ArticlePLoS neglected tropical diseases2014
Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012.
Article in PLoS neglected tropical diseases, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 59 citations in OpenAlex.
- Global Prevalence and Distribution of Human Sarcocystosis: A Systematic Review and Meta-Analysis.Tropical medicine and infectious disease · 2026Review
- Zoonotic potential of bovine Sarcocystis species: a challenge for public health and meat inspection.Revista do Instituto de Medicina Tropical de Sao Paulo · 2026Review
- Sarcocystosis in Farm Animals in Brazil: A One-Health Approach.Veterinary sciences · 2025Review
- Article
- Zoonotic parasites associated with predation by dogs and cats.Parasites & vectors · 2023Review
- Epidemiological and Histopathological Investigation ofVeterinary sciences · 2020Article
- Zoonotic Parasites of Reptiles: A Crawling Threat.Trends in parasitology · 2020Review
- Seroprevalence of Sarcocystis falcatula in Two Islands of Malaysia using Recombinant Surface Antigen 4.The Korean journal of parasitology · 2020Article
- Are molecular tools clarifying or confusing our understanding of the public health threat from zoonotic enteric protozoa in wildlife?International journal for parasitology. Parasites and wildlife · 2019Review
- Atypical Presentation of Human Acute Muscular Sarcocystosis: Sarcocystis Nesbitti Confirmed on Molecular Testing.The American journal of case reports · 2019Article
- Sarcocystis myopathy in a patient with HIV-AIDS.Journal of neurovirology · 2018Article
- Muscular sarcocystosis: an index case in a native Malaysian.BMJ case reports · 2017Article
- Article
- Ancient, globally distributed lineage of Sarcocystis from sporocysts of the Eastern rat snake (Pantherophis alleghaniensis) and its relation to neurological sequalae in intermediate hosts.Parasitology research · 2016Article
- Human Extraintestinal Sarcocystosis: What We Know, and What We don't Know.Current infectious disease reports · 2015Article
- Human Invasive Muscular Sarcocystosis Induces Th2 Cytokine Polarization and Biphasic Cytokine Changes, Based on an Investigation among Travelers Returning from Tioman Island, Malaysia.Clinical and vaccine immunology : CVI · 2015Article
- Human infections with Sarcocystis species.Clinical microbiology reviews · 2015Review
- Reply to Italiano et al.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2015Article
- Molecular Evidence ofIranian journal of parasitologyArticle
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFrom the 17th to 19th January 2012, a group of 92 college students and teachers attended a retreat in a hotel located on Pangkor Island, off the west coast of Peninsular Malaysia. Following the onset of symptoms in many participants who presented to our institute, an investigation was undertaken which ultimately identified Sarcocystis nesbitti as the cause of this outbreak. METHODOLOGY/PRINCIPAL
findingsAll retreat participants were identified, and clinical and epidemiological information was obtained via clinical review and self-reported answers to a structured questionnaire. Laboratory, imaging and muscle biopsy results were evaluated and possible sources of exposure, in particular water supply, were investigated. At an average of 9-11 days upon return from the retreat, 89 (97%) of the participants became ill. A vast majority of 94% had fever with 57% of these persons experiencing relapsing fever. Myalgia was present in 91% of patients. Facial swelling from myositis of jaw muscles occurred in 9 (10%) patients. The median duration of symptoms was 17 days (IQR 7 to 30 days; range 3 to 112). Out of 4 muscle biopsies, sarcocysts were identified in 3. S. nesbitti was identified by PCR in 3 of the 4 biopsies including one biopsy without observed sarcocyst. Non-Malaysians had a median duration of symptoms longer than that of Malaysians (27.5 days vs. 14 days, p = 0.001) and were more likely to experience moderate or severe myalgia compared to mild myalgia (83.3% vs. 40.0%, p = 0.002). CONCLUSIONS/SIGNIFICANCE: The similarity of the symptoms and clustered time of onset suggests that all affected persons had muscular sarcocystosis. This is the largest human outbreak of sarcocystosis ever reported, with the specific Sarcocystis species identified. The largely non-specific clinical features of this illness suggest that S. nesbitti may be an under diagnosed infection in the tropics.
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