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Letter
Taenia solium Cysticercosis,
Irian Jaya, Indonesia
Toni Wandra,* Akira Ito,† Hiroshi Yamasaki,† Thomas Suroso,* and Sri
S. Margono‡
*Ministry of Health, Jakarta, Indonesia; †Asahikawa Medical College, Asahikawa,
Japan; and ‡University of Indonesia, Jakarta, Indonesia
Suggested citation for this article: Wandra T,
Ito A, Yamasaki H, Suroso T, Margono SS. Taenia solium systicercosis,
Irian Jaya, Indonesia. Emerg Infect Dis [serial online] 2003 Jul [date
cited]. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no7/02-0709.htm
To the Editor: Cysticercosis, a tissue infection caused by accidental
ingestion of eggs released from humans harboring the pork tapeworm, Taenia
solium (TsCysti), is one of the most serious reemerging parasitic
diseases worldwide (1). Taeniasis is an intestinal infection
caused by the adult stage of the large tapeworm. Carriers of T. solium
acquire infection through eating undercooked pork contaminated with cysticerci
(larvae). Although most Indonesian people are Muslim and do not eat pork,
infection with T. solium has occurred in some areas or islands
where most local people are Christian or Hindi.
The area most affected by this infection is Irian Jaya, Indonesia, the
western half of New Guinea Island (2-4). In field surveys
conducted in 2000 and 2001, we found that 5 (8.6%) of 58 local people
and 7 (11%) of 64 local dogs living approximately 1 km from the local
capital city, Wamena, in Jayawijaya District, harbored adult tapeworms
and cysticerci of T. solium, respectively (5,6).
We have further seroepidemiologic data from 1996 and molecular confirmation
of subcutaneous nodules (SCN) as cysticerci of the T. solium Asian
genotype. We believe this organism is an emergent problem in Irian Jaya.
We previously reported that TsCysti was highly endemic in Jayawijaya
District, Irian Jaya (2-6). A total of 96 local people
>18 years of age from Assologaima, Jayawijaya District, were
chosen at random and examined by serologic testing and by administering
questionnaires in February 1996 after the local and Indonesian governments
gave their ethical approval. The 96 persons were divided into three groups
on the basis of a history of epileptic seizures (ES, n=17), physical examination
of SCN by palpation (n=32), or good health (including no ES or SCN; n=47).
A total of 14 subcutaneous nodules removed from 14 men in both ES and
SCN groups were confirmed to be cysticerci of T. solium by morphologic
observation and to be T. solium Asian genotype by mitochondrial
DNA analysis with cytochrome c oxidase subunit 1 gene (3,7).
For serologic analysis, we conducted an enzyme-linked immunosorbent assay
(ELISA) that used glycoproteins purified from cyst fluid of T. solium
cysticerci by preparative isoelectric focusing (fractions of pH 9.1) (8)
in 2001.
On the basis of serologic results, 12 (70.6%) of 17, 20 (62.5%) of 32,
and 12 (25.5%) of 47 of ES, SCN, and healthy groups, respectively, were
infected with the larval stage of T. solium. Serologically positive
rates increased to 83.3% (10/12) of people with subcutaneous nodules in
the ES group. A follow-up study of seropositive persons in the healthy
group in 1997 showed that five of eight persons had ES (two persons),
headache (one person), or SCNs in upper arm (two persons). Seropositive
persons in all three groups (ES, SCN, and health) were considered to be
infected with TsCysti. Persons of the SCN and healthy groups who showed
optical density values higher than the cut-off value were considered to
have asymptomatic TsCysti cases.
The local persons we examined ranged from 18 to 29 years of age (n=30),
30–44 years of age (n=36), and >45 years of age (n=30). Seropositive
persons (n=12) from the ES group (n=17) were 18 to 29 years of age (40.0%,
2/5), 30–44 years (71.4%, 5/7), and >45 years (100%, 5/5). The
prevalence of TsCysti did not vary statistically by sex (males 53.6% [37/69]
versus females 33.3% [9/27], Pearson’s chi-square test, p=0.074).
That 14 persons confirmed to have subcutaneous cysticerci of T. solium
were seropositive strongly suggests that the serologic test (ELISA) is
highly reliable for detecting TsCysti in patients, whether their infection
is symptomatic or asymptomatic. In contrast, one of the following scenarios
was expected for cases in three of five persons in the ES group who did
not have SCN and were seronegative: 1) the case was not due to TsCysti,
2) the case was caused by TsCysti but without antibody response, rather
common in cases of a solitary cyst, or 3) the case was caused by TsCysti
with calcified cysts and without antibody response. Twelve (approximately
40%) of seronegative persons from the SCN group (n=32) were expected to
have cases of TsCysti without antibody response or to have calcified cysts
without antibody response. Cases without antibody response would be most
expected because of the heavily contaminated environment in Irian Jaya
(3-6). However, further evaluation with computed tomography
or magnetic resonance imaging scans is necessary. Based on serologic results
and mitochondrial DNA confirmation of T. solium Asian genotype
(3,7), we concluded that 47.9% (46/96) of local people
examined at random, 53.6% of men (37/69) and 33.3% of women (9/27) >18
years of age had TsCysti.
An additional 30 local people in non–TsCysti-endemic Merauke District
underwent serologic testing. One woman had an exceptionally high antibody
titer. She was a transmigrant from another island (South Sulawesi Province).
Although Paniai, Jayawijaya, and Manokwari Districts are contaminated
with T. solium taeniasis and cysticercosis (2-4),
no additional critical evidence exists to show that Merauke District has
already been contaminated with this parasite.
Taeniasis and cysticercosis may have been accidentally introduced into
Irian Jaya in 1969 when the country was governed by Indonesia, since the
governing body came from Bali, the only area in Indonesia where TsCysti
was exclusively endemic (2). The contaminated areas in
Irian Jaya have increased from the central area (Paniai), to the east
(Jayawijaya) (3), and then to the west (Manokwari), where
54 TsCysti cases have been reported (Papua Province Health Office Services,
1997, unpub. data). We wanted to know if taeniasis/cysticercosis had been
introduced into the eastern half of New Guinea Island, called Papua New
Guinea (PNG) (9). We had already serologically confirmed
that 16 (3.0%) of 541 local residents and Irianese refugees in Alice River
villages along the border in PNG had asymptomatic TsCysti (Ito et al.,
unpub. data). Follow-up surveys will be crucial in several other districts
including Merauke District in Irian Jaya, PNG, and other islands such
as Timor Island, where most of the population is Christian and many suspected
cases have recently been reported by the District Health Office Services
(10). Schoolchildren should also be checked so that cases
can be detected and treated early. Sustainable education of the local
community in Irian Jaya, Indonesia, and Papua New Guinea is also necessary.
Financial support
was provided by a grant-in-aid from the Nissan Foundation and the Ministry
of Education, Japan (09044279, 10557029, 11694259, 1255702414, and 14256001)
(A.I.) and by the Japan Health Science Foundation (S.S.M.).
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