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110

Marqobo et al

The

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.la

tah

1994

1995. 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.lensan

inn

robLot lans noryhulifian 67a/,, ktsut densan qe|.nd kejane

epiLepsi 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 1995

rcsFtrireL!. Qu5riahnair^ \r.re dittribukd to

ll

rcspard.its with t?sult.s folLot's: 8l.gEa tecte illi\etute,93 6Cafanuts 1hd aU

ofihehso;nctind ate not wett.aoked park;no onetn dt\|as L.nsuhed.In thd ureo

n

h.aLth,- .lrinkins watzr tus awildbLe: also

theft 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! innunobLot

fi$

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 pigs

h

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 llme

in Enarotali. Paniai Districl. Among 170 hospjtaliTed

pcr<nr.

o'r

$ere ,ou_d

p.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<l

al' found that many palients wilh bums also suffered

from epilepdc seizures, probably caused by a number

of

cysticerci located

in

the

brains.

A

serologicd survev revealed a cofielation between symptoms and seropositive results.a

Cases

with

epileptic seizures were increasing in

AssoLogaima Subdistrict, Jayawijaya Districl. In 1991

only 4 cases among a population number

of

13 334

werc reDorted, rvbereas

in

1995, with a population nn mher of 1 7 ,193. I 45 cases were recorded.j

Thc disease was spreading

iiom

the lveslem to the eastem

pirt

of Papua already crossing lhc border

oi

Indonesia into Papur New Guinea. Besides the high

mobility 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 keeping

their pjgs and consuming not well-cooked pork are

important aspects in causing the high endemicity of

The diagnosis

of

the disease, treatment and health

educatjon 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

(2)

V,l 10. No 2. ArnL Ju . 20Al

budgel are limited for

ProbknoJtaeniasisantl.rsti.eruEis 111

the control

of

taenlasis xnd

DESCRIPTION OF LOCATION

Paniai District

is

located

in

the Kamu Valley, rhe

weslem part

of

the central highlands

of

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 found

in

this area with fertile. wide

spread 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

CYSTICERCOSIS

IN

IRIAN

JAYA

The first cases suflering iiom taeniasis were reported

after stool

examinations revealed

9E of

170

hospiialized patients positive

for

Taenid e'Z,gs. Tne

method used

for

the

stool examinarions was the

formal ether method6. Stool samples

from

several patients were examined more than once.r

During a period of 6 months

in

1972,1973, 13 cases suspecled vr'ith cysticercosis were diagnosed at the

Enarotali

hospibl,

Paniai

District.

The

patients

consisted 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 the

7

patienrs had

personality changes, which was repofted

by

their relatives- Complaints

on

dishrrbances

of

the eyes, .uLh a( bluned vision. pholophobid and diplupi. $ere fbund in six patients- Palpable cysticercus nodules in

the 13 patients were mostly locared

in

the biceps

muscle rcgion (9 cases). Other location

of

palpable cysticercus nodules were in the region of the forearm,

region

of

the lateral portion

of

the rnajor pectoral muscle. region of the deltoid muscle. neck, abdominal

wall

and

near

the

mouth. Severai subcutaneous nodules were removed and djagtosed as cysticerci

of

Cljnical signs

and

symproms

by

age,

of

318

inhabitants

of

the Obano village. sourh-wes!

of

the Paniai Lake, who were jnrervjewed and examined. by Desowitz et

ala

are shown in Table

l.

It

was found

that none of the sixty-six children berween lhe age of

0rl

years had any signs

or

symptoms.

Only

one among the forty children, aged 5 9 years had epileplic

seizures (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 group

15 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) ot

125 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

history

of

seizures

only

77.37o were posirive,

whereas

22.5',

indi!tduaL

\

hout any

clinical

!omplaints !rerc positive."

