Taeniasis, a Neglegted Tropical Disease in Sumatra Utara Province,

Indonesia

Umar Zein

and Indra Janis

Faculty of Medicine, Universitas Islam Sumatera Utara

Keywords: Taeniasis, Simalungun Regency, Neglegted Tropical Disease

Abstract: Taeniasis is humans and animals infection due to Taenia or tapeworm specieses. The infection that occurs in

humans because ingestion of meat and visceral organs that containing cysts as infective stage (Cystecercus

larvae). The cause of taeniasis in humans are Taenia solium, Taenia saginata and Taenia asiatica. Taeniasis

is one of the neglected diseases and is an unsolved problem in the world because it corelates with human

behavior and lifestyle. Material and Methode: The survey was conducted from September 2017 until

November 2017 ini Nagori Dolok, Village, Silau Kahaean Sub-district, Simalungun Regency, Sumatra Utara

Proince, Indonesia We met some of the people who had been Taeniasis patients and conveyed the purpose of

the team's arrival. From 180 patients we suspect as Taenia carriers by clinical signs and physical examination

and microscopic examination of eggs and proglottid worm that passing with feces or by anal swab. Result:

From 180 suspected taenia carriers, we confirmed 171 patients diagnosed as Taeniasis and we treated by

Praziquantel Tablet single dose and laxative. All of patients passing proglottids (segment of the worms), taenia

eggs and proglottids strands. The longest proglottids strands that we found were 10.5 meters. Conclusion:

Taeniasis (Tapeworm infection) is still widely found in the district Simalungun Regency which is negleted

tropical disease that needs to get the attention of the Indonesia government through the Health Office of

Regency and Province.

1 INTRODUCTION

Taeniasis is an infection caused by Taenia or

tapeworm species in humans and animals (Ito et al.,

2004). Human taeniasis results from ingestion of

meat and visceral organs containing cysts at infective

stage (certicercus larvae). T. solium and T. asiatica

are acquired by eating inadequately cooked pork

contaminated with cysts, whereas T. saginata by

eating undercooked beef. Taeniasis is one of the

neglected diseases and is an unsolved problem

because it correlates with human behaviour and

lifestyle. Taeniasis cases are found mostly in

developing countries, but has been spreading to

developed countries like USA and Japan due to

increase in tourism and immigration (Yanagida et al.,

2012). Prevalence in the world is about 50 million

people, whether infected with T. saginata, T. solium,

or T. asiatica. WHO reported that there were 2-3

million people infected with T. solium tapeworms.

The highest prevalence of taeniasis is found in Latin

America, Africa, and Asia (CDC., 2013). Taeniasis is

an endemic infection in several countries in Southeast

Asia such as Thailand, Cambodia, Lao PDR,

Philipine and Indonesia ( Wandra et al., 2006a, WHO

2011, CDC., 2013).

The prevelance of taeniasis in Indonesia was

estimated to be 1.1%-45.8% (Suroso et al., 2006;

Wandra et al., 2006a). At present there has been

reported 4 endemic provinces for taeniasis and

cysticercosis in Indonesia: Papua (formerly Irian

Jaya), Bali, East Nusa Tenggara, and Sumatra Utara

(MoH RI, 2012). The highest prevalence reported in

Papua was 42.7% in 1997. (Widarso et al., 2001). In

Assologaima, a subdistrict in northwest of Wamena,

Jayawijaya District, a total of 293 new cases of

epileptic seizures were reported during 1991-1995.

Resected cysts from patients and a pig examined

histopathologically revealed T. solium cysticerci,

which were confirmed by DNA analysis (Wandra et

al., 2000). Meanwhile, Theis et al., reported that the

prevalence of human cysticercosis in Bali was 13%.

Positive serological results was 10/74 (13.5%) among

patients with epilepsy suggested a significant cases

suffered from neurocysticercosis. Sporadic taeniasis

cases was also reported in Lampung, Sulawesi Utara

and Sulawesi Tenggara from the transmigrant

Balinese who are mostly Hindu and eat pork.

Zein, U. and Janis, I.

