High prevalence of Taenia saginata taeniasis and status of Taenia solium cysticercosis in Bali, Indonesia, 2002-2004.

An epidemiological survey of taeniasis/cysticercosis was carried out in one semi-urban and two urban villages in three districts of Bali, Indonesia in 2002 and 2004. In total, 398 local people from 247 families were diagnosed by anamnesis and clinical examinations, and 60 residents were suspected to be taeniasis carriers. Among 60 suspected carriers, 56 persons expelled a total of 61 taeniid adult worms after praziquantel treatment. From 398 residents, 252 stool samples were available for analysis of taeniid eggs, coproantigens or copro-DNA for identification of taeniid species, and 311 serum samples were available for detection of antibodies against Taenia solium cysticercosis. Taeniasis prevalences were highly variable among three villages (1.1-27.5%), and only one case of cysticercosis due to T. solium infection was detected. All expelled tapeworms were confirmed to be Taenia saginata by mtDNA analysis. There was no Taenia asiatica human case in Bali. Case control analysis of 106 families chosen at random from 179 families in 2004 and another 106 families from non-endemic areas revealed that risk factors of T. saginata taeniasis for families were: level of education (P<0.01); consumption of beef lawar (P<0.01); and the source of lawar (P<0.01).

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.

Cysticercosis/taeniasis: recent advances in serological and molecular diagnoses.

Serodiagnosis by immunoblot, using recombinant chimeric T. solium antigen and native glycoprotein antigens, has been applied for neurocysticercosis cases. Specific antibodies against both antigens were detected in serum samples from NCC patients involving multiple cysts in the brain, whereas it was not always easy to detect specific antibodies in NCC cases with a solitary cyst or calcified lesion(s). On the other hand, the diagnosis for human taeniasis or worm carriers has been routinely performed by stool examination. In this study, multiplex PCR has been established to differentiate taeniasis using Taenia mitochondrial DNA in fecal samples from worm carriers. Furthermore, the molecular identification of human taeniid cestodes by base excision sequence scanning thymine-base analysis has also been introduced. This method provides four thymine-base peak profiles unique for Asian and American/African genotypes of T. solium, T. saginata and T. asiatica. By comparing thymine base peak profiles, it is possible to differentiate human taeniid cestodes without DNA sequencing. The approaches are powerful tools for the routine diagnosis of taeniasis and the molecular identification of taeniid cestodes.

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.

Recent advances in basic and applied science for the control of taeniasis/cysticercosis in Asia.

Detection of seven specific bands by immunoblot (IB) using glycoproteins (GPs) purified by lentil-lectin affinity chromatography has been the gold-standard for neurocysticercosis (NCC) serodiagnosis since 1989. However, due to the presence of contaminants, it was impossible to apply the GPs to ELISA. Our group at Asahikawa Medical College (AMC) succeeded in purifying the GPs by preparative isoelectric focusing; these higher quality GPs were suitable for ELISA. Based on the results of both IB and ELISA testing, developed at AMC for a field survey in Irian Jaya, it became evident that that area had pandemic NCC. We found many NCC patients, pigs full of cysts, and one dog infected with two cysts: these findings were based on serology. Recently, we conducted another survey to detect of the worm carriers of T. solium. Three of the 38 local people were positive by copro-antigen specific to Taenia species; these three patients expelled segments of Taenia spp and these were confirmed as those of T. solium by mitochondrial DNA analysis. When viable eggs of any taeniid species could be obtained, they can be developed into metacestodes in NOD-scid mice; it then becomes possible to analyze morphological dynamics, metacestode antigenicity, the efficacy of new metacestocidal drugs, and mitochondrial DNA. Mitochondrial DNA analysis of the specimens obtained in Irian Jaya was compared with that of other isolates worldwide. T. solium is now divided into two genotypes: the Asian type, and the Africa-American type. Some aspects of the pathological differences between the Asian and Africa-American types and the antigenic components of these two types are discussed.

Cysticercosis in Indonesia: epidemiological aspects.

Cysticercosis caused by the larval stage, cysticercus or cysticerci, of the pork tapeworm Taenia solium was recognized at first in Bali and in Paniai District, Irian Jaya (Papua), Indonesia in the 1970s. In the 1990s a rapid increase in the number of the cases of epileptic seizures and burns in Jayawijaya district, eastern Papua, was observed. There were a total of 1,120 new cases of burns (7.0%) and 293 new cases of epileptic seizures (1.8%) from 15,939 local people during 1991-1995. Both histopathological examination and mitochondrial DNA analysis of resected cysts from patients and pigs revealed cysticerci of T. solium. Antibody responses highly specific to cysticercosis were revealed in approximately 67% and 65% of persons respectively with epileptic seizures and with subcutaneous nodules. Therefore, most cases of epileptic seizures and burns were considered to be associated with cysticercosis in Papua. Additional serologically data from Bali showed that 13.5% of epileptic seizures (10/74) and 12.6% of asymptomatic individuals (94/746) were supposed having been exposed to T. solium. Histopathological evaluation of 80,000 tissue samples in East Java revealed that nine were cysticercosis. All cases were non-moslems and from two ethnic groups, Chinese and Balinese. Epidemiological data on cysticercosis are not available from other provinces of Indonesia, although cases of cysticercosis are occasionally reported. Therefore, other intensive epidemiological studies are strongly recommended, especially covering the eastern part of Indonesia.

