Towards the international collaboration for detection, surveillance and control of taeniasis/ cysticercosis and echinococcosis in Asia and the Pacific.

Both cysticercosis and echinococcosis are potentially among the most serious helminth zoonoses threatening human health worldwide. However, due to the lack of reliable tools for confirmation or identification of patients or infected animals, epidemiological data are expected to be underestimated. Conversely, sometimes, such data are over estimated due to the lack of specificity. The most important issue for doing field surveys is that they use evidence based science. In this communication, advanced immunological and molecular tools for detection of individuals infected with either metacestodes or adult tapeworms are briefly overviewed, and the applications of such tools for epidemiological surveys in Indonesia, China and other countries are introduced. As immunological tools are based on antigen-antibody responses, there may exist some cross-reactions. Therefore, immunodiagnostic tools are expected to be useful for primary screening, and should be combined with confirmation of direct parasitological evidence (morphology or DNA), and imaging techniques for cysts. As a risk factor for human cysticercosis is the presence of tapeworm carriers, detection of taeniasis cases and differentiation of the three human Taenia species (Taenia solium, T. saginata and T. asiatica) in Asia and the Pacific requires consideration. Similarly, in northwest China, Echinococcus granulosus and E. multilocularis are coendemic and differentiation of these species is required in humans and definitive hosts. It is stressed that combination of several tools for identification of the parasite and for confirmation of diseases is important for obtaining highly reliable data before consideration of control of these zoonoses. Recent projects coordinated by Asahikawa Medical College have concentrated on immunological and molecular diagnostic techniques transferable to colleagues from endemic regions of Asia and the Pacific, and on organization of two international symposia to establish a platform for further collaboration in the future.

Taeniasis and cysticercosis in Asia and the Pacific: present state of knowledge and perspectives.

Several topics on taeniasis and cysticercosis in Asia and the Pacific are overviewed. In Asia and the Pacific, three human taeniid species have been recognized: Taenia solium, Taenia saginata and Taenia asiatica. The first topic is on evolution of T. solium. Mitochondrial DNA polymorphisms of T. solium worldwide are discussed with emphasis of two specific genotypes: American-African and Asian. The second topic is recent major advances in sero- and molecular-diagnosis of T. solium cysticercosis in humans, pigs and dogs. The third is the present situation of T. solium taeniasis/cysticercosis in Papua (Irian Jaya), Indonesia. The forth is the present situation of T. solium cysticercosis and T. saginata taeniasis in Bali, Indonesia. The fifth is the present situation of T. asiatica taeniasis in Asia and the Pacific and in North Sumatra, Indonesia. The sixth is on the debate of the exact definition of T. asiatica. Because T. asiatica can not be differentiated from T. saginata morphologically, it is time to re-evaluate T. saginata in Asia and the Pacific. New and broad-based surveys across this region are necessary from epidemiological and public health perspectives, based on evidence.

Treatment of taeniasis and cysticercosis with praziquantel and albendazole.

Recent methods, doses and results of medical treatment on taeniasis/cysticercosis, a zoo-notic parasitic disease caused by Taenia solium and Taenia saginata are discussed. In cases of cysticercosis T. solium, especially neurocysticercosis the optimal length and dose of albendazole is a course of 8 days with doses of 15 mg/kg/day divided in two times added by 50 mg/day of prednisone in the morning. The drug is effective in almost any location of the parasites for 80-90% of macroscopic cysts seen by imaging studies. For taeniasis a single dose of praziquantel, 10-15 mg/kg achieves cure rates of more than 90%. Side effects such as nausea, headache and abdominal pain are mild. Evaluation of drug treatment is done by clinical, radiological and serological evaluation. In Papua (=Irian Jaya) nine cases with suspected neurocysticercosis, serologically positive, were treated with 1200 mg single dose albendazole for 15 days. Prednisone tablets, three times daily one tablet, 5 mg during 7 days were added. After one year 6 cases were still serologic positive. At the same time praziquantel, 1200 mg, single dose was given to ten cases during 15 days and prednisone tablets, 3 times daily one tablet, 5 mg during 7 days. After one year 5 sero-positive cases were still found. Albendazole and praziquantel are both effective drugs for taeniasis and cysticercosis, with minor side effects. In addition symptomatic treatment should be given if necessary.