Taeniasis, a Neglegted Tropical Disease in Sumatra Utara Province, Indonesia.

DOI: 10.5220/0010044804570461

In Proceedings of the 3rd International Conference of Computer, Environment, Agriculture, Social Science, Health Science, Engineering and Technology (ICEST 2018), pages 457-461

ISBN: 978-989-758-496-1

457

Detection of taeniasis carriers is based on

questionnaire and stool examination (Wandra et al.,

2015). However, it is not easy to detect them as local

customs of consumption uncooked or undercooked

has changed to a well-cooked pork (Ito et al., 2004).

This is also compounded by the fact that most patients

are asymptomatic. The most reliable clinical

diagnosis of taeniasis is history of the expulsion of the

gravid proglottids passed spontaneously through the

rectum or in the feces (Wandra et al., 2006a).

Microscopic stool examination for detection of the

eggs is a simple method but lacks both sensitivity and

specificity (Mayta et al., 2008). Differentiation of T.

solium and T. saginata or Taenia saginata asiatica is

based on the morphological characteristic of the

scolex or gravid proglottids. The number of uterine

branches present in gravid proglottids or the presence

or absence of rostellum in the scolex can be examined

by staining with carmine dyes, pressed and fixed with

alcohol formalin acetic acid (Parija and Ponnambath,

2013) or histologically using hematoxylin-eosin

staining (Mayta et al., 2000). However, PCR-based

molecular examinations such as mitochondrial DNA

analysis and DNA sequencing are more sensitive for

differentiating among the three species of taeniasis

carriers (Ito et al., 2008; Okamoto et al., 2001).

The prevalence of taeniasis in Sumatra Utara in

1972 was reported to range from 2.0 to 9.5 %

(Widarso et al., 2001; Wandra et al., 2007). However,

there had been no other report of taeniasis in Sumatra

Utara over the last decade (Wandra et al., 2006b).

The strain of Taenia saginata asiatica had been

reported in Samosir island, North Sumatra, in 1997

whose larvae were found in the liver of infected pig.

This larvae is the source of taeniasis infection for

human (Depary et al., 2003). There had been a limited

effort to eradicate the disease by conducting a

measured program such as training of health

professional, community education, and provision of

antihelminthics (Suroso et al., 2006). However, drugs

of choice for taeniasis such as praziquantel and

niclosamide are difficult to be obtained in Indonesia,

and prevention is also hampered by local community

culture barriers (Zein et al., 2014). Thus,

epidemiological data of this disease in the endemic

areas has to be provided so that the prevention

program can be implemented appropriately. Here, we

report our recent surveys of taeniasis carriers in

Simalungun Regency, Sumatra Utara Province,

Indonesia.

1.1 Materials and Method

In September 2017, we did a prelimimary survey

accompanied by a local community leader to meet

taeniasis carriers who were our former patients at

Nagori Dolok village, Silau Kahaean, a sub-district of

Simalungun Regency. These patients would inform

local people who had expelled “worms” previously to

be examined by our research team. Subsequently, we

conveyed our aims of study to the head of local health

officer, who would gather the patients at the Primary

Health Center in Nagori Dolok village, so that the

fecal samples can be obtained. This colloboration was

strengthened by signing a memorandum of

understanding. Ethical Clearence for this research

from Ethical Committee Faculty of Medicine,

Universitas Methodist Indonesia. All subjects signed

Informed Consent form before conducted clinical and

laboratory examination

On October 20, 2017, we examined 30 patients

who had been gathered at the Primary Health Center.

Among them twenty nine patients were having worms

expelled in the stools, and bring feces samples and we

examined them by anal swab to microscopic

examination to found taenia eggs in faces, so that they

were clinically diagnosed as taeniasis carriers, and

were given Praziquantel 600 mg as a single tablet,

followed by 2 tablets of Dulcolax 5 mg as a laxative

after 1-2 hours. The stools were collected in the

plastic bags provided.