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.

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.

The effect of intervention methods on nutritional status and cognitive function of primary school children infected with Ascaris lumbricoides.

The prevalence rate of ascariasis in primary school children in northern Jakarta, Indonesia varies from 60% to 90%. An association between helminthic infection and educational achievement has long been recognized. This study was carried out in the northern part of Jakarta among primary school children 6-8 years of age. Treatment of ascariasis and health education were used as the interventions. Before the interventions, basic data on socioeconomic status, epidemiology, infection with Ascaris lumbricoides, nutritional status, and cognitive function were collected. After the interventions, only data on infection with A. lumbricoides, nutritional status, and cognitive function were collected. The children were divided into five groups. Group I was given an anthelminthic (mebendazole), group II was provided with health education, group III was given an antihelminthic and provided with health education, group IV was given a placebo (controls), and group V consisted of egg-negative children, who also served as controls. Data from 336 students were analyzed by analysis of covariance. Parasitologic examinations showed a mean prevalence rate of 58.4% for A. lumbricoides infection in the pre-intervention children and a mean prevalence rate of 40.6% in the post-intervention children. Concerning nutritional status, approximately 80% of the children showed good scores in the pre- and post-treatment data, and only a small percentage (0.9-16.2%) showed mild or moderate malnutrition. No significant difference was found between the pre- and post-treatment nutritional status. The results of the cognitive test showed that the group treated with mebendazole showed significant improvement in the Colored Progressive Matrices and Coding test. Children also showed an improvement in their learning ability, concentration, and eye-hand coordination after five months of receiving this intervention.

Oxantel-pyrantel pamoate for the treatment of soil-transmitted helminths.

A mixture of oxantel-pyrantel pamoate was given to 147 primary school children. A single daily dose of 15 mg per kg body weight was administered to cases with Ascaris lumbricoides and Trichuris trichiura infections. The same single daily dose was given for three consecutive days to 10 cases with hookworm infections. The cure rate was 93.7% for ascariasis and the egg reduction rate was 98.2%. A cure rate and an egg reduction rate for trichuriasis was 70.2% and 86.5% respectively. All cases with hookworm infection were cured. Side effects were light and did not cause any anxiety.

Hookworm in dogs and cats in the area of Jakarta.

An investigation of the distribution and prevalence of hookworms in dogs and cats was carried out during the year 1976 in the area of Jakarta. Sixty-eight percent of the dogs harboured A. caninum, whereas 37% harboured A. ceylanicum and 18% A. braziliense and 32.1% as A. ceylanicum. Hookworms were recovered from 78% of the fifty cats; 72% of the cats were infected with A. braziliense and 24% with A.ceylanicum. Among the 1895 hookworms in cats, 73,5% were A. braziliense and 24.5% were A. ceylanicum. Only one female A. tubaeforme was found in one cat.

Gnathostoma spinigerum from the cervix of a woman in Jakarta.

A male Gnathostoma spinigerum was removed from the cervix of a 29-year-old Jakarta resident who suffered from chronic cervicitis. The worm was 6.7 mm in length and had eight rows of spines on the cephalic bulb. This is the third case of gnathostomiasis reported from Indonesia.

Burns and epileptic fits associated with cysticercosis in mountain people of Irian Jaya.

The number of patients with burns, admitted to the hospital in Enarotali, Central highlands of Irian Jaya, New Guinea, Indonesia, markedly increased during the last years. Before 1973 only a few cases were hospitalized whereas from 1973 to 1976 157 cases were admitted. Most of the burns (74.5%) were classified as third and fourth degree burns. Clinical observation and stool examination revealed epileptic seizures, cysticercus-nodules and eggs or proglottids of Taenia in respectively 62.8%, 33.1% and 16.6% of the cases with burns. Among infants, burns were not associated with clinical manifestations of cerebral cysticercosis. In the age group of over 11 years 88 out of 121 cases had epileptic seizures before or during hospitalization. It is assumed that the increasing number of burns during the last years is caused by the high prevalence of cerebral cysticercosis.

Cysticercosis cerebri in Irian Jaya. A case report.

A case is presented in which epilepsy was caused by diffuse involvement of cysticerci in the cortical layer of both cerebral hemispheres. The diagnosis was confirmed by histopathological examination. In the area of Irian Jaya cerebral cysticercosis should always be taken into consideration as the possible cause of epilepsy.

Another case of human gnathostomiasis in Indonesia.

A male Gnathostoma spinigerum was removed from the abdominal wall of a 29-year-old woman, who was in the habit of eating "naniura", a dish containing raw carp (Cyprinus carpio). After the removal of the worm she still had pain in her chest and noticed intermittent swelling of her right lower arm. Probably the patient still had one or more Gnathostoma worms migrating in her body.

An investigation on taeniasis and cysticercosis in Bali.

A survey was carried out in 3 villages in Bali to determine the prevalence of taeniasis in humans and cysticercosis in pigs. A total of 548 people were examined and Taenia sp. eggs were found in the faeces of 11. Four individuals passed proglottids; two T. solium and two T. saginata and three of these people also passed eggs in the faeces. A total of 12 or 2.2% were infected. Three pigs from a slaughterhouse were found heavily infected with Cysticercus cellulosae. Socio-ecological data indicate infections to be more common in people who eat raw meat dishes than those who eat fish. Poor sanitary conditions and the easy access of pigs to human faeces perpetuate the infection.