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.ceylanicwn, Trichostrongylus colubrifotmis, T.axei and Oesophagostomwn 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 filariasis 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 ofA.caninwn andA.braziliense and Strongyloides stercoralis were diagnosed only clinically. Also diagnosed clinically were occult filariasis 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. INTRODUCTION man in Indonesia, but only 8 species are prevalent, widely distributed and cause public In Indonesia, parasitic infections in health problems. Other Nematodes, espegeneral are decreasing. However, parasitic cially the non human parasites, may infect infections are still important, especially in man, and cause clinical symptoms, which are rural areas and slums of the big cities. At least sometimes difficult to diagnose, and there18 Nematodes have been reported infecting fore not easy to determine the treatment. Be* Department of Parasitology, Faculty of Medicine University of Indonesia Bul. Penelit. Kesehat. 17 (2) 1989 parasites may give different symptoms than in the natural host. Moreover, the parasites themselves, as erratic parasites are hidden in unusual tissues and difficult to be found with the usual technics. Soil transmitted helminths The most prevalent are the soil transmitted helminths, consisting of Ascaris lumbricoides, Trichuris trichiura, Nector americanus and Ancylostoma duodenale. These parasites are widely distributed and may be found in all stool surveys. Before the implementation of the control programme, very high prevalences are common. In many areas, one species may be predominant, but in other areas high prevalences of all soil transmitted helminths may be found, while in areas with good sanitary conditions, mostly involving the higher socio economic group, low prevalences are common. Ascaris lumbricoides may be found in almost 100% of the inhabitants of certain areas. Especially high prevalences have been reported in children. In a slum area in Jakarta, follow up studies of babies born in that area, showed that 100% of the children have been infected with A.lumbricoides, when they have reached their second year of life lv2. In Kresek, West Java, Clarke et a1 (1973) reported A. lumbricoides in 90%, T. nichiura in 91% and hook worm infection in 67% of the stools examined. In KalirnantaqMasbar and Purnomo reported an infection of A. lumbricoides in 80%, hookworm infection in 82% and Trichuris nichiura in 78% in a stool surveys, Margono made a summary on the results of stool surveys, showed high prevalences in all provinces surveyed except East Nusa Tenggara with only 10% A. lumbricoides, 35% T. trichiura and 1 % hookworm infection. High prevalences of all the 3 species of soil transmitted helminths were found in the provinces of West Java, Yogyakarta, Bali, West Nusa Tenggara and South Sulawesi. In 1985, the CDC of the Department of Health reported overall lower figures, which may be due to the control programmes. Another possibility is that the data from the Department of health include the whole population, while Margono's data were results from certain groups. The clinical symptoms of these infections are usually not severe, but very often disturbing, and when calculated in terms of loss of working hours because of weakness, fever, abdominal pain and diarrhoea. The economic loss caused by these infections may be considerable. Moreover the clinical symptoms are usually not typical and not easy to diagnose. More severe are the unusual symptoms of complications of soil transmitted helminthic infections. Halimun et a15 reported 40 cases of complications of Ascaris infection as intestinal obstruction and acute appendicities, which had occurred in the years 1973-1975. Hookworm infections may cause severe anemia with heart failure as result, while Trichuris infection may cause severe anemia and malnutrition due to dysentery syndrome. Clinical symptoms caused by the larval stages are even more difficult to diagnose. Loeffler's syndrome caused by the larvae of Ascaris has only been suspected and never confirmed in Indonesia. The same happens with ground itch caused by the larvae of hookworms. Infections with the non human soil transmitted helminths are difficult to confirm, because of the unusual situation. Toxocara canis and T. cati are revalent in dogs and cats in In? donesia6' , but visceral larva migrans caused by the larvae have never been diagnosed. Some of the soil transmitted helminths have been decreasing very much. StronBul. Penelit. Kesehat. 17 (2) 1989 8 gyloides stercoralis, which Sri Oemijati in 1956 found 9.4% positives among hospital patients and 16.3% in autopsies, is now rarely found in surveys, and also in autopsies. Lie Kian Joe in 1947~ found in autopsies in Jakarta, 47 % positive with Trichostrongylus colubroformis and T.axei. These worms are now also very rarely found. Moreover these 3 species are very small worms, and need special technics to diagnose. Many species of animal nematodes have been discovered and identified because of the findings of these worms in autopsies and clinical cases. Ancylostoma caninum, A. braziliense, A. ceylanicum and Acanthocephala have been discovered in autosies1° while Gnathostom spinigerum have been 11,12 discovered in clinical cases .