The Current Situation of Parasitic Infections in Indonesia

Parasitic infections are highly prevalent in Indonesia, especially in rural areas, suburbs and slums of big cities. Twenty two species of protozoa and 32 species of helminths have been reported infecting man in Indonesia. Among the 16 species of intestinal protozoa, nine are constantly found in stool surveys, but only Entamoeba histolytica and Giardia lamblia are real pathogens. Among the blood and tissue protozoa, the most important are the malaria parasites. The most frequently encountered and widely distributed species are Plasmodium falciparum, and P. vivax. P. malariae is at present more difficult to find, while P. ovale has been reported only from Flores, Timor and Irian Jaya. The non human parasites so far has not been diagnosed in human. Among the 80 species of Anopheline mosquitoes in Indonesia, 16 have been reconfirmed as vectors. Among the other tissue protozoa, Trichomonas vaginalis is frequenUy found in the Gynaecological clinic, while Toxolasma gondii is found only in special studies. Among the 13 species of intestinal nematodes, five are highly prevalent namely : Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, Trichuris trichiura and Oxyuris vermicularis, while Strongyloides stercoralis is getting more difficult to find. Filariasis is widely distributed and is still highly endemic in certain areas. Both urban and rural Wuchereria bancrofti are prevalent, but B. malayi is causing more public health problems in rural areas. Both the human and the zoonotic type are prevalent. B. timori so far has been described only from the south eastern part of Indonesia. The filarial worms have different vectors and are therefore different in epidemiology and distribution. Non human filarial worms have not been reported infecting man in Indonesia. Among the 12 species of Trematodes, only Schistosoma japonicum is endemic in Central Sulawesi, and recently an endemic area oiFasciolopsis buski was discovered in a restricted area in South Kalimantan. Echinostoma lindoense which was highly endemic in lake Lindu area has disappeared completely. Among the 8 species of Cestodes, Taenia saginata and T. solium with its cysticercus are found more often. While endemic in a few areas only, cases been reported from many places. Infections with other Cestodes have been reported occasionally. On the whole, parasitic infections in Indonesia have been decreasing. Some parasites which were prevalent in the older days, have dissappeared, and human infections with animal parasites have been reported occasionally because of the difficult diagnosis

Important Nematode Infections in Indonesia

At least 13 species of intestinal nematodes and 4 species of blood and tissue nematodes have been reported infecting man in Indonesia. Five species of intestinal nematodes are very common and highly prevalent, especially in the rural areas and slums of the big cities. Those species are Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, Trichuris trichiura and Oxyuris vermicularis, while Strongyloides stercoralis is disappearing. The prevalence of the soil transmitted helminths differs from place to place, depending on many factors such as the type of soil, human behaviour etc. Three species of lymph dwelling filarial worms are known to be endemic, the urban Wuchereria bancrofti is low endemic in Jakarta and a few other cities along the north coast of Java, with Culex incriminated as vector, high endemicity is found in Irian Jaya, where Anopheline mosquitoes act as vectors. Brugia malayi is widely distributed and is still highly endemic in many areas. The zoonotic type is mainly endemic in swampy areas, and has many species of Mansonia mosquitoes as vectors. B.timori so far has been found only in the south eastern part of the archipelago and has Anopheles barbirostris as vector. Human infections with animal parasites have been diagnosed properly only when adult stages were found either in autopsies or removed tissues. Cases of infections with A. caninum, A.Braziliense, A.ceylanicum, Trichostrongylus colubriformis, T.axei and Oesophagostomum apiostomum have been desribed from autopsies, while infections with Gnathostoma spiningerum have been reported from removed tissues. Infections with the larval stages such as VLM, eosinophylic meningitis, occult filanasis and other could only be suspected, since the diagnosis was extremely difficult and based on the finding and identification of the parasite. Many cases of creeping eruption which might be caused by the larval stages of A.caninum and A.Braziliense and Strongyloides stercoralis were diagnosed only clinically. Also diagnosed clinically were occult filanasis which was caused by animal filarial worms, and eosinophylic meningitis caused by Angiostrongylus cantonensis. While Toxocara canis and T.cati are prevalent in dogs and cats, Anisakis in marine fish, no cases of Visceral larva migrains and anisakiasis have been reported in man in Indonesia

Filariasis in the Transmigration Area of Kumpeh, Jambi Sumatera

Penelitian mengenai penularan filariasis yang disebabkan oleh Brugia malayi telah dilakukan di daerah transmigrasi Kumpeh, Jambi. Pemeriksaan darah dilakukan terhadap para transmigran di tiga blok C, D dan E; 3 bulan, 9 bulan dan 18 bulan setelah mereka tiba di daerah ini. Filariasis klinis telah tampak dalam 3 bulan setelah kedatangan mereka dan terus naik pada pemeriksaan-pemeriksaan berikutnya. Delapan belas bulan sesudah kedatangan mereka di tempat ini ditemukan satu transmigran yang mengandung mikrofilaria sedang­kan "disease rate" paling tinggi ditemukan di blok D, sebesar 20,3%. Di blok E ditemukan satu orang dengan gejala limphodema

