TMJ  Vol. 02 No. 2  172 - 179 Soleman landi et al., Filariasis malayi in Pondok Village, West Umbu Ratunggay, Central

Filariasis malayi in Pondok Village, West Umbu Ratunggay, Central Sumba Regency

Soleman landi1*, Tri Baskoro T. Satoto2, Soeyoko2 1Postgraduate Program, Majoring in Health Entomology, Universitas Gadjah Mada, Yogyakarta, ; 2Department of Parasitology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Corresponding author: [email protected]

ABSTRACT Introduction: Lymphatic filariasis is a communicable disease that still cause public health problem include in Sumba Island, Province. The cause of disease is three species of filaria and had been distributed almost in all area of Indonesia. There are differences in the distribution of species in the Indonesian region Objectives: To investigate the profile of filariasis, the species and Microfilaria rate in Pondok Village. Methods: The sample was all of population in Pondok Village who meet the criterion and examination was performed by observation and fingerprick blood survey. Results: Fingerprick blood survey was performed on 500 respondents and was found 23 respondents suffered microfilaremia. Based on their clinical symptoms it was found 45 respondents had acute limfangitis symptoms, headache and frequent relapse fever (10 was positive mikrofilaremia) and 4 respondents suffered chronic symptoms. Based on the microfilaria morfology identification it was known that all of the filariasis caused by Brugia timori species. Conclusion: Pondok Village was lymphatic filariasis endemic area, caused by Brugia timori with microfilaria rate at 4,6%.

Keywords : Filariasis, Microfilaria rate, Brugia timori, Sumba Island.

INTISARI Pendahuluan: limfatik filariasis adalah penyakit menular yang masih menimbulkan masalah kesehatan masyarakat termasuk di Pulau Sumba, Provinsi Nusa Tenggara Timur.Penyebab penyakit ini adalah tiga spesies cacing filaria yang terdistribusi hampir di seluruh wilayah Indonesia. Setiap spesies filaria memiliki distribusi geografis yang berbeda. Tujuan: Untuk mengetahui gambaran filariasis, identifikasi spesies dan menghitung angka mikrofilaria di desa Pondok Pulau Sumba. Metode: Sampel adalahsemua penduduk di desa Pondok yang memenuhi kriteria.Penelitian dilakukan dengan metode observasi dan pemeriksaan darah dari ujung jari. Hasil: Pemeriksaan darah dilakukan pada 500 responden dan ditemukan 23 dengan microfilaremia. Berdasarkan gejala klinis maka ditemukan 45 responden memiliki gejala limfangitis akut, sakit kepala dan demam kambuhan (10 diantaranya positif mikrofilaremia) dan 4 responden menderita gejala kronis.

172 Soleman landi et al., Filariasis malayi in Pondok Village, West Umbu Ratunggay, Central Sumba Regency

Berdasarkan hasil identifikasi morfologi mikrofilaria dapat diketahui bahwa semua penyebabnya adalah Brugia timori. Simpulan: Desa Pondok adalah daerah endemis filariasis yang disebabkan oleh Brugia timori dengan angka mikrofilaria 4,6%.

Kata kunci: Filariasis, Angka mikrofilaria, Brugia timori, Pulau Sumba.

INTRODUCTION domestic expenditure. Economic loss per chronic Lymphatic filariasis is a communicable filariasis individu was about IDR 735,380 per disease caused by nematoda infection from year, including treatment and drugs cost and Filariodides family in limph vessels and gland. economic loss for productivity loss, productivity The number of limfatic filariasis throughout the period loss of cronic filariasis4. world until 2010 was estimated 120 millions The number of filariasis incidence in people and more than 1.3 billions was Indonesia until to 2009 was 11.914 and East Nusa threathened to be infected and the most was Tenggara Province (NTT) was the second greatest scattered in Southeast Asia Region include contributor with 1.749 incidences5. The report Indonesia 1. from Health Office showed that one of region in The main goal of Global Program to East Nusa Tenggara Province which had many Eliminate Lymphatic Filariasis is to eliminate this filariasis incidences was Central Sumba Regency. disease which is caused by Wuchereria bancrofti, Until to 2010, the number of filariasis incidences Brugia malayi and Brugia timori, throughout the that had been treated achieved 328 incidences. world. This is because limphatic filariasis is Filariasis incidences in East Nusa Tenggara treatable disease and their transmission chain Province was only found in several villages area 2 is breakable . Indonesian government in 2002 whereas in other area was still not studied yet. in Banyuasin declared the starting of filariasis Filariasis epidemiology for each area was very elimination and established filariasis elimination different because in principle there are as a one of communicable disease eradication geographical area characteristics and climate priority programs throughout Indonesian area3. difference between one area to other area. The Lymphatic filariasis not cause direct purpose study is is epidemiology filarias study mortality but the increasing of the prevalence is determining the endemicity of the area, the significantly cause a poverty and able to impede factors which influencing and their eradication theachievementof MileniumDevelopmentGoals planning. In this study it is reported the result (MDGs). Acute filariasis patients will spend time about 5 weeks per year in bed, which is of descriptive study from fingerprick blood equivalent to 11% of their productive period. survey on the population in Pondok Village, West The economic loss for this disability was Umbu Ratunggay Subdistrict, Central Sumba estimated achieve 67% of their monthly Regency.

