https://doi.org/10.1093/cid/ciu622
DO - https://doi.org/10.1093/cid/ciu622
M3 - Article
C2 - 25091309
SN - 1058-4838
VL - 59
SP - 1401
EP - 1410
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -