1 November, 2012
Sarcocystosis in travellers to Malaysia
A cluster of 32 cases of muscular sarcocystosis in travellers who visited Tioman Island, Malaysia, was reported in travellers in the summer of 2011 . Further cases of muscular sarcocystosis associated with travel to Malaysia continue to be reported in European travellers during 2012. In August 2012, three cases of muscular sarcocystosis were reported in French travellers who travelled to Malaysia in June, and a fourth case in a Swiss traveller who spent three months in Malaysia and Indonesia . A further two cases were reported in Dutch travellers who visited Malaysia during late August and early September 2012 . All travellers had visited Tioman Island in Malaysia.
Sarcocystosis is a disease caused by a protozoan parasite called Sarcocystis. Sarcocystosis is common amongst wild and domestic animals, but can cause human infection. The disease occurs in tropical and sub-tropical countries including South East Asia.
Two types of sarcocystosis have been described in humans; intestinal and muscular. This outbreak is of the muscular sarcocystosis type.
Muscular sarcocystosis is probably caused by several unidentified species of the parasite, genus Sarcocystis. Humans become infected by eating food contaminated with faeces containing sporocysts of the parasite from an infected animal e.g. a fox, racoon, dog, coyote or wolf. The parasite reproduces and migrates to muscle tissue where it forms cysts. These cysts contain parasites that are infectious if eaten. Most human infections are asymptomatic. Symptoms when present include fever and muscle pains. The infection is diagnosed by muscle biopsy.
Intestinal sarcocystosis caused by two species of the parasite genus Sarcocystis, S. hominis and S. suihominis. Humans become infected by eating undercooked meat of an infected animal, either a cow or pig. Symptoms, when present, include diarrhoea, nausea, vomiting and abdominal pain. It is diagnosed by finding the Sarcocystis parasite in the faeces.
Advice for travellers
All travellers are advised to take food, water and personal hygiene precautions. All meat should be thoroughly cooked before eating. In addition, sarcocystis parasites are killed by freezing meat prior to cooking.
1. U.S Centers for Disease Control and Prevention. Notes from the field: Acute muscular sarcocystosis in returning travelers – Tioman Island, Malaysia, 2011. MMWR. 61(2):37-8, 2012. [Accessed 1 November 2012]. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6102a4.htm
2. U.S Centers for Disease Control and Prevention. Sarcocystosis in Malaysia. 10 September 2012. [Accessed i November]. Available at: http://wwwnc.cdc.gov/travel/notices/outbreak-notice/sarcocystosis-malaysia-outbreak.htm
3. ProMED Mail. Sarcocystosis, human – Malaysia (03): New cases, travel related. 21 October 2012. [Accessed 1 November 2012]. Available at: http://www.promedmail.org/direct.php?id=20121021.1356457