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MATERIALS AND METHODS microfilaria rate (mf rate) in the village3. Blood Location of the study fingerprick was collected during night time by The study was performed in Pondok Village visiting a quarters where chronic filariasis were in the West Umbu Ratunggay Subdistrict, inhabitant. Central Sumba Regency, that is located at Fingerprick blood samples was collected in 9 031’08"- 9032’16" South Lattitude and November 2011 and started at 08:00PM local 119031’06"- 119033’52" East Longitude. The time. Morphology of microfilaria was identified 7 location of the study is far from the coastal area microscopically by Giemsa staining. Oval thick with altitude at 270-400 meter above sea level blood film with size of ± 1 x 2 cm was made with hilly topographic area for settlement area from about 60 µl blood sample, then let it dry (villages) and plain area below the hill as a rice for at least 3 hours. The next steps was hemolysis fields area. There are five water springs that is by using water and Giemsa staining. The species 8 flowing to one big river that extend throughout of microfilaria was identified microscopically . Clinical signs and symptoms were observed the central of the village and never dry throughout year thus make the rice fields area individually. as very better for disease vector mosquito breeding habitat. RESULTS AND DISCUSSIONS Fingerprick blood survey The subject of the study and blood sampling There were 23 filaremia people out of 500 The subject was all population in Pondok respondents (Table 1). Demographic profile Village, more than 5 years old and who was showed that number of filaremia in male (15) willing to participated in the study. The minimum was higher than female (8), the youngest sample size for fingerprick blood survey was 500 filaremia was male 7 years old. people according to the standard of calculation

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Table 1. Distribution of filariasis by age, sex and residence in Pondok Village, 2011

Explanation: 1) 2) 3) 4) 5) = people who live in the same house M = Male F = Female

Table 1 showed that the highest microfilaria The species of microfilaria rate was 80 /60 µl blood in 10 years old female Filariasis in East Nusa Tenggara was caused who was still in their elementary school. The by Brugia malayi and Brugia timori, while filariasis distribution was scattered in three Wuchereria bancrofti has not reported yet9. quarters but the most prevalence was in Malisa Based on the morphologic identification it was Quarter that was 13 (56,52%). found that all samples were Brugia timori. The morphology of Brugia timori microfilaria can be seen at Figure 1.

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Figure 1. The morphology of Brugia timori microfilaria under microscopic observation that was found in Pondok Village, 2011.

Microfilaria rate Accute disease rate and chronic disease rate Microfilaria rate is a proportion between the Observation and interview to the 500 number population whose their blood are respondents showed that 45 (9%) people positive microfilaria to the total population suffered accute symptoms that were limphangi- examined7. The microfilaria rate in Pondok tis descendens accompanied by fever, headache, Village was 4,6%. limp but dissappear and relapse again frequent- ly,whereas 4 (0.8%) people were chronic filariasis with elephantiasis at legs and arms.

Table 2. Filariasis based on age group, clinical symptoms and microfilaremia in Pondok Village, 2011

176 Soleman landi et al., Filariasis malayi in Pondok Village, West Umbu Ratunggay, Central Sumba Regency

Table 3. Distribution of filariasis by residential location and symptoms in Pondok Village, 2011

