Sri S. Margono

Taeniasis/cysticercosis in Indonesia as an emerging disease

This shoFt report summarizes a two-day discussion on the h;story and present state of taeniasis/cysticercosis (T/C) in Indonesia, with a view to determining priorities for collaborative work. There are several primary and review papers discussing Asian Teenia and taeniasis I 6, but this is the first report focusing exclusively on TIC in Indonesia as an emerging disease. Indonesia comprises more than 17500 islands, and has many languages, religions, sociocultural histories and biogeographic characteristics, The majority of the people are Moslems, but Christians predominate in East Indonesia (including Irian Jaya) and Hindus in Bali. The three major endemic areas of T/C in Indonesia are Non.h Sumatra, Bal; and Irian Java (Fig. I). Endemic areas are also found on other islands, such as Timor, Flores, north Sulawesi, west Kalimantan and south Sumatra <7. Table I summanzes the prevalence o f taeniasis in areas o f Indonesia.

Dogs as alternative intermediate hosts of Taenia solium in Papua (Irian Jaya), Indonesia confirmed by highly specific ELISA and immunoblot using native and recombinant antigens and mitochondrial DNA analysis

Serology (ELISA and immunoblot) using native glycoproteins, affinity purified glycoproteins, and a recombinant antigen is known to be highly specific to Taenia solium cysticercosis in humans and pigs. These techniques were applied for dogs in the highly endemic area of cysticercosis in Papua (Irian Jaya), Indonesia. Analysis of dog sera by both ELISA and immunoblot revealed 7 of 64 dogs were highly positive. Examination of two sero-positive dogs revealed cysticerci of T. solium in the brain and heart of these dogs. Mitochondrial DNA analysis confirmed that they were the same as T. solium previously confirmed from pigs and biopsies from local people from Irian Jaya. It is suggested that the life cycle of T. solium may be completed not only between humans and pigs but also between humans and dogs.

Multiple genotypes of Taenia solium - ramifications for diagnosis, treatment and control

Mitochondrial DNA sequences of Taenia solium have fully been analyzed. Analysis of the full length of cytochrome c oxidase subunit 1 (1620 bp) and cytochrome b (1068 bp) genes of T. solium, isolated from Asia (China, Thailand, Indonesia and India), from Latin America (Mexico, Ecuador, Bolivia, Peru and Brazil) and from Africa (Tanzania, Mozambique and Cameroon), has revealed that the two phylogenies obtained were similar to each other regardless of the genes examined. The isolates from Asia formed a single cluster, whereas those from Latin America combined with those from Africa to form an additional cluster. It was estimated that these two genotypes emerged approximately 4-8 x 10(5) years ago. These results together with recent study of the ancient of human taeniid cestodes emerged several MYA in Africa, historical data on swine domestication, distribution of pigs and colonization patterns suggest that T. solium was introduced recently into Latin America and Africa from different regions of Europe during the colonial age, which started 500 years ago, and that T. solium of another origin independently spread in Asian countries, perhaps from China. Why did not T. solium of European origin invade or spread into Asia during the colonial age? Analysis of T. solium distribution must include other Taenia species, especially T. saginata and T. asiatica, which can not be differentiated from each other morphologically. BESS T-base analysis for differentiation of all human Taenia species including the two genotypes of T. solium, and T. saginata and T. asiatica has also been characterized. BESS T-base analysis differentiates African isolates from Latin American isolates as well but more samples should be analyzed for obtaining conclusive evidence for the latter. Serological analysis of cyst fluid of T. solium cysticerci obtained in China and Indonesia and from Mozambique and Ecuador indicates geographical differences in their banding patterns. These differences are discussed in the light of possible differences in pathology of T. solium worldwide. As it has been speculated that the ancient T. solium emerged several million years ago in Africa, it is necessary to analyze more isolates from Africa. Such working hypothesis may be evaluated combined with symptomatology and serology when we get additional DNA data from such areas, since there are some varieties of manifestation of neurocysticercosis with or without subcutaneous cysticercosis and of antigens of cyst fluid of T. solium from Asia and from Africa and/or America. Transfer of techniques of molecular identification and sero- and immuno-diagnoses between researchers and technicians from endemic countries using their own materials should be promoted with the aim of better international cooperation for the control of cysticercosis.