Furlher investigations

in

lhis

area discovered that

bum.

dnd eprleptrc \ei,,ures \4ere assocrared wirh

cy.ri(ercosis.' The number

ol

palienrs wirh bumr,

admitted

to

the

hospital

of

Enarotali markedly

increased dudng 1913

to

19'76. Before 1973 only a

few cases were hospitalized, whereas during 1973 to

1976, 15? were treated at the hospital. Among the

cases

with

bums

62.87o, 33.1Va

and

l6.6Vo

rcspecli\el) cuJfered lrum .ei/ures. had c).ucercur

nodules and stool samples were positive for Ta€rid eggs

or

proglottids.

Bums

were associated with
(3)

ll2

ltar|otu etat

these groups 88 out 121 cases had epileptic serzures before or dudng hospitalization.

During

the last

years cases

with

taeniasis and

cysticercosis were ibund

in

increasing numbers in Jayawijaya District, an area east

of

Paniai District. Repnn"

q;

20

locrl

h.dlrh

,enteF

in

JryrwijalJ

District 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

anci

eighl.

one of the local heal$

cenler was in Assologaima.

At

this health center an

rn.rer.ind n"rnb(r

ol

i"\es

urrh

.ei/Lre.

wa.

re.urJeLl . In lhe yerr

laql

only 4 cd.e' were r(poned

among 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 of

Table 2. Nuhber

ol

new cNes with epileptrc seizures at heilth unns {HU) in Jlyawijaya District, 1994 and

t995

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 oi

3l

respondents in Subdistrict Asologaima (l 996)

Identily and eating habits

Cooking wnh hot stones source r widaso et all

'lable

4.

Pesonai

md

eDvironmental hygiene

dl

3l

respondenLs 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 collaboration

was

eslablished, especially with Department of Parasitology, Asahilawa

Medical

Couege serological studjes

and

DNA

analysis could be conducted- Wandra et al.i reported a

pig iiom

Jayawijaya, harboring

multiple

cysts,

serologically posilive, using new GP antigens for the

imnunoblot and

ELISA

method3'q. Mitochondrial

DNA

analysis

of

lhe

materiai

(the pigs

cyst)

confirmed

the

identification except

fbr

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 patients

wilh

anamnesis

ol

seizures and 20 (65%) of

3l

cases with subcutaneorls nodules were serologically positive for cysticercosis.5

A

rccent survey in other villages, i.e. Tulem, Hepuba and Siepkosi found

that

among

50

persons with

Source 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 dislributed

to

3l

respondents in

Assologaima subdistrict revealed that 83.9% were

illiterates.93.69.

farmers

and

all

of

therr

were

sometimes 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% and

90.37. admilted that lhey

did

not cook the waler

betbre 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 et

al.'

described that none of

them had

toilet

faciliries, thcret'ore probably rhe

number

of

lhe

respondents

who

are

defecating

promiscuously was much higher than admilted by themselves (Table 4).

It

was also observed that pigs [image:3.596.307.538.282.393.2]
(4)

Vol lA, No2,

Aptil

l

n.20Al

immunoblot seropositive cysticercosis 68.07. suffered

from

clhical

signs (Table 6). Table

7

shows lhat

anong

16l

seropositive cases. living

in

these three

villages. 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 l3

cysticercosis was 0.150.' These preliminary resuhs

strongly suggest tbat a new serodiagnostic technique

using GPs puritied

by a

preparative iso-electric

focusing is most useful and reliable

lbr

both swine and human cysticercosis.s After this preliminary study

dnd

.crerrl nr\er.ludie.

hnpe"LII) rhe serodiagno.i\

using specific antigens purlfied

by a

single step

ol

preparative iso-eLectric focusing could

be

used in

detecting human, as well as swine cysticercosis.

At the end

of

1999 a study using copro-antigens was sources of the spreading

persons harboring adult

NuDrber

Seropositivc('/.)

started as a modus to detect

of

the disease, which are Tn?hia

$li

m e,tanns. l8

3l

12 \6',1) 20165)

Source : Wandra eI al5

Table6. Chrical signs

oi

peorles

nr

lhree Jayarv,jayd Disrnd

vith

imDunobld cysdcercosis, I99rj

Seizures, 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 and

environmental hygiene. husbandry

of

pigs

and

consuming

of

not well cooked pork are imponan!

rJr..l

lhe prLrbl(m on Idenirri\ and c)'rrcer(usr. in

lrian

Jaya

Prolince

of

Indonesia.