Data on Table 2 and 3 showed that among who was positive microfilaremia was Brugia 45 people with clinical symptomps of acute timori. The specific morphology which filariasis, only 10 people positive microfilaremia. determining and differentiate Brugia malayi to There was no microfilaremia and asymptomatic the other species are (1) the number of terminal filariasis on 4 and 13 (56.52%) people with nuclei at the tail, that is 2, (2) microfilaria’sheath chronic filariasis respectively. wich extend beyond the head and tail, (3) The result of fingerprick blood survey in this proportion of length and width of head space is study showed that Pondok Village was filariasis 3:1 (Figure 1)8. Brugia timori microfilaria in endemic village considering the microfilaria rate Pondok Village, Central Sumba was same to was above 1%. According to WHO, any endemic filariasis types which was ever found in several area with microfilaria rate >1%, control other islands in Flores, Alor and Timor management should be done as soon as posible Island9,10,12. to break the chain of transmission such as mass There was no corelation between micro- drug treatment3. filaremia and clinical symptoms, some micro- The filariasis incidence by age group showed filaremic patients did not showed any clinical that the highest was in < 10 years old that was symptoms while some amicrofilaremic 14,29% (Table 2). The number of microfilaremia patients had clinical symptoms. At high incidence in the children were 4 children and all endemic area, clinical symptomts mostly found of them were live in one house with their in young age group. parents or their family who were also positive The acute disease rate (ADR) was 9% (45 filariasis. This showed that the filariasis out of 500 samples) with synptoms of recurrent transmission still continue in the community. descenden limfangitis, fever, headache and limp. Filariasis on children age group in any area Chronic desease rate (CDR) was 0.8% (4 people) showed that the transmission had already with elephantiasis on the leg and arm. occured for long time and until to now was still Selective drug treatment had been occurs effectively10. implemented in Central Sumba Regency by The species of microfilaria based on Health office since 2006. Amicrofilaremic microscopic identification of 23 respondents patients tends to be missed from the treatent

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and become source of transmission. Prevention 3. Ministry of Health Republic Indonesia. of the desease trans-mission can be done at least National Acceleration Program on by three approaches (1) tratment to all patients Filariasis Elimination in Indonesia, Subdit (or mass drugtreatment if mf rate >1%); (2) avoid Filariasis & Schistosomiasis. Ditjen PP&PL, contact to mosquito vectors; (3) combination Jakarta, 2010. of those two approaches13. Environmental 4. Gani A. Draft: Research Report on Economic factors also contribute to the disease Analysis of Filariasis. MOH RI Ditjen PPM & transmission. Study area was about 100m from PLP-Directorate PP-BB, Jakarta, 2000. rice fields, one of filariasis mosquito vector 5. Ministry of Health Republic Indonesia. 2 breeding place . Indonesian Health Profile 2009. Jakarta, 2010. CONCLUSION 6. Health Office. Health Profile of Central Pondok Village was filariasis endemic area Sumba Regency. Waibakul, 2010. caused by Brugia timori with microfilaria rate 7. WHO. Global Programme To Eliminate 4,6%. Lym-phatic Filariasis (Monitoring And Epidemio-logical Assessment Of Mass Drug ACKNOWLEDGEMENT Administrat-ion). Geneva, 2011. The author acknowledgeespecially to Health 8. Purnomo, Dennis DT, Partono F. The micro- Professional Education Quality Improvement filaria of Brugia timori (Partono et al. 1977 (HPEQ) Project, Faculty of Medicine, Universitas = Timor microfilaria, David and Edeson, Gadjah Mada Yogyakarta, which was supporting 1964): Morphologic description with this study through Research Grant Epidemology comparison to Brugia malayi of Indonesia. Of Health Status In NTT, Laboratory Unit of JournalofParasitology, 1977;63:1001-6. Central Sumba Wairasa Public Health Center, 9. Partono F, Purnomo, Dennis DT, Atmosoe- Mrs Ningsih Karyadi, Amd and Mr Purwono as a djono S, Oemijati S, Cross JH.Brugia timori technician of Parasitology Laboratory of Sp. N. (Nematoda: Filarioidea) From Flores Medicine Faculty, Universitas Gadjah Mada, Island, Indonesia., Journal of Parasitology Yogyakarta. 1977;63:540-6. REFERENCES 10. Supali T, Wibowo H, Rüeckert P, Fischer K, Ismid SI, Purnomo, Djuardi Y, Fischer P. 1. WHO. Global Programme To Eliminate High prevalence of Brugia timori infection Lymphatic Filariasis (Progress Report 2000– in the highland of Alor island, Indonesia. 2009 And Strategic Plan 2010 – 2020). American Journal Tropical Medicine & Geneva, 2010. Hygiene. 66(5), 2002:560-5. 2. Fischer P, Supali T, Maizels RM. Lymphatic 11. WHO. Expert Committee On Filariasis, filariasis and Brugia timori: prospects for Third Report. Wld Hlth Org Tech Rep Ser elimination. TRENDS in Parasitology, 2004; No. 542, 1974. 20:351-5.

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12. Oqueka T, Supali T, Ismid IS, Purnomo, Island, Indonesia. Filaria Journal, 2005;4:5 Rückert P, Bradley M, Fischer P. Impact of doi:10.1186/1475-2883-4-5 two rounds of mass drug administration 13. Ottesen EA, BOL Duke, Karam M, Behbehani using diethyl-carbamazine combined with K. Strategies and Tools For The Control/ albendazole on the prevalence of Brugia Elimination Of Lymphatic Filariasis., Bulletin timori and of intestinal helminths on Alor of WHO, 1997;75(6):491-503.

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