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Thecurrent Status of Parasitic Diseases in Japan

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Thecurrent Status of Parasitic Diseases in Japan å¡ REVIEW ARTICLE å¡ The Current Status of Parasitic Diseases in Japan Fukumi NAKAMURA-UCHIYAMA,Kenji HiROMATSU, Kenji ISHIWATA, Yukiko Sakamoto and Yukifumi Nawa Abstract tively. Some other helminthes that cause serious diseases such as schistosomiasis, domestic malaria and lymphatic In Japan parasitic diseases have been considered to be filaria were also successfully eradicated by the middle of successfully controlled in the last 30 years. However, 1980s (1). Such successful eradication/control of parasitic some parasitic diseases, such as food-borne zoonoses diseases resulted in the termination of the Parasite Control and/or larva migrans, are emerging and/or re-emerging Law in 1994 (1). Although the new Infectious Diseases in Japan. Furthermore, imported parasitic diseases like Control Law was applied in 1999, only five parasitic dis- malaria are also gradually increasing. Unfortunately ac- eases, four protozoan diseases (amebiasis, cryptosporidiosis, curate numbersof parasitic diseases other than echino- giardiasis and malaria) and one helminthiasis, echino- coccosis, malaria, amebiasis, giardiasis, or cryptospori- coccosis are assigned as the notifiable parasitoses. Nownot diosis are obscure in Japan because of the lack of a legal only the public but also medical professionals tend to con- registration system. Since symptoms and diagnostic im- sider parasitoses as a disease of the past. However,the num- aging patterns of parasitic diseases are non-specific and ber of patients having parasitic diseases referred to and have similarities with other infectious diseases or cancer, diagnosed in our laboratory has been increasing every year parasitic diseases are sometimes overlooked or left misdi- (Fig. 1A) (2, 3). In agreement with our experience, Arizono agnosed. In this review, the current status of parasitic has recently reported that morethan 1,000 case reports of diseases in Japan is briefly summarized based on the parasitic diseases were found in the database, Igaku-Chuo- analysis of the accumulated cases seen in our department. Zasshi (Japana Centra Revuo Medicina) between 1995 and Wealso outline the clinical features, differential diagno- 1999 (4). In this review, we summarize the current status of sis and treatment of representative parasitic diseases for parasitic diseases in Japan together with clinical features, di- the better understanding and managementof the para- agnosis and treatment of clinically important and frequently sitic diseases in Japan. (Internal Medicine 42: 222-236, 2003) experienced parasitoses. Key words: food-borne zoonoses, emerging/re-emerging Current Status of Parasitic Diseases in Japan diseases, larva migrans, imported parasitoses, It is difficult to grasp the concrete number of parasitic dis- differential diagnosis, orphan drugs eases, especially those of helminthiases in Japan due to the changeover of legislation for infectious diseases. Weimple- mented the immuno-serological tests for diagnosis of para- sitic diseases in 1986. Multiple-dot ELISA method (Fig. IB), Have Parasitic Diseases Really Been which was introduced in 1991 for the primary screening to Eradicated in Japan? detect parasite-specific antibodies, has enabled us to respond faster than before to the attending physicians. The numberof In the immediate post-World War II period, Japan was re- samples referred to our laboratory has drastically increased garded as "Paradise of Parasites" because of spreading of since 1995, and reached over 400 new samples and 200 sam- soil-transmitted parasitoses such as ascariasis, trichuriasis ples for follow-up per year in 2000 and 2001. Amongthose and hookwoomdisease. After a nationwide campaign, mass consultations, about 40%of patients were diagnosed as hav- screening, treatment and prevention of parasitic diseases ing parasitoses (Fig. 1A). The incidence of each parasitic dis- under the Parasite Control Law, the egg detection rates of ease referred to and diagnosed in our laboratory is Ascaris and hookwormin stool examination decreased from summarized in Table 1. 