ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2014
Acute muscular sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011-2012.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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25 citing papers in PubMed, 63 citations in OpenAlex.
- Global Prevalence and Distribution of Human Sarcocystosis: A Systematic Review and Meta-Analysis.Tropical medicine and infectious disease · 2026Review
- GeoSentinel: past, present and future†.Journal of travel medicine · 2020Review
- Molecular differentiation of cattleFood and waterborne parasitology · 2020Article
- Seroprevalence of Sarcocystis falcatula in Two Islands of Malaysia using Recombinant Surface Antigen 4.The Korean journal of parasitology · 2020Article
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- 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
- Intravenously administered cloxacillin-induced neutropenia with eosinophilia in a patient with infective endocarditis: a case report.Journal of medical case reports · 2018Article
- Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel.Trends in parasitology · 2018Review
- 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
- Secondary myopathy due to systemic diseases.Acta neurologica Scandinavica · 2016Review
- Molecular evidence of Sarcocystis nesbitti in water samples of Tioman Island, Malaysia.Parasites & vectors · 2016Article
- Role of Macrophages in the Repair Process during the Tissue Migrating and Resident Helminth Infections.BioMed research international · 2016Review
- Molecular evidence of Sarcocystis species in captive snakes in Japan.Parasitology research · 2015Article
- Eosinophilia in Infectious Diseases.Immunology and allergy clinics of North America · 2015Review
- 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
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29 authors at 17 institutions in 7 countries.
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Abstract
backgroundThrough 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.
methodsClinicians 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.
resultsSixty-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.
conclusionsClinicians 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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