Resurgence of cases of epileptic seizures and burns associated with cysticercosis in Assologaima, Jayawijaya, Irian Jaya, Indonesia, 1991-95.

Historically, neurocysticercosis (NCC) caused by the larval stage, cysticercus or cysticerci, of the pork tapeworm Taenia solium was recognized in Paniai District, western Irian Jaya Province, Indonesia, in the early 1970s. In the 1990s, we observed a rapid increase in the number of cases of epileptic seizures and burns in Assologaima Sub-District, Jayawijaya District, eastern Irian Jaya. There were totals of 1120 new cases of burns and 293 new cases of epileptic seizures during 1991-95 in Assologaima where the number of inhabitants was 15,939. Histopathological examination of resected cysts from patients and a pig revealed that they were cysticerci of T. solium. DNA analysis of these cysts revealed that the nucleotide sequences of 391 base-pair fragments of the mitochondrial cytochrome c oxidase subunit 1 gene were exactly the same in those from patients and the pig. Although 3 of 391 base-pair fragments might differ from that of T. solium reported previously, there were no differences in the amino-acid sequences. Approximately 67% and 65% of persons with epileptic seizures and with subcutaneous nodules, respectively, showed antibody responses highly specific to cysticercosis. Therefore, most cases of epileptic seizures and burns were considered to be associated with cysticercosis in Irian Jaya.

Cysticercosis/taeniasis in Asia and the Pacific

Three taeniid tapeworms infect humans in Asia and the Pacific: Taenia solim, Taenia saginata, and Taenia asiatica. Although there is continuing debate about the definition of a new species, phylogenetic analyses of these parasites have provided multiple lines of evidence that T. asiatica is an independent species and the sister species of T. saginata. Here we review briefly the morphology, pathology, molecular biology, distribution and control options of taeniasis/cysticercosis in Asia and the Pacific and comment on the potential role which dogs may play in the transmission of T. solium. Special attention is focused on Indonesia: taeniasis caused by T. asiatica in North Sumatra, taeniasis/cysticercosis of T. solium and taeniasis of T. saginata in Bali, and taeniasis/cysticercosis of T. solium in Papua (formerly Irian Jaya). Issues relating to the spread of taeniasis/cysticercosis caused by T. solium in Papua New Guinea are highlighted, since serological evidence suggests that cysticercosis occurs among the local residents. The use of modern techniques for detection of taeniasis in humans and cysticercosis in humans, pigs and dogs, with the possible adoption of new control measures will provide a better understanding of the epidemiology of taeniasis/cysticercosis in Asia and the Pacific and lead to improved control of zoonotic and simultaneously meat-borne disease transmission.

ELISA and immunoblot using purified glycoproteins for serodiagnosis of cysticercosis in pigs naturally infected with Taenia solium.

The establishment of reliable serological methods for cysticercosis in pigs is important for the surveillance, control and prevention of taeniosis/cysticercosis in humans as well as in pigs to prevent economic loss. Both ELISA and immunoblot using glycoproteins (GPs) purified by a single step of preparative iso-electric focusing, which are highly useful for human cysticercosis, have been applied for a serological study in pigs naturally infected with Taenia solium. All sera from pigs showed similar responses to those in human cysticercosis. Therefore, it is expected that both ELISA and immunoblots using GPs would be useful in differentiating infected pigs from uninfected ones.

