2258 Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03 Public Health Relevance of Sparganosis in Javan Spitting Cobra Snakes (Naja sputatrix): A Neglected Zoonotic Disease In Indonesia Aditya Yudhana1, Ratih Novita Praja2, Dhandy Koesoemo Wardhana3, Maya Nurwartanti Yunita4, Faisal Fikri5, Eunike Melanda Fransiska6, Wardah Afifah Ismail6 1Lecturer, Department of Veterinary Parasitology, 2Lecturer, Department of Veterinary Microbiology, 3Lecturer, Department of Veterinary Public Health, 4Lecturer, Department of Veterinary Pathology, 5Lecturer, Department of Veterinary Basic Medicine, 6Assistant Lecturer, Department of Veterinary Parasitology, Faculty of Veterinary Medicine, Universitas Airlangga, Indonesia Abstract Sparganosis is a zoonotic disease caused by the spargana (larvae) of Spirometra sp. (Diphyllobothriidae). Snakeare particularly important intermediate hosts for the transmission of this parasite in Asia especially Indonesia. However, their role for sparganosis in javan spitting cobra (Najasputatrix) is unrecognized. This study aimsto investigate the infection of cobra snakes with Spirometra tapeworm in Banyuwangi, Indonesia where several local sellers have been identified recently sold snakes meat for culinary purposes. A total of 37 cobra samples were bought from a localseller and euthanized. Then, continued with necropsy and parasitological examination. The result founds 71 plerocercoids within muscular and subcutaneous tissues and the prevalence were recorded at 56,7%.Our finding is the first identification confirmed recordSpirometra of tape worm in javan spitting cobra in Indonesia. Since snakes are often a component of mammalian diet, they can be a source of Spirometra tapeworm infection in human and Indonesian wildlife. However, further studies are needed to investigate the prevalence ofinfection in other reptiles and amphibian hosts. Keywords: Javan Spitting Cobra, Najasputatrix, Sparganosis, Spirometra, Zoonotic. Introduction water, consumption of insufficiently cooked amphibians (frogs or tadpoles), snakes, birds, or even mammals Sparganosis is a food and water-borne zoonotic such as rodents and pigs and by poulticing the skin or disease caused by spargana (the infective stadium) of the eyes with a split frog. The clinical manifestation of Spirometra sp. tapeworm (Diphyllobothriidae). Most sparganosis includes ocular, subcutaneous, oral and research regarding sparganosis has been conducted in maxillofacial syndromes and it may sometimes be fatal Asia, especially in mainland China where sparganosis not only in humans but also animals.3 is a serious threat for public health.1,2 However, sparganosis reports are still little known in Indonesia. Intermediate hosts for Spirometra tapeworm such This tapeworm is transmitted to humans in the following as amphibians and reptiles, are already considered ways such as swallowing an infected copepod in natural important wildlife for parasite transmission in Asia.2,3In Indonesia, the only two cases of infected reptiles, in oriental rat snakes (Ptyasmucosus) and Indonesian bronzeback snakes (Dendrelaphispictus), have been Corresponding Author: recorded in Sidoarjo City and Mojokerto City with high Dr. Aditya Yudhana prevalence.4,5 The parasite first intermediate hosts are Department of Parasitology, Banyuwangi Campus, copepods (Cyclops sp.), planktonic crustaceans in which Wijaya Kusuma Street No 113, East Java, Indonesia procercoids (the first larval stadium) develop. The second e-mail: [email protected] intermediate or paratenic hosts can be vertebrates, such Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03 2259 as amphibians, reptiles, birds, or mammals (including Java Province, Indonesia (114.369227 Longitude and rodents and human).3 Procercoids then develop into -8.219233 Latitude) then euthanized and necropsied. plerocercoids (the larval infective stadium) which settle The presence of spargana in snakes was examined in organs and tissues of intermediate hosts. according to the following method.9 Briefly, the snakes were euthanized using ethyl-ether anesthesia, weighed The life cycle of Spirometra sp. may also include and skinned. The muscles and subcutaneous tissues were paratenic hosts, in which plerocercoid or commonly carefully observed for the presence of spargana by eyes. known as spargana once more settle in the tissues Then, the spargana were removed from the muscles or 6 after passing through the intestinal wall. However, subcutaneous tissues and put in a Petri dish containing these hosts are not necessary for the completion of physiological saline to observe their movement. The Spirometra tapeworm life cycle. Therefore, knowledge number of spargana collected from each infected snake of the Spirometra sp. life cycle is stilllimited. Adult were counted to estimate the intensity of sparganum Spirometra sp. reproduces mainly in the intestinesof infection. Identification of the larval infective stadium felids and canids such as the Eurasian lynx (Lynx lynx) (plerocercoids) in wet preparation using carmine and wolf (Canis lupus) which parasite eggs are shed staining and clearing with glycerin then examine using a 7 with animal feces. The high prevalence of sparganosis light microscope with a magnification of 40x and 100x. in Asia may be related to the local dietary habit, where 8 snake is regarded as popular and nutritious culinary. Results In Indonesia, about half of the local restaurants provide wild-caught snakes which used for culinary purposes. Based on examination results, 21 snakes were Moreover, the worse matters, many people enjoy eating positive infected with larvae of Spirometra tapeworm half cooked or even completely raw meat, skin and gall or called spargana with the total prevalence of 56.7%. bladder of snakes, without considering the high risk of Moreover, a total of 71 spargana were collected in infection by parasites.4,5 Based on the high prevalence this study which divided into 47 (66.1%) sparganain of sparganosis and the unhealthy habit of eating muscular and 24 (33.8%) spargana were found in snakes in Indonesia, we conducted this study to further subcutaneous tissues of Najasputatrix snakes. Spargana understand the prevalence of saprganosis occurrence were macroscopically identified as flat, thin and white in Najasputatrix snakes which commonly sold in local colored with ribbon-like structure. Those spargana restaurants. The aim of our study were to assess the risks frequently founds in groups in almost all parts of of human spargana infection caused by the consumption muscular and subcutaneous tissues (Figure 1). The of wild-caught snakes and provide scientific foundation spargana average length is +12cm, with +0,3cm body for preventing sparganosis transmission from animals to width. Microscopy examination using carmine staining humans. method shows segmented body and mouth-like shape at the top of anterior side (Figure 2). Therefore, the results Materials and Method of microscopic observation were confirmed plerocercoid larvae of Spirometrasp. or spargana. A total of 37 living Najasputatrix snakes were collected from local seller in Banyuwangi City, East A B Figure 1. Spargana