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. 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,

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Abstract

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.

Item Type:	Article
Funders:	UNSPECIFIED
Additional Information:	ISI Document Delivery No.: AJ5OS Times Cited: 0 Cited Reference Count: 20 Italiano, Claire M. Wong, Kum Thong AbuBakar, Sazaly Lau, Yee Ling Ramli, Norlisah Omar, Sharifah Faridah Syed Bador, Maria Kahar Tan, Chong Tin University of Malaya Research Grant RG324/11HTM, RP011-2012; Tropical Infectious Disease Research and Education Center Internal Research Fund; University of Malaya High Impact Research Fund UM.C/HIR/MOHE/MED/02, UM.C/HIR/MOHE/MED/18, E00004-20001; University of Malaya HIR grant UM.C/625/HIR/MOHE/MED-06 This study imaging protocol was funded with the assistance from a University of Malaya Research Grant (RG324/11HTM). The molecular work was funded by Tropical Infectious Disease Research and Education Center Internal Research Fund, University of Malaya High Impact Research Fund (UM.C/HIR/MOHE/MED/02 and UM.C/HIR/MOHE/MED/18) and University of Malaya Research Grant (RP011-2012). Pathological studies were funded by University of Malaya High Impact Research Fund (E00004-20001) and University of Malaya HIR grant UM.C/625/HIR/MOHE/MED-06. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Public library science San francisco
Uncontrolled Keywords:	Infection coccidia
Subjects:	R Medicine
Divisions:	Faculty of Medicine
Depositing User:	Ms azrahani halim
Date Deposited:	04 Nov 2014 01:56
Last Modified:	13 Mar 2019 04:47
URI:	http://eprints.um.edu.my/id/eprint/11213

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