A REVIEW OF SCHISTOSOhlIASIS IN INDONESIA WITH REFERENCE TO SCHTSTOSOMA JAPONICUM Lim Boo ~iat'and M. sudomo2 ABSTRAK Tinjauan tentang Schistosoma di Indonesia ini mencakup Schistosonza japonicurn, S. ztrcog~rzr!m~. S. spindale dan Trichobilhmzia brevis. Tinjauan dibuat atas dasar laporan-laporan penelitian yang leiah diterbitkan. Di dalamnya dapat dijumpai uraian singkat tentang S. spinale dan T brevis. Dari banyak pu blikasi tentang S. j~ponicum dan S. incoganiturn dapat disajikan uraian tentang peranan kedua p arasi t tersebut sebagai penyehab penyalut baik manusia maupun hewan INTRODUCTION ti~~oclinical tor:ns of the disease. the vesical and the intestinal. In the orien- Schistosomiasis, sometimes called tal the disease, which is an intestinal bilharziasis, is one of the most wides- forms, is known as oriental schistosomid- ;>read of' all human parasitic diseases. sis, Kata)-ama fever, bilharziasis japoni- it ranks second in terms of social econo- ca and Yangtze I7alle)- fever. The diseasc mic and public health importance in is accompanied by toxic and dysenteric tropical and sub-tropical areas, immedia- symptoms, as well as loss of appetite tely behind mahria. In terms of preva- and ~veight. emaciation and retarded lence, it takes first place among the qo~-thof youns patients. The most \traters borne diseases, representing one characteristic of the disease, are enia~- oi' the major health risks in rural areas ged liver and spleen, and often ascites of develol~ingcountries. usuall~.more pronounced in the oricntal Schistosimiasis is a three-factor com - form than in intestinal schistosomiasis plex, involving and agent, an interme- 01 Africa, Central and South America. diate molluscan host and a mammalian Four species of Schistosoma have been defenitive host (Fig. 1). reported from this archipelago. The!. It is caused by certain diyenetic are the classical Schistosoma japonicum, trematodes which choose as their habitat S. incogniturn, S. Schistosoma japonicum, the venous system of man. There are S. Spindale and Trichobilharzia brevis. 1. C/0 Institute for Medical Research, Kuala Lumpur, Malaysia. 2 Health Ecology Research Centre, National Institute of Health Rescarh and Development, Jakarta, Indonesia. Bul. Penelit. Kesehat 15 (3) 198: 1 A Review of Schistosomiasis . Lim Boo Liat et al. F. f 1% I. rife cycle Shistosoma japonicum. .'L. .'L. Cop'hting pair of S. japonicum inhabiting the upper rnesenteric veins of definite host. B. Intermediate molluscan host, O~comelaniahu.pensis li~doensis.'c. Definitive host represented by man, although any mam?lal th:?t enters infested waters will provably serve as a definite host. Eggs of S, japor:icurn, after being passed from female worm into small veins, make their way into bowel of host, pass out with faces, and, if deposited in aquatic habitat,hatch, and release a motile rniracidium. Xf miracidium comes in contact with an oncomeianid snail, it will pelreirate and go through a series of asexual multiplications resulting in the production of larval worms, known as cercarias. These escape into an aquatic environment, and penetrate :he skin of mammals frequenting that habitat. Within the definitive mamialian host the cercaria metamorphoses into an adult schistosome, mates and, thus, completed the life cycle. 2 Bul. Penelit. Kesehat. 15 (3) 1987 A Review of Schistosomiasis . Lim Boo Liat er al. Of these, S. japonicum is the most impor- miasis area in the Sap11 valley \vas dis- tant in terms of human health and its covercc16. Durins these period, thc bioloa is best understood. this review, intermediate host , Oncomela~ziahupensis brief mention is made of what is known lvas found in the Lakc Lindu vallc). about S. Spindale and T. brevis and then Thus confirmed that the disease situati- the discussion concentrate on S. japoni- o~iin Indonesia \\.as, in fact, .Lform of cum and S. incognitum. The classical classical oriental schistosomiasis similar from of S. japonicum from S. japonicum in its bioloq!. ant1 transmission to tliat like schistosomes of Indonesia and their found in the Philipj~incs.J :li~anand Chi- respective roles in the etiolog) of human na. The lnolluscan host 01's. japonicurn and animal disease are also discussed. in the Lake Lindu \:alle) \vas subsequcn- tl~.described as a ne\z species, 0.h. lit?