Pengobatan Artesunat pada Penderita Malaria Falsiparum tanpa Komplikasi di Daerah Resisten Multidrug

A treatment trial of artesunate for uncomplicated falciparum malaria cases was conducted at ITCI Hospital, Balikpapan, East Kalimantan, Indonesia, in November 1992 - Januari 1993. The objectives of this study were to assess the efficacy and safety of artesunate. Thirty eight falcipamm malaria patients who had been selected according to criteria for the in vivo sensitivity test were treated orally with 100 mg artesunate 12 hourly on DO and followed 50 mg 12 hourly on Dl-4. All patients were hospitalized until declared cured clinically and parasitologicalty. The most prevalent clinical symptoms of these malaria patients were fever (84,2%), headache (81,6%), nausea (73,7%) and splenomegaly (71,0%o). The cure rates of artesunate were 100% (38/38 and 28/28) on D7 and D14, but on D21 and D28 there were 88,2% (15/17) and 75% (6/8) because of the presence of late Rl cases. The mean fever clearance time (FCT) and parasite clearance time (PCT) were as follows 15,1 1,8 h and 32,1 3,0 h (D7), 14,1 2,2 h and 33,3 3,8 h (D14), 15,7 3,0 h and 37,6 5,6 h (D21), 14,0 4,6 h and 32,0 5,9 h (D28) respectively. No side effect was found clinically and on laboratory examinations. Artesunate is effective and safe for treatment of uncomplicated falciparum malaria until D14 in a multidrug resistant area. A sequential combination of artesunate and other antimalarial drugs should be studied to achieve a radical cure

Pengobatan Penderita Malaria Falsiparum tanpa Komplikasi dengan Meflokuin di Daerah Resisten Klorokuin

Treatment with mefloquine of uncomplicated falciparum malaria patients was undertaken in ITCI Hospital, Balikpapan, East Kalimantan, Indonesia in 1991. This study was conducted to assess the efficacy and safety of mefloquine, and to assess in vitro sensitivity of P. falciparum to other antimalarials currently in use. A total of 16 falciparum malaria patients who had been selected according to WHO criteria for the drug sensitivity test were treated with 750 mg mefloquine single dose orally. All patients were hospitalized for 3-5 days and followed up on day 7, 14, 21 and 28. Clinical and parasitological examinations were carried out during the study, haematological and biochemical examinations were also performed before drug administration and when the patient was discharged from the hospital. The main presenting symptoms were chills, headache and fever. Cure rate was 100% with the mean fever clearance time and parasite clearance time was 9.3 ±_ 2.4 hours and 47.1 +_ 3.7 hours respectively. No significant drug-related changes were noted in hematological or biochemical parameters. Only nausea was observed as a side effect of mefloquine which was mild and disappeared without treatment. ITCI Hospital area is a highly chloroquine resistant area (90,9%) and also as a multidrug resistant area (50%). This study shows that mefloquine is effective and safe for the treatment of uncomplicated falcipamm malaria resistant to chloroquine as well as for multidrug resistant cases

Lymphatic Filariasis in Indonesia

Filariasis masih merupakan masalah kesehatan masyarakat di Indonesia. Walaupun penyakit tersebut tidak mematikan tetapi akan menyebabkan kecacatan serta menurunnya produktivitas penderitanya, keluarganya maupun masyarakat, dan merupakan beban sosial. Penyakit tersebut di Indonesia disebabkan oleh tiga spesies cacing filaria yaitu Brugia malayi, B. timori dan Wuchereria brancofti. Filariasis di Indonesia tersebar di hampir seluruh provinsi terutama di daerah pedesaan. Pengobatan masal dengan DEC sampai saat ini merupakan cara pemberantasan yang paling baik untuk menurunkan prevalensi penyakit tersebut. DEC yang diberikan dengan dosis konvensional akan menyebabkan efek samping yang berat. Pengobatan dengan dosis rendah akan menurunkan efek samping dan dosis ini lebih disukai penduduk daripada dosis konvensional. Kendala pengobatan dosis rendah adalah lamanya pengobatan, yaitu 40 minggu, sehingga mengakibatkan adanya ketidakpatuhan. Perubahan lingkungan baik lingkungan fisik maupun sosio-budaya sangat penting di daerah endemik filariaris karena secara tidak langsung akan menghilangkan penyakit tersebut, dengan demikian kerjasama lintas sektor, kemitraan dan peran serta masyarakat sangatlah penting