Muskuläre Sarkozystose nach Malaysiareise: eine Fallserie aus Deutschland

Abstract

Muscular sarcocystosis develops in a biphasic pattern with initial fever and later prolonged myalgia, eosinophilia, and CK-elevation. Steroids achieve symptomatic relief in the late phase. Early cotrimoxazole-therapy could possibly prevent parasitic muscle invasion. In fever after travel to Malaysia differential diagnosis should include sarcocystosis. The source of infection appears to be located in North-West of Tioman. Further studies are needed, including addressing early diagnosis and treatment.

Human Invasive Muscular Sarcocystosis Induces Th2 Cytokine Polarization and Biphasic Cytokine Changes, Based on an Investigation among Travelers Returning from Tioman Island, Malaysia

“…One outbreak occurred in 2012 on Pangkor Island, located on the west coast of peninsular Malaysia (2,3), and involved 89 students and teachers, mostly from Asia. The other one took place in two successive waves in 2011 and 2012 on Tioman Island, located on the east coast, and affected Ͼ100 international travelers (4)(5)(6)(7). A third wave of infected travelers returning from Tioman Island was reported in 2014 (8), indicating an ongoing transmission from a still unknown source.…”

“…The disease has a two-phase symptomatology (3, 6, 7) consisting of an early phase characterized by fever, headache, and myalgia (phase one), followed by an asymptomatic or less symptomatic interval, and a later, again symptomatic myositic phase (phase two). Severe symptoms and prolonged and relapsing courses, even over months, have been documented (3,6,7,11). Unusual for a protozoal parasite, the organism causes eosinophilia in the human accidental intermediate host.…”

“…Creatine kinase and eosinophil counts were elevated in all patients, and trichinellosis serology was negative. All patients had stayed in various villages at the northern tip of the island, as reported previously (6). According to the clinical course and the two-phase nature of invasive sarcocystosis, 3 travelers were diagnosed with phase one of the illness (2 male, 1 female; 15 to 41 years old), and 6 travelers were diagnosed with phase two of the disease (1 male, 5 female; 9 to 44 years old).…”

“…The biphasic changes in cytokine levels observed during the two clin- ical phases of invasive sarcocystosis likely reflect the hosts' immune response during parasite invasion and formation of schizonts in the vascular endothelium (assumed phase one of the clinical symptomatology), followed by the development of sarcocysts in muscles (phase two). Eosinophilia, a hallmark of human muscular sarcocystosis (1)(2)(3)(4)(5)(6)(7)(8), is unusual in unicellular invasive parasitic infections and is rather seen in tissue-invasive infections involving multicellular parasites, allergy, and hematological disorders. Levels of IL-4 and IL-10, additional Th2 cytokines, were not elevated, but the observed decrease of intracellular IL-2 and IFN-␥ following lymphocyte stimulation also points toward a slightly Th2-biased immune response.…”

Muskuläre Sarkozystose nach Malaysiareise – Eine Fallserie aus Deutschland mit 40 Patienten von 2011–2014

“…Muskelbioptisch fand sich bei einem Patienten eine muskuläre Sarkozystose [1]. Nach Meldung an internationale Netzwerke (ProMed-mail, GeoSentinel, EuroTravNet, TropNet) wurden weltweit bis 11/2012 circa 100 Fälle nach Tiomanurlaub identifiziert [2][3][4][5], inlusive im Herbst 2012 kurz nacheinander 9 Erkrankte an der Tropenklinik Paul-Lechler-Krankenhaus Tübingen [6,7]. Weit über 100 verschiedene Sarcocystisarten sind bekannt [4,8].…”