110
Marqobo et alThe
problem of Taeniasis and
Cysticercosis
in
Irian
Jaya,
Indonesia
sri Surastuti Margono'. Aklra Itor,Tbo*os Suroso/
Abstrak
Penfakit ]un8 dnebabk'n Taenia soliun rlewa!. daa lana, n?nrcbar ke arah barat ltnrn Jala sahPai ndiatasi batas Indanesia kc
Pdpua NewGini. Dud prltlh Puskesnas nelalrorkan 63S !1dn 945 kdsus baru denga S.jala eriLePsi
b.xutut'tl
t Pa.latah
19941995. Kuesionet tetharlap 31 rcspond.n nentLqdttaa 83 91a b La hultf,93 6% Pttdti lan lanua res?on.l.n kadns'kulan? k@kn dasinE babi; tid.k pe nah r akan dariq lain. Di ddctuh ifti lnldk dda sunbo an tnihuh bercih dan jusa tidak add Jasilitas sannali Bdbi be*diarun .ti s.krat tunah, jarcns dikdnrtuhgkdr. Set.lah ketjasana .leuan b.rbdlai pihlk ant.ra llin detlsan Asahika||d MedicalCollele,
lepd\
tldpdt .lirenksa 49 sdry)el serun.lensaninn
robLot lans noryhulifian 67a/,, ktsut densan qe|.nd kejaneepiLepsi dan 6i1" dengan
binjok
subkutuh pasui|t.rl .lq
sistisetkosis. A]|Jivnds rckrltduk ke da.rah Ldut, higiene rcrcransan dan tingkungan, penringn a babi datan klli.lupan dtlarakst nentPdkn bebery)a hal Jans notebobknn tderiarn da' rBrs.*ord nprupakan nlsalah penti,tS .Ii daerah ini. (Med J hulones 2001 ; l0: 110'1)ThLdiseose,.a <7b)-thead tt antt ldfla olTaettu sotiuh, syead ta the \'e$enl Nrt ol lrian .lara .rcssin:! the botdet oI Indotesit to
Pq
a N.w G ined TtuhN tocal h.alth rente^ ,zrotktl 633 aall 915 net .dks ||ith eliL.Ptic sei.urcs ih 1991 and 1995rcsFtrireL!. Qu5riahnair^ \r.re dittribukd to
ll
rcspard.its with t?sult.s folLot's: 8l.gEa tecte illi\etute,93 6Cafanuts 1hd aUofihehso;nctind ate not wett.aoked park;no onetn dt\|as L.nsuhed.In thd ureo
n
h.aLth,- .lrinkins watzr tus awildbLe: alsotheft was t1o smitur! fd.iLiti.s Piss ||42 roahins urouktl the hauses, rdruD the l)iis wrc
Nt
b?hind feflces Aler intctutional.ottdbatutioh with sereml institutions, e.t wiihAsdhika||a Medical CaUes., JaNn 29
stru
stmpLes \'e.e eehihe.l b! innunobLotfi$
pasniE resutts.[ot 67E af thc.ases suffenn|lton.Pi]qti.
Pir r.s ani 65'/,, \tnh sub.utanzous nod l.s. Mornls oJ PaPle to olhd ateas personat anrl uNironn.rtal hr-siu1c the nnrotanc. oI pigsh
te riatb liJe aJ the cohhuniry -erc inporlahl issres in tnaintainin! the disease beine .dused ht T. soliuh in this trea ( Med J Indoha 2401; l0: 110'1)K.lwotds: Taenia soliu"t, I tba lq"d, srteodinS, ntutn.tionul colhbardtion
Cases
of
taeniasis and cysticercosis in kian Jaya. a province ol Indonesia were reported for the first llmein Enarotali. Paniai Districl. Among 170 hospjtaliTed
pcr<nr.
o'r
$ere ,ou_dp.r.iIvc
ur'n frr,r,a
e9...Thrilecn
.u.e'
\uller.ng
fiUm
c)'rr.Fr,u.r'
s,J.rcp.red JJrrng b monrh.