To

solve the

problem, heahh education especially

for

studenls.

treatment

of

adult worm carders and their tamiiies should be given hlgh priority. These activities should

be

based

on

an

integrated approach

of

several

insrirutions and sirong commitnent of the central as

well as the Local government.

REFERENCES

L

Tumadd LR. Margono SS. Inrestinal hclminthic inldtion

in rhe Pdiai Highl.nds, with spccial relerence to racnla

^nt1 Hynenolet)is kdtu. Madj Kedol Indotr 1973a: 7 8

Madj Kedok lndoi I973ar 103'?.

6J

6-\4 l5-21 24 32 l3r1l 42-50 >51

2 e5.$) s (23 08) t9 (47.50)

I r128.95)

9 (16.00) 4 (20 001

Sourcc : Intcrnationil colldb.raLron tern (unpublishcd data)

Sera. obra nFo

lro-

erghr pig'.rurn severdl cnrrn,-ie..

including one

fron

Jayarviiaya, lndonesia. harboring

multiplc cysticerci. showed

very

similar antibody

responscs as hurnan cysticercosis. The ELISA optical

density

values were

between

0.567

and

2500

(maximum OD), whereas lhose from uninfected four

pigs werc 0.07610.014. The cut off vahre in human

Tunada LR, Margono SS. Cystice.cosis in the area ofthe Wisscl Lakcs, west l!an. Sou$east AsiaD J T.op Med

Pub Heafth 1973b:3:371 6.

Snbimto DB, Tumada LR, Margono SS. Bums and

cprleor. ,r\ d...c,ard

sr .yr(e!o!.

rn m unirr

peopleof lrian Jaya TropGcogrMed 1978i 30:2?5 8. Desowiiz RS, Margono SS. Sutjahyo, Simatriuntak CM. Observatrons on rhe application

of

counLenhnuno' electrophoresis

fff

Lhe sero-epidetniology

of

human

cysticercosis. Soutleasl Asian .l Trop Med Pub Health

I t) 1 11 8: 303-'1

Wandra T, subahar R. Simanjlnlat GM,

M

gono SS,

Suro$ 1, Okanolo M, Nakao Y, Nlkaya K, S.hanz PM, fto A. Rcsurecnce olclses ol eFrlepdc seizurcs and burns

".'r,

cd

!irL.)

r(crLU

r'

rn A...l.Crnr. J.'yJwii,)d.

ki

.layd,Indoncsia, 1999 95. Trans Royal Soc Trcp Med

Hygiene 2000i 94 46-50. 8

26

38 25

(5)

114

Marsoha et dt Med J Indones

6.

Ritchie l-S. An ethcr sedimentation lechnique for

rourine

dtigens for neurocysriccrcosis: simpte nethod for

stool examinatior. From: Craig and Faust's

Clinical

serodiagnosis. AmJTropMedHyg 1998;58;29t-4. Parasitology, Faust and Rusel. 1964;

1948.

9.

Ito A, Plancarte A, Nakao M, Nakaya K, Ikejima T, Piao

7.

Widaso, Purba WH, Wsdra T, Suroso T.

Pemasalaho

ZX, Kduawa T, Mdgono SS. ELISA

ed

inmunoblor dalam program pembe.antasd taeniasis / sisriserkosis

di

using pu.ified glycopruleins

for

sercdiagnosis of

lndonesia, khususnya di ldan Jaya. Scientilic Se$ion

al

cysticercosis

in

pigs naru.ally infected with lazzn

KONAS V PETRI, KONAS VIII P4I and KONAS

PKWI.

rolah. J Helmirth 1999i 73: 361-5

Makasd, 1999.

8.

fto A, Plancarte A, MaL, KongY, Flisser A. Cho SY, LiD

Gambar

Table 2. Nuhber ol new cNes with epileptrc seizures atheilth unns {HU) in Jlyawijaya District, 1994 andt995

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