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

Seit 2011 wurde weltweit bei über 100 Besuchern der Insel Tioman, Malaysia, die Verdachtsdiagnose einer muskulären Sarkozystose gemeldet, einer bislang nur sporadisch beobachteten parasitären Erkrankung. Ursächlich ist vermutlich Sarcocystis nesbitti. Ausbruchsursache sowie Therapie sind unklar. Die Diagnosesicherung erfordert den mikroskopischen Zystennachweis im Muskelbiopsat. Studienziel war die systematische Beschreibung der diagnostisch wegweisenden Symptome, Laboruntersuchungen und des Therapieansprechens.

Die 40 Fälle aus 6 tropenmedizinischen/infektiologischen Zentren Deutschlands hatten zumeist einen Aufenthalt im Nordwesten der Insel Tioman und zeigen einen charakteristischen 2-phasigen Krankheitsverlauf mit initialem Fieber und später prolongierten Myalgien, Eosinophilie und CK-Erhöhung. Bei einer Schwangeren trat eine fetale Wachstumsretardierung auf. Eine Steroidstoßtherapie ist in der Spätphase rasch beschwerdelindernd. Bei möglichst frühzeitiger Cotrimoxazoltherapie war die Beschwerdedauer kürzer (0,7 vs. 3,0 Monate; p = 0,03), möglicherweise kann damit die Muskelinvasion der Parasiten verhindert werden.

Bei Fieber nach Malaysiaaufenthalt sollte die Sarkozystose differenzialdiagnostisch bedacht werden. Die Infektionsquelle erscheint konzentriert auf den Nordwesten Tiomans. Weitere Untersuchungen, inklusive zur Frühdiagnostik und Therapie, sind notwendig.

Since 2011, over 100 travelers to the island of Tioman, Malaysia, have been diagnosed worldwide with suspected muscular sarcocystosis, a previously only sporadically observed parasitic disease. Sarcocystis nesbitti is the presumptive causative agent. Source of the infection and therapy remain unclear. The final diagnosis requires the microscopic identification of cysts in muscle biopsies. Study goal was the systematic description of characteristic symptoms, laboratory investigations and treatment response.

The 40 cases from 6 centers for tropical medicine/infectiology in Germany had mostly stayed in the north-west of the island Tioman. They showed a characteristic biphasic development with initial fever and later prolonged myalgia, eosinophilia, and CK-elevation. In a pregnant woman fetal growth retardation was noted. Systemic steroid therapy leads to a rapid symptomatic relief. The duration of symptoms was shorter when cotrimoxazole treatment was initiated as early as possible (0.7 vs. 3.0 months, p = 0.03), possibly preventing muscular invasion by the parasite.

In fever after travel to Malaysia, the differential diagnosis should also include sarcocystosis. Source of infection appears to be concentrated in north-west of Tioman Island. Further studies are needed, including investigations for early diagnosis and treatment.

Key words

muscular sarcocystosis - sarcocystis - Tioman - Malaysia - clinical course of disease

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