rr
lrl-2-lq-.{
.Srbixnlo<lal' found that many palients wilh bums also suffered
from epilepdc seizures, probably caused by a number
of
cysticerci locatedin
the
brains.A
serologicd survev revealed a cofielation between symptoms and seropositive results.aCases
with
epileptic seizures were increasing inAssoLogaima Subdistrict, Jayawijaya Districl. In 1991
only 4 cases among a population number
of
13 334werc reDorted, rvbereas
in
1995, with a population nn mher of 1 7 ,193. I 45 cases were recorded.jThc disease was spreading
iiom
the lveslem to the eastempirt
of Papua already crossing lhc borderoi
Indonesia into Papur New Guinea. Besides the highmobility of people, the level of personal hygiene and
environmentai hygiene
in
these areas should be considered as parts of the problem. Important issues such as behavior of the people in the ,i!ay of keepingtheir pjgs and consuming not well-cooked pork are
important aspects in causing the high endemicity of
The diagnosis
of
the disease, treatment and healtheducatjon create many difficulties. Manpower and
' Dcpaftnent of PatasroloSr ra.u|a' of Mcdicn?,
Unive rcitt oJ bd.nesia, Jdk rla, Itldonaja
' D.Ftun nt oJ PdrasnabSJ, Atahikawa Metlidl Calks(, I Dir..torcteGe eral aJ C.n nuni.dble Dneav Contnl anj
V,l 10. No 2. ArnL Ju . 20Al
budgel are limited for
ProbknoJtaeniasisantl.rsti.eruEis 111
the control
of
taenlasis xndDESCRIPTION OF LOCATION
Paniai District
is
locatedin
the Kamu Valley, rheweslem part
of
the central highlandsof
kian Jaya.The altitude runges from
1400
1800 m above sea-level. There are three lakes in this valley: Paniai, Tage and Tigi Inke.The dislrict ofiayawijaya is located in the eastem part
of Irian Jaya. The allitude is between 600 m to more
than
3000
m
above sealevel.Low
and
high mountains are foundin
this area with fertile. widespread valleys. For most areas ihe climate is tropical
hot and humid. the lemperature varies between 12 28"C. wilh much rain, average 190
ff
monrh.TAXNIASIS
AND
CYSTICERCOSISIN
IRIAN
JAYA
The first cases suflering iiom taeniasis were reported
after stool
examinations revealed9E of
170hospiialized patients positive
for
Taenid e'Z,gs. Tnemethod used
for
the
stool examinarions was theformal ether method6. Stool samples
from
several patients were examined more than once.rDuring a period of 6 months
in
1972,1973, 13 cases suspecled vr'ith cysticercosis were diagnosed at theEnarotali
hospibl,
PaniaiDistrict.
The
patientsconsisted of 5 women and 8 men ranging in age from
16 to 40 years. Seven patienls suffered from loss of
consciousness and general sonvulsions from 1-3 times a week, These selen patients complained of headache
and
or
dizziness.Two
among the7
patienrs hadpersonality changes, which was repofted
by
their relatives- Complaintson
dishrrbancesof
the eyes, .uLh a( bluned vision. pholophobid and diplupi. $ere fbund in six patients- Palpable cysticercus nodules inthe 13 patients were mostly locared
in
the bicepsmuscle rcgion (9 cases). Other location
of
palpable cysticercus nodules were in the region of the forearm,region
of
the lateral portionof
the rnajor pectoral muscle. region of the deltoid muscle. neck, abdominalwall
and
nearthe
mouth. Severai subcutaneous nodules were removed and djagtosed as cysticerciof
Cljnical signs
and
sympromsby
age,
of
318inhabitants
of
the Obano village. sourh-wes!of
the Paniai Lake, who were jnrervjewed and examined. by Desowitz etala
are shown in Tablel.
It
was foundthat none of the sixty-six children berween lhe age of
0rl
years had any signsor
symptoms.Only
one among the forty children, aged 5 9 years had epileplicseizures (2-57.). One among 11 chitdren in rhe age
group
of
10-14 years had epileptic seizures (8.37a) and 1 ('7.1E ) among 13 individuals in rhe age group15 19 years suffered fiom seizures and cysts. In the age group of 20 50 years, consisting
of
186 persons,eighly-six persons had signs and symploms. Epileptic
seizures were found in 39 cases (21.070), 6 cases had seiTures as well as subcutaneous nodules, whereas 5 cases had only palpable cysls. Thirty cases (16.17.) complained of headache and 6 cases of "wealoess" or
pai,n (3 .2Eo) .