- doensis and is most similal- to 0.11.qua- drasi. the vector host in the ~l?ili~~ines~. CLASSICAL SCHISTOSOMA The disease occurs now only in two ver!. JAPONICUllS isolated areas, the Lake Lindu valle). and Kapu valley in Central Sulawesi. Prelinimary studies of schistosomia- sis in Indonesia were made in the late 1930's and the early 1940's. The first human case of S. japonicum \vas dis- covered by hluller and Tesch from Lindu valley of Central Sula\vesi (Cele- DESCRIPTION OF THE LINDU &ID bes). Early epidemiological studies prior NAPU VALLEYS to IVorld War I1 demonstrated that, in addition to man, wild deer and domestic Detailed descriptions of both these 9 dogs served as reservoir hosts, and sub- valle).s were given by Clarke et. al. and sequent microscopic examination of Carney et. aL6 However, it will be useful adult worms from these mammals con- to summarize some of the salient featu- firmed them to be S. japonicum 273 A1 res of the areas. though extensive snail surve),s were . The Lindu valley is located in the conducted at that time, the molluscan highlands of Central Sulawesi (Fig. 2). host was not found. The schistosomiasis The valley has an area of approximatel! problem in Lindu Valley virtually 100 km 2' in the Takolekadju mountain remained dormant until 1956. Epidemio- range. In the northwestern portion of logical stadies were made, which confir- the valley lies Lake Lindu, which is 10 med the findings of precious investiga- km in length and average 5 - 6 km in tors4, and since then lake Lindu Valley width. Nun~erous streams originating has been known as the only area of en- from the surrounding mountains empty demic S. japonicum in 1ndonesia5. into the lake. At the northwest corner, S, japonicurn in 1ndonesia5 the Gumbasa river, which is the only In the 1970's there was a resurgence outlet, flows into the adjoining Palu of interest in the epidemiology of schis- valley. Therc are flat stretches of 10~7- tosomiasis in Indonesia. A new schistoso lying marshy areas on the eastern and Bul. Penelit. Kesehat. 15 (3) 1987 3 A Review of Schistosomiasis . Lim Boo Liat et al. northern sides as well as at the northwest Human population numbering about corner of the lake. These open swampy 1,500 - 2,000 are spread among the areas are utilized by the village popu- villages there, most of which lie on the lation for cultivating rice and grazing western shone of the lake. cattle. Climatologically the Lindu valley Napu valley is also located in the is situated in a tropical rain forest cha- highlands of Central Sulawesi, about racterized by high temperatures and 50 km southeast of Lake Lindu (Fig. 2). humidity. Fig. 2. Map showing the two known endemic areas for Schistosoma japonicum in Central Sulawesi, Indonesia : Palu Valley and Napu Valley. 4 Bul. Penelit. Kesehat. 15 (3) 1987 A Review of Schistosorniasis . Lim Boo Liat et al. The valley lies between the Takolekedju In the Napu valle), the habitats mountains on the west and the Tineba are mainly swampy fields with dense, mountains on the east, and is now a short or tall marsh grasses, usually dried-out lake bed of more than 1,000 adjacent to actively worked padd>-fields. km2. It is surrounded by tropical rain Forested areas or along the edge of the forest characterized by high teinpcratu- forest have not yet been searched for res and humidit). The valle) floor is the snails. a well-drained gassy plain. 4 small bod) Potential oncornelallid habitat in of water, Lake \Yanga, is situated 5 km Napu valley is far greater than thdt south of Wuasa, the district capital. The available in Lindu ~~alle).I11 Lindu valle) Napu valle) is drained b) the Lariang less than 50 krn2 are lowlands or moors which river empties into the strait of needed for 0. hupensls habitat, whereas Rlakassar. in Napu valley there are 7,500 km2 of Presentl) more than 4,000 people such terrain6. inhabit the Napu valle) in \illages loca- Infection rates of S. japonicum in ted along the Lariang river and its tribu- 0.h. lindoensis varied considerabl! bet- taries. ween foci and between sampling periods. The overall average infection rate in the Lndu valley was 2.4 % in large disturbed ECOLOGY OF ONCOMELANIA area foci, and about 7.0 % in small na- SNAILS AND INFECTIVITY tural foci bordering the lake shore or in the virgin lowland forests. Infection rates Foliowing the discovery of a single were higher in females (2.70 %) than in specimen of Oncomelunia snail in 1971 male snails (1.95 %). Cy age (length) by Carney et. a~.~,further intensive snail infection rates were quite consis- surveys revealed over 70 foci of this snail tent in snails two months of aqe 01- were found on the lowlands surrounding older1 the lake Lindu area1 O and 15 foci in Napu valley about 50 km southeast of ~indu'l '. The ecolog) of this EXPERIMENTAL INFECTION snail is well documented by these inves- STUDIES tigators, and later also by Pinardi Hadi- djaja and ~udomo'3. The subspecific Studies on experimental animals, status of the Onwmelania in the Napu using mice, Wistar rats, Long Evans rats, valley has not been determined as yet. hlongolian gerbils, wild rats (Rattus and is presently referred to at the Napu norvegicus), hamsters and guinea pigs geographic strain of 0. hupensis. showed that mice were found to be the In the Lake Lindu valley, most of most susceptible experimental host for the Oncomelunia colonies isolated have the Indonesian strains of S.