Taenia solium Cysticercosis, Irian Jaya, Indonesia

To the Editor: Cysticercosis, a tissue infection caused by accidental ingestion of eggs released from humans harboring the pork tapeworm, Taenia solium (TsCysti), is one of the most serious reemerging parasitic diseases worldwide (1). Taeniasis is an intestinal infection caused by the adult stage of the large tapeworm. Carriers of T. solium acquire infection through eating undercooked pork contaminated with cysticerci (larvae). Although most Indonesian people are Muslim and do not eat pork, infection with T. solium has occurred in some areas or islands where most local people are Christian or Hindi. The area most affected by this infection is Irian Jaya, Indonesia, the western half of New Guinea Island (2–4). In field surveys conducted in 2000 and 2001, we found that 5 (8.6%) of 58 local people and 7 (11%) of 64 local dogs living approximately 1 km from the local capital city, Wamena, in Jayawijaya District, harbored adult tapeworms and cysticerci of T. solium, respectively (5,6). We have further seroepidemiologic data from 1996 and molecular confirmation of subcutaneous nodules (SCN) as cysticerci of the T. solium Asian genotype. We believe this organism is an emergent problem in Irian Jaya. We previously reported that TsCysti was highly endemic in Jayawijaya District, Irian Jaya (2–6). A total of 96 local people >18 years of age from Assologaima, Jayawijaya District, were chosen at random and examined by serologic testing and by administering questionnaires in February 1996 after the local and Indonesian governments gave their ethical approval. The 96 persons were divided into three groups on the basis of a history of epileptic seizures (ES, n=17), physical examination of SCN by palpation (n=32), or good health (including no ES or SCN; n=47). A total of 14 subcutaneous nodules removed from 14 men in both ES and SCN groups were confirmed to be cysticerci of T. solium by morphologic observation and to be T. solium Asian genotype by mitochondrial DNA analysis with cytochrome c oxidase subunit 1 gene (3,7). For serologic analysis, we conducted an enzyme-linked immunosorbent assay (ELISA) that used glycoproteins purified from cyst fluid of T. solium cysticerci by preparative isoelectric focusing (fractions of pH 9.1) (8) in 2001. On the basis of serologic results, 12 (70.6%) of 17, 20 (62.5%) of 32, and 12 (25.5%) of 47 of ES, SCN, and healthy groups, respectively, were infected with the larval stage of T. solium. Serologically positive rates increased to 83.3% (10/12) of people with subcutaneous nodules in the ES group. A follow-up study of seropositive persons in the healthy group in 1997 showed that five of eight persons had ES (two persons), headache (one person), or SCNs in upper arm (two persons). Seropositive persons in all three groups (ES, SCN, and health) were considered to be infected with TsCysti. Persons of the SCN and healthy groups who showed optical density values higher than the cut-off value were considered to have asymptomatic TsCysti cases. The local persons we examined ranged from 18 to 29 years of age (n=30), 30–44 years of age (n=36), and >45 years of age (n=30). Seropositive persons (n=12) from the ES group (n=17) were 18 to 29 years of age (40.0%, 2/5), 30–44 years (71.4%, 5/7), and >45 years (100%, 5/5). The prevalence of TsCysti did not vary statistically by sex (males 53.6% [37/69] versus females 33.3% [9/27], Pearson’s chi-square test, p=0.074). That 14 persons confirmed to have subcutaneous cysticerci of T. solium were seropositive strongly suggests that the serologic test (ELISA) is highly reliable for detecting TsCysti in patients, whether their infection is symptomatic or asymptomatic. In contrast, one of the following scenarios was expected for cases in three of five persons in the ES group who did not have SCN and were seronegative: 1) the case was not due to TsCysti, 2) the case was caused by TsCysti but without antibody response, rather common in cases of a solitary cyst, or 3) the case was caused by TsCysti with calcified cysts and without antibody response. Twelve (approximately 40%) of seronegative persons from the SCN group (n=32) were expected to have cases of TsCysti without antibody response or to have calcified cysts without antibody response. Cases without antibody response would be most expected because of the heavily contaminated environment in Papua (3–6). However, further evaluation with computed tomography or magnetic resonance imaging scans is necessary. Based on serologic results and mitochondrial DNA confirmation of T. solium Asian genotype (3,7), we concluded that 47.9% (46/96) of local people examined at random, 53.6% of men (37/69) and 33.3% of women (9/27) >18 years of age had TsCysti. An additional 30 local people in non–TsCysti-endemic Merauke District underwent serologic testing. One woman had an exceptionally high antibody titer. She was a transmigrant from another island (South Sulawesi Province). Although Paniai, Jayawijaya, and Manokwari Districts are contaminated with T. solium taeniasis and cysticercosis (2–4), no additional critical evidence exists to show that Merauke District has already been contaminated with this parasite. Taeniasis and cysticercosis may have been accidentally introduced into Irian Jaya in 1969 when the country was governed by Indonesia, since the governing body came from Bali, the only area in Indonesia where TsCysti was exclusively endemic (2). The contaminated areas in Irian Jaya have increased from the central area (Paniai), to the east (Jayawijaya) (3), and then to the west (Manokwari), where 54 TsCysti cases have been reported (Papua Province Health Office Services, 1997, unpub. data). We wanted to know if taeniasis/cysticercosis had been introduced into the eastern half of New Guinea Island, called Papua New Guinea (PNG) (9). We had already serologically confirmed that 16 (3.0%) of 541 local residents and Irianese refugees in Alice River villages along the border in PNG had asymptomatic TsCysti (Ito et al., unpub. data). Follow-up surveys will be crucial in several other districts including Merauke District in Irian Jaya, PNG, and other islands such as Timor Island, where most of the population is Christian and many suspected cases have recently been reported by the District Health Office Services (10). Schoolchildren should also be checked so that cases can be detected and treated early. Sustainable education of the local community in Papua, Indonesia, and Papua New Guinea is also necessary.