Table
l
Clinicaldrra and serological rcsuits (CIEP) ot125 serun sdhples in Obdo, Paniai District
Number Seroposit,ve (..h)
8
22
3
2t
71
8 0 00)
17 (77.3) 2 (66.6) 9 (:42.9) r6 (22.5)
Source : Desowirz et al.4
The immuno-electrophoresis (CIEP) technique found
that among 125 serum samples all individuals (8) wilh palpable subcutaneous cysticerci were serologically
positive. Four among the 8 individuals with nodules had a hislory of seizures. Among 22 individuals with
a
historyof
seizuresonly
77.37o were posirive,whereas
22.5',
indi!tduaL
\
hout any
clinical!omplaints !rerc positive."
Furlher investigations
in
lhis
area discovered thatbum.
dnd eprleptrc \ei,,ures \4ere assocrared wirhcy.ri(ercosis.' The number
ol
palienrs wirh bumr,admitted
to
the
hospitalof
Enarotali markedlyincreased dudng 1913
to
19'76. Before 1973 only afew cases were hospitalized, whereas during 1973 to
1976, 15? were treated at the hospital. Among the
cases
with
bums
62.87o, 33.1Vaand
l6.6Vorcspecli\el) cuJfered lrum .ei/ures. had c).ucercur
nodules and stool samples were positive for Ta€rid eggs
or
proglottids.Bums
were associated withll2
ltar|otu etatthese groups 88 out 121 cases had epileptic serzures before or dudng hospitalization.
During
the last
years caseswith
taeniasis andcysticercosis were ibund
in
increasing numbers in Jayawijaya District, an area eastof
Paniai District. Repnn"q;
20
locrl
h.dlrh,enteF
in
JryrwijalJDistrict mentioned a total of 638 and 9,15 new cases
with seizures respectively in 1994 and 1995 (Table 2).
Durins the two vears the number of death due to the
ciisea# were
sii
ancieighl.
one of the local heal$cenler was in Assologaima.
At
this health center anrn.rer.ind n"rnb(r
ol
i"\es
urrh
.ei/Lre.
wa.re.urJeLl . In lhe yerr
laql
only 4 cd.e' were r(ponedamong a population of 13 334 people, whjch neant an incidence rate of0.037D. During the years 1992, 1993, 1994 and 1995 respeclively 41.68, 35 and 145 cases were recorded at the same health center. During these fours years the incidence rates were respectiveiy 0-28,
0.43, 0.21 and 0.837'. The cysls extirpated from 14
men and
I
pig
were diagnosed as cysticercus ofTable 2. Nuhber
ol
new cNes with epileptrc seizures at heilth unns {HU) in Jlyawijaya District, 1994 andt995
Med.l ltulan^
Diagnosis of the disease was mostly based on clinical
symploms. Laboralory facilities were very iirlxted: no
radlological equipment was available such as CT
Scan.
Tablc
3.
Identit) and eating habits oi3l
respondents in Subdistrict Asologaima (l 996)Identily and eating habits
Cooking wnh hot stones source r widaso et all
'lable
4.
Pesonaimd
eDvironmental hygienedl
3lrespondenLs in Subdistnd Assolog.ima (7.) Habils md environmcntal hygicnc
83.9
93.6 100
100 100
1995
90.3
Source: Wida6o et ali
INTERNATIONAL COLLABORATION
After
intemalional collaborationwas
eslablished, especially with Department of Parasitology, AsahilawaMedical
Couege serological studjesand
DNAanalysis could be conducted- Wandra et al.i reported a
pig iiom
Jayawijaya, harboringmultiple
cysts,serologically posilive, using new GP antigens for the
imnunoblot and
ELISA
method3'q. MitochondrialDNA
analysisof
lhe
materiai(the pigs
cyst)confirmed
the
identification exceptfbr
3 of
391 basepairs,at
130, 136 and 334,ol
the CO 1 gene,while Bowles and McManus described R. R and Y.