The second visit to the Primary Health Center,

Nagori Dolok on November 2, 2017, 96 from 104

patients had a history of passing worms in the stools

and we diagnosed as Taenia carriers. On the third visit

conducted on November 4, 2017, we found 46 Taenia

carriers patients by the same method. The same

treatments were given to all the carriers. Thus, a total

of 171 taeniasis cases was definitely diagnosed

among 180 fecal samples collected

2 RESULTS

The youngest patient was 12 years, and the oldest 70

years. The highest numbers of cases found in the age

group of 41-50 years (70 patients, 40.9%). The ratio

male and female was 7:1. The results of macroscopic

and microscopic examinations of fecal samples are

shown in Table 1.

ICEST 2018 - 3rd International Conference of Computer, Environment, Agriculture, Social Science, Health Science, Engineering and

Technology

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Table 1. Age and Gender Characteristics of Taeniasis

Carriers

Age

(Year)

Gender

Total %

Male % Female %

12 - 30 18 10,5 3 1,8 21 12,3

31 - 40 26 15,2 2 1,2 28 16,4

41 - 50 58 33,9 12 7,0 70 40,9

51 - 60 29 16,9 4 2,4 33 19,3

> 60 18 10,5 1 0,6 19 11,1

Total 149 87,0 22 13,0 171 100

All the samples showed proglottids macroscopically,

and eggs were recovered in the gravid proglottids.

The longest proglottids strands that we found on

October 20, 2017 was 2.86 meters in the stool of a 46

year old male patient (Figure 1).

Figure 1. The proglottids strands are 2.86 meters in length.

The longest proglottids strands found in the stool on

November 2, 2017 was 10.5 meters and on November

4, 2017, the longest proglottids stands was 8 meters

respectively (Figure 2, and Figure 3).

Figure 2. The proglottids strands is 8 meter in length.

Figure 3. The proglottids strands of the taenia collected in

two jars from a taeniasis carrier measured 10.5 meters in

length.

2.1 Discussion

Three years ago, we found three cases of Taenia

asiatica infection which was confirmed by

histological examination of the proglottids. These

cases had a history of consuming inadequately

cooked pork. Two patients lived in the Silau Kahaean,

a sub-district of Simalungun Regency, Sumatra Utara

and another from Silindak village, Serdang Bedagai

Regency (borders Simalungun Regency) of Sumatra

Utara Province. These cases led us to discover more

cases of taeniasis in this new endemic areas

Batak Simalungun tribe is the indigenous people

at the Simalungun Regency. The other tribes are

Batak Karo and tribal immigrants. The religions

adopted by the Simalungun are mostly Protestant or

Catholics Christians (47%), Moslem (46.6%),

Taeniasis, a Neglegted Tropical Disease in Sumatra Utara Province, Indonesia

459

Buddhist (2.06%), Hindu (0.05%), and others like

Parmalim. This regency has 32 sub-districts with an

area of 438,660 ha or 6.12% of the total area of

Sumatra Utara Province. The entire sub-district

consists of 345 villages (nagori) and 22 new villages

(kelurahan).

Table 2. Duration of symptoms and Consumption of

Antihelminth Drugs in Patients

≤ 1 year 1 – 5 years 5 – 10 years ≥ 10 years Total

Duration of

symptoms

5 10 30 126 171

Combantrin Albendazole Mebendazole

Traditional

Medicine

Antihelminth

consumption

65 54 43 9 171

The duration of symptoms of the disease is felt by all

patients more than 10 years. The main complaint is

the release of proglottid (worm pieces) from the anus

spontaneously or when defecating. All patients

claimed to have visited a Primary Health Centre

(Puskesmas) or physician clinic and were always

given antiheminth treatment for Soil Transmitted

Helminth types, such as Combantrin, albendazole and

Mebendazole (Table

3 CONCLUSIONS

We have been found a new endemic area of taeniasis

Silau Kahaen, a sub-district of Simalungun Regency

in Sumatra Utara Province, Indonesia, besides those

recorded in Samosir Island, also in North Sumatra and

some other parts of Indonesia. We can call this

disease is Neglegted Tropical Disease, because

almost patients have camplaint during more than 10

years and specific medicine for the disease no

available in Indonesia, especially di Sumatra Utara

Province

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