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Sarcocystosis in Malaysia

Warning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced Precautions
Watch - Level 1, Practice Usual Precautions

Updated: September 05, 2014

What is the current situation?

CDC has received reports from GeoSentinel1 and other European travel and tropical medicine partners of more than 6 patients with suspected acute muscular sarcocystosis. All of the patients had traveled to Tioman Island in Malaysia in March and April 2014.  Sarcocystis was first reported in travelers to Tioman Island starting in 2011, with subsequent report in 2012 and 2013.

What is sarcocystosis?

Sarcocystosis is a disease caused by a parasite called Sarcocystis. Sarcocystosis occurs in tropical or subtropical countries, including countries in Southeast Asia. This disease is common among wild and domestic animals but can also cause disease in humans. Two forms of the disease can occur: one causes diarrhea and the other causes muscle pain, fevers, and other symptoms. Muscle sarcocystosis is spread through food, water, or soil contaminated with infected animal feces. Many people infected with Sarcocystis may have mild symptoms or no symptoms at all.

The travelers described in this notice returned from Malaysia with muscle pain, sometimes severe, and fever and headache. Some complained of joint and neck pain. Most people became ill 1–2 weeks after leaving the island.

How can travelers protect themselves?

No vaccine or medicine can prevent or treat sarcocystosis. Because sarcocystosis is spread through food or water contaminated with animal waste, travelers are advised to avoid contact with animals, to eat and drink safe food and water, and to wash hands frequently.

Avoid contact with animals

  • Do not touch or feed animals, especially cats and wild animals.
  • Do not touch animal droppings.
  • Avoid contact with soil that may be contaminated with animal droppings.

Drink and use safe water

  • Drink bottled water or water that has been boiled or filtered. Water purification tablets and chlorine products may not kill Sarcocystis.
  • Do not drink beverages with ice unless you are sure the ice was made with safe water.
  • When swimming, avoid getting water in the mouth, eyes, or nose.

Eat safe food

  • Cook all meat to 160°F (71°C), especially pork and beef.
  • Eat cooked food while it is still hot.
  • Keep all food covered.
  • Do not eat raw or undercooked foods, especially shellfish, except for fruits and vegetables you can wash with safe water or peel yourself.

Wash your hands

  • Wash your hands with soap and safe water. If you do not have soap, use an alcohol-based (at least 60% alcohol) hand sanitizer.
  • Wash your hands before you eat or prepare food, before feeding your children, after using the toilet, after changing diapers, and after taking care of someone ill with diarrhea.

Clinician Information:

Muscle sarcocystosis can be suspected in people with signs and symptoms of myositis, with or without fever. Ill patients may have an elevated eosinophil count and may have an elevated creatine kinase (CK) with no other explanation for these findings. Eosinophil counts and CK levels may be normal initially and rise approximately 4 weeks after infection. A muscle biopsy can be done by using a conventional histologic staining and will show myositis but may or may not demonstrate classic sarcocysts, which may be very diffusely located. Although cardiac muscle can be involved, cardiac symptoms or abnormalities have only rarely been reported. Molecular testing is not widely available. Physicians are encouraged to contact CDC at 800-232-4636 or 888-232-6348 or with questions regarding suspicious cases and for assistance with diagnosis.

Additional Information:

1 GeoSentinel is a global sentinel surveillance system consisting of more than 50 participating travel and tropical medicine clinics located in 25 countries on 6 continents. Surveillance data are collected on patients seen at these clinics during or after international travel. GeoSentinel is managed through a cooperative agreement between the International Society for Travel Medicine and the Centers for Disease Control and Prevention.

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