59.6% and 4.5% in 1950 to <0.1% and 0% in 1980s, respec- The majority of cases diagnosed in our laboratory are From Department of Parasitology, Miyazaki Medical College, Miyazaki Reprint requests should be addressed to Dr. Yukifumi Nawa, Department of Parasitology, Miyazaki Medical College, Kiyotake, Miyazaki 889-1692 222 Internal Medicine Vol. 42, No. 3 (March 2003) Parasitic Diseases in Japan 500 Table 1. Incidence of Various Parasitic Diseases Diag- å¡ nosed in Our Laboratory during 1999-2001 1 400 Protozoa Giardiasis 3 Entoamebiasis 5 Malaria 300 Trematoda Paragonimiasis 99 Fascioliasis 10 4 200 Schistosomiasis Clonorchiasis 1 Metagonimiasis 1 3 100 Cestoda Diphyllobothriasis 1 Diplogonoporiasis 2 Taeniasis saginata 2 llll å y '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '99 '00 '01 Sparganosis i Cysticercosis Year Echinococcosis A Nematoda Ascariasis lumbricoides Strongyloidiasis 16 Hookwormdisease (human origin) 3 Trichuriasis 3 Multiple-dot ELISATest for Parasitic Diseases Enterobiasis 2 I Thelaziasis 1 Lymphatic filariasis 9 NHS NHS A n g io str o n g y lia s is 7 Di Pw Di Pw A . s u u m - 1 T . c a n i s - V L M 17 0 Tc Pm Tc Pm A n isa k ia sis 1 9 G n a th o sto m ia s is 4 2 As Fh As I Fh 蝣I I S I S p i r u r o i d l a r v a m i g r a n s 3 Asx 蝣 Cs Asx M l Cs II H o o k w o r m d i s e a s e ( a n i m a l o r i g i n ) 9 i Gd L Se D ir o fila ria sis 1 0 Gd [蝣I Se li 蝣 Sr Cc Sr m蝣 Cc Others Tick bite Myasis Serum Pleural Effusion B Scabies Bold-face: Food-borne zoonoses, | : Larva migrans. Figure 1. Number of cases referred to our laboratory (A) and multiple-dot ELISA for parasitic diseases (B). Recently about 40% of the cases were diagnosed as having parasitoses area of this disease (5). Meanwhile A. suum-VLM is an (A). The patient's serum and pleural effusion showed a high titer of IgG against Paragonimus westermani with some emerging disease in this area probably due to recent concen- cross-reactions to other trematode antigens (B). Pw: P. tration of cattle, pig and poultry farms in southern Kyushu westermani, Pm: P. miyazakii, Fh: Fasciola hepatica, Cs: (6). Although imported parasitic diseases are rather rare in Clonorchis sinensis, Se: Spirometra erinaceieuropaei, Cc: our data, weencountered somepatients assumedto be in- Cysticercus cellulosae, Di: Dirofilaria immitis, Tc: Toxocara fected during traveling overseas, such as giardiasis, malaria, cards, As: Ascaris suum, Asx: Anisakis simplex, Gd: cysticercosis and creeping eruption due to percutaneous in- Gnathostoma doloresi, Sr: Strongyloides ratti. (b: Reprinted fection with larval dog hookworm. It should also be pointed from Clinics in Chest Medicine, 23, Nakamura-Uchiyama F out that classical soil-transmitted parasites are still present to et al, "Paragonimiasis: A Japanese perspective", 409-420, cause diseases in Japan. Copyright 2002, with permission from Elsevier Science). In contrast to our data, protozoan diseases accounted for about 45%of total case reports of parasitoses from an analy- sis of the Japanese database, Igaku-Chuo-Zasshi, during food-borne helminthiasis, especially of zoonotic nature and/ 1995 and 1999 (Table 2) (4). All patients with malaria were or larva migrans as indicated in Table 1. Among them, infected during travel in tropical and subtropical countries. Ascaris suum-YLM(visceral larva migrans) and paragoni- However, patients with other protozoan diseases seemed to miasis are the two foremost parasitic diseases. The majority be infected in Japan. In fact, amebiasis is currently epidemic of these cases were from Kyushu(2). Paragonimiasis is a re- in male homosexuals and institutionalized people; few cases emerging disease in Kyushu a previously heavily endemic are imported (7). Twowater-borne outbreaks of cryptospori- Internal Medicine Vol. 42, No. 3 (March 2003) 223 Nakamura-Uchiyama et al Table 2. Numbersof Parasitic Diseases Case Reports in Japan Found in Japana Centra Revuo Medicina Database (1995-1999) (4) Pr ot oz o a T re m a to d a C e sto id e a N e m a to d a E n to a m o e h a 16 7 S c h is to sn m a 9 0 D ip h yl lo b ot h ri u m 6 2 An is aki s 9 9 P ne u mo c y s ti s 15 4 P a ra g o n im u s 4 9 S p a rg a n u m 3 1 D irofila ria 5 4 T o x o p l a sm a 10 2 C lo n o rc h is 1 6 T a e n ia s o liu m 2 7 A s c a r is 5 2 P la s m o d iu m 9 4 F a sc io la 1 3 E c h in o c o c c u s 2 1 St ron g yl o id es 4 8 A c a n t h a m o e b a 3 5 T a en ia s a g in a ta 6 T ox o ca r a 2 7 G ia rd ia 1 4 D ip lo g o n o p o ru s 5 G n a th o stn m a 2 3 L e is h m a n ia 1 3 Sp iru rina 19 A m e b ic e n c ep h a litis 1 0 A s c a r is su u m 16 Iso sp o ra 6 H o o k w o r m s l l T r ic h o m o n a s 6 E n te r o b iu s 10 C ry p t os po r i di um 5 A ng i os tr on gy lu s 8 Trich u ris 8 蝣 Trich ine lla 5 T o ta l 6 0 6 1 5 5 1 5 2 3 9 3 diosis are still fresh in our mind (8, 9).
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