MyMedR

Suspected new wave of muscular sarcocystosis in travellers returning from Tioman Island, Malaysia, May 2014

Tappe D, Stich A, Langeheinecke A, von Sonnenburg F, Muntau B, Schäfer J, et al.

Euro Surveill, 2014 May 29;19(21).

In May 2014, six patients presented in Germany with a Sarcocystis-associated febrile myositis syndrome after returning from Tioman Island, Malaysia. During two earlier waves of infections, in 2011 and 2012, about 100 travellers returning to various European countries from the island were affected. While the first two waves were associated with travel to Tioman Island mostly during the summer months, this current series of infections is associated with travel in early spring, possibly indicating an upcoming new epidemic.

[Muscular sarcocystosis after travel to Malaysia: a case series from Germany]

Slesak G, Tappe D, Keller C, Cramer J, Güthoff W, Zanger P, et al.

Dtsch. Med. Wochenschr., 2014 May;139(19):990-5.

PMID: 24782151 DOI: 10.1055/s-0034-1370004

Since 2011, about 100 travellers to the island of Tioman, Malaysia, have been diagnosed worldwide with suspected muscular sarcocystosis, a previously only sporadically observed parasitic disease. Source of infection and therapy remain unclear. Final diagnosis requires microscopic identification of cysts in muscle biopsies. The study objective was a systematic description of characteristic symptoms, laboratory investigations and treatment response.

Fulltext Travel-related Streptococcal toxic shock syndrome caused by emm type 78 Streptococcus pyogenes

Tappe D, Schulze MH, van der Linden M, Ziegler U, Müller A, Stich A

J Clin Microbiol, 2011 Aug;49(8):3094-5.

PMID: 21632896 DOI: 10.1128/JCM.02623-10

Streptococcal toxic shock syndrome is a serious health problem in developed and developing countries. We here report a case of severe protracted disease after a minor skin infection in a young traveler returning from West Malaysia which was caused by an unusual emm-type strain harboring speG and smeZ superantigen genes.

Fulltext Initial patient cluster and first positive biopsy findings in an outbreak of acute muscular Sarcocystis-like infection in travelers returning from Tioman island, Peninsular Malaysia, in 2011

Tappe D, Ernestus K, Rauthe S, Schoen C, Frosch M, Müller A, et al.

J Clin Microbiol, 2013 Feb;51(2):725-6.

PMID: 23224083 DOI: 10.1128/JCM.03063-12

Fulltext Acute muscular sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011-2012

Esposito DH, Stich A, Epelboin L, Malvy D, Han PV, Bottieau E, et al.

Clin Infect Dis, 2014 Nov 15;59(10):1401-10.

PMID: 25091309 DOI: 10.1093/cid/ciu622

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

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