respectively.5
A total of49 serum samples frompeople attending the
local health unit in Assologaima were serologically exarmned (Table 5). Immunoblot analysis revealed
thar
12
(67q.)of
18 patientswilh
anamnesisol
seizures and 20 (65%) of
3l
cases with subcutaneorls nodules were serologically positive for cysticercosis.5A
rccent survey in other villages, i.e. Tulem, Hepuba and Siepkosi foundthat
among50
persons withSource olwaler (nvei) Dnnking w.te. (uNooked)
Habit of dcfecalion (bushcyforcs!)
64.5
58.t
64.5
r00
15 610 1r-15 t6-20
352 175
u
0
5
431
3
0
Source i wida$o et all
A
questionnaire dislributedto
3l
respondents inAssologaima subdistrict revealed that 83.9% were
illiterates.93.69.
farmersand
all
of
therr
weresometimes eating pork. no olher meat.
All
of
lhem roasted the meat on hot stones (Table 3). The river was used as a source of d.inking w.tter by 90.3% and90.37. admilted that lhey
did
not cook the walerbetbre drinking. Among them 6,1.57o did no! wash
their hands betore eating and 58.170 ailer defecation.
Of the respondents 64.57. detecated around bushes or
in
lhc fores!. Widarso etal.'
described that none ofthem had
toilet
faciliries, thcret'ore probably rhenumber
of
lhe
respondentswho
are
defecatingpromiscuously was much higher than admilted by themselves (Table 4).
It
was also observed that pigs [image:3.596.307.538.282.393.2]Vol lA, No2,
Aptil
l
n.20Alimmunoblot seropositive cysticercosis 68.07. suffered
from
clhical
signs (Table 6). Table7
shows lhatanong
16l
seropositive cases. livingin
these threevillages. 47.507. was found in the age group of 24-32
years (irtemational collaboratjon team, unpublished data).
'lable
5.
lnnunobkn dalysls of49 scrum samples ftotn Jalaliraya Distric!Prcbleh of taeaiasis
and.rsti.ercasis
I l3cysticercosis was 0.150.' These preliminary resuhs
strongly suggest tbat a new serodiagnostic technique
using GPs puritied
by a
preparative iso-electricfocusing is most useful and reliable
lbr
both swine and human cysticercosis.s After this preliminary studydnd
.crerrl nr\er.ludie.
hnpe"LII) rhe serodiagno.i\using specific antigens purlfied
by a
single stepol
preparative iso-eLectric focusing couldbe
used indetecting human, as well as swine cysticercosis.
At the end
of
1999 a study using copro-antigens was sources of the spreadingpersons harboring adult
NuDrber
Seropositivc('/.)started as a modus to detect
of
the disease, which are Tn?hia$li
m e,tanns. l83l
12 \6',1) 20165)
Source : Wandra eI al5
Table6. Chrical signs
oi
peorlesnr
lhree Jayarv,jayd Disrndvith
imDunobld cysdcercosis, I99rjSeizures, headlche and cysts
S.izures dnd heddache
Cysts 220 16.0 2.0 10.0 0.0 12.0 10.0 280 50 100.0 Source i Inrehdtiondl collaborariorlealr(unpublisheddala)
Tible ?. Idnnnoblol seropositilc cystice.cosis according to dgc groups in three vill.ges of Jayarvrjaya Distnct,
1998 1t 8 I 5 0 5 l4 CONCLUSIONS
The
hish
nobilily
ol
people,
personal andenvironmental hygiene. husbandry
of
pigs
andconsuming
of
not well cooked pork are imponan!rJr..l
lhe prLrbl(m on Idenirri\ and c)'rrcer(usr. inlrian
JayaProlince
of
Indonesia.To
solve theproblem, heahh education especially
for
studenls.treatment
of
adult worm carders and their tamiiies should be given hlgh priority. These activities shouldbe
basedon
an
integrated approachof
severalinsrirutions and sirong commitnent of the central as
well as the Local government.
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lro-
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fron
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