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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

Background: From 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 un...

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Main Authors: Italiano, C.M., Wong, Kum Thong, AbuBakar, Sazaly, Lau, Y.L., Ramli, Norlisah, Omar, S.F.S., Bador, M.K., Tan, C.T.
Format: Article
Language:English
Published: Public Library of Science 2014
Subjects:
R Medicine
Online Access:http://eprints.um.edu.my/11213/1/Italiano-2014-Sarcocystis_nesbitti.pdf
http://eprints.um.edu.my/11213/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031117/
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spelling my.um.eprints.112132019-03-13T04:47:57Z http://eprints.um.edu.my/11213/ 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 Italiano, C.M. Wong, Kum Thong AbuBakar, Sazaly Lau, Y.L. Ramli, Norlisah Omar, S.F.S. Bador, M.K. Tan, C.T. R Medicine Background: From 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 Findings: All 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. Public Library of Science 2014 Article PeerReviewed application/pdf en http://eprints.um.edu.my/11213/1/Italiano-2014-Sarcocystis_nesbitti.pdf Italiano, C.M. and Wong, Kum Thong and AbuBakar, Sazaly and Lau, Y.L. and Ramli, Norlisah and Omar, S.F.S. and Bador, M.K. and Tan, C.T. (2014) 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. PLoS Neglected Tropical Diseases, 8 (5). ISSN 1935-2727 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031117/
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
language English
topic R Medicine
spellingShingle R Medicine
Italiano, C.M.
Wong, Kum Thong
AbuBakar, Sazaly
Lau, Y.L.
Ramli, Norlisah
Omar, S.F.S.
Bador, M.K.
Tan, C.T.
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
description Background: From 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 Findings: All 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.
format Article
author Italiano, C.M.
Wong, Kum Thong
AbuBakar, Sazaly
Lau, Y.L.
Ramli, Norlisah
Omar, S.F.S.
Bador, M.K.
Tan, C.T.
author_facet Italiano, C.M.
Wong, Kum Thong
AbuBakar, Sazaly
Lau, Y.L.
Ramli, Norlisah
Omar, S.F.S.
Bador, M.K.
Tan, C.T.
author_sort Italiano, C.M.
title 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
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
publisher Public Library of Science
publishDate 2014
url http://eprints.um.edu.my/11213/1/Italiano-2014-Sarcocystis_nesbitti.pdf
http://eprints.um.edu.my/11213/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031117/
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score 13.211869

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