Taenia solium taeniasis/cysticercosis in Papua, Indonesia in 2001 : detection of human worm carriers

A preliminary study to detect human worm carriers of Taenia solium in Papua (Irian Jaya), Indonesia was carried out using stool examinations for the detection of copro-antigens and adult proglottids after chemotherapy, and confirmation by mitochondrial DNA analysis using expelled proglottids and metacestodes developed in NOD/Shi-scid mice from eggs of expelled proglottids. Approximately 8.6% of the local population in Kama (5/58), 1 km from the local capital city centre, Wamena, were confirmed to harbour adult T. solium using these techniques.

DAMPAK PENGELOLAAN TINJA TERPADU TERHADAP INFEKSI ASCARIS LUMBRICOIDES DI DAERAH KOTA (I)

In April 1988, a study was conducted among the parents of Elementary School children to ascertain their knowledge of and attitude toward the soil-transmitted helminthiasis control programme in Jakarta. Sample selection was based on systematic random sampling and data were collected using a questionnaire. There were 192 respondents selected from 2 Elementary Schools. One of the schools participated in the soil -transmitted helminthiasis program and the other one served as control. The results showed that knowledge of all the respondents about soil-transmitted helminthiasis was relatively poor with generally good attitudes ; Almost all respondents (93,5%) thought that helminth examinations were needed and 96.8% of them agreed that examinations could be done at the school. Nevertheless 14.8% objected making payment for these examinations. It is recommended to improve the method of health education to the parents of children besides the improvement of environmental health efforts.To determine the risk of medical personnel for the acquisition on hepatitis B infection, we performed a prevalence survey for serologic evidence of exposure to this virus. During January 1987 through May 1987 two serologic markers (HBs Ag and anti HBs) had been taken from 381 nurses and 60 administrators in the Borromeus General Hospital, Bandung. The results were as follows : Six personnel ( 6% ) of the exposed group (381 nurses) were positive for HBs Ag and 37 (9,7%) were positive for anti HBs. Of the 60 administrators, 3 (5%) were positive for anti HBs and none were HBs Ag positive. These data indicate that HB V serological examinations of health workers are very important, and support the concept that paramedics should be considered for vaccination with hepatitis B vaccine, not only for their personal protection but also to prevent the remote but real possibility of transmission of HB infection to patients.An epidemiological analysis study of Dengue Haemorrhagic Fever (DHF) suspected cases has been done at two hospitals in Jakarta; namely Ciptomangunkusumo Hospital and Sumber Waras Hospital, from 1986 to 1987. From 3,164 suspected DHF cases there were 1,868 paired serum and all of them were tested with H.I. against D2 antigen from PN Biofarma based on microtechnique method by Qark & Cassals. Among them 1£10 were positive ( 70.1%) according to WHO Criteria. Analysis of DHF cases with positive H.I. test shows that the number of DHF cases started to increase continuously from February 1986, until June 1987 with a second and third peak on January and April 1987. The dominant age group were 5 - 7years old children (30.1%) and 15 - 20years old adults (15.8%). There were no significant difference between males and females, although the frequency among females was higher then males. Factors which influence those patterns : sex, age, seasonal variation were discussed in detail in this paper.