Muskuläre Sarkozystose nach Malaysiareise: eine Fallserie aus Deutschland
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Muskuläre Sarkozystose nach Malaysiareise: eine Fallserie aus Deutschland. / Slesak, G; Tappe, D; Keller, Christian; Cramer, J; Güthoff, W; Zanger, P; Frank, M; Ernestus, K; Rauthe, S; Stich, A; Schäfer, J.
in: DEUT MED WOCHENSCHR, Jahrgang 139, Nr. 19, 01.05.2014, S. 990-5.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Muskuläre Sarkozystose nach Malaysiareise: eine Fallserie aus Deutschland
AU - Slesak, G
AU - Tappe, D
AU - Keller, Christian
AU - Cramer, J
AU - Güthoff, W
AU - Zanger, P
AU - Frank, M
AU - Ernestus, K
AU - Rauthe, S
AU - Stich, A
AU - Schäfer, J
N1 - © Georg Thieme Verlag KG Stuttgart · New York.
PY - 2014/5/1
Y1 - 2014/5/1
N2 - BACKGROUND: Since 2011, about 100 travellers to the island of Tioman, Malaysia, have been diagnosed worldwide with suspected muscular sarcocystosis, a previously only sporadically observed parasitic disease. Source of infection and therapy remain unclear. Final diagnosis requires microscopic identification of cysts in muscle biopsies. The study objective was a systematic description of characteristic symptoms, laboratory investigations and treatment response.METHODS: Systematic case series.RESULTS: The 26 cases of 5 centers for tropical medicine in Germany showed a characteristic biphasic development: symptoms began in general 2 weeks after mid-holidays (min. 7.5, max. 22 days) with unspecific fever and headaches lasting for almost 1 week. After an asymptomatic period of 2 weeks, severe myalgia (6.5, scale 0-10) and fever developed and lasted for about 6 weeks (min. 7, max. 207 days), accompanied by creatin-phosphokinase(CK)-elevation (up to 3.5 times), and eosinophilia (2.9 times). One out of two muscle biopsies revealed a cyst typical for sarcocystosis. In 6 out of 7 patients an increase in Sarcocystis-specific antibody concentration could be demonstrated by ELISA. Treatment with systemic steroids and albendazole, or ivermectin resulted in significant symptomatic improvement in most of the patients. One patient was treated early with cotrimoxazole and subsequently did not develop a second phase of the disease. All patients had stayed in the North-West of the island Tioman.CONCLUSIONS: 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.
AB - BACKGROUND: Since 2011, about 100 travellers to the island of Tioman, Malaysia, have been diagnosed worldwide with suspected muscular sarcocystosis, a previously only sporadically observed parasitic disease. Source of infection and therapy remain unclear. Final diagnosis requires microscopic identification of cysts in muscle biopsies. The study objective was a systematic description of characteristic symptoms, laboratory investigations and treatment response.METHODS: Systematic case series.RESULTS: The 26 cases of 5 centers for tropical medicine in Germany showed a characteristic biphasic development: symptoms began in general 2 weeks after mid-holidays (min. 7.5, max. 22 days) with unspecific fever and headaches lasting for almost 1 week. After an asymptomatic period of 2 weeks, severe myalgia (6.5, scale 0-10) and fever developed and lasted for about 6 weeks (min. 7, max. 207 days), accompanied by creatin-phosphokinase(CK)-elevation (up to 3.5 times), and eosinophilia (2.9 times). One out of two muscle biopsies revealed a cyst typical for sarcocystosis. In 6 out of 7 patients an increase in Sarcocystis-specific antibody concentration could be demonstrated by ELISA. Treatment with systemic steroids and albendazole, or ivermectin resulted in significant symptomatic improvement in most of the patients. One patient was treated early with cotrimoxazole and subsequently did not develop a second phase of the disease. All patients had stayed in the North-West of the island Tioman.CONCLUSIONS: 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.
KW - Adolescent
KW - Adult
KW - Antibodies, Protozoan
KW - Biopsy
KW - Child
KW - Developing Countries
KW - Diagnosis, Differential
KW - Enzyme-Linked Immunosorbent Assay
KW - Female
KW - Fever of Unknown Origin
KW - Germany
KW - Humans
KW - Infectious Disease Incubation Period
KW - Malaysia
KW - Male
KW - Middle Aged
KW - Muscle, Skeletal
KW - Myalgia
KW - Sarcocystis
KW - Sarcocystosis
KW - Travel
KW - Young Adult
U2 - 10.1055/s-0034-1370004
DO - 10.1055/s-0034-1370004
M3 - SCORING: Zeitschriftenaufsatz
C2 - 24782151
VL - 139
SP - 990
EP - 995
JO - DEUT MED WOCHENSCHR
JF - DEUT MED WOCHENSCHR
SN - 0012-0472
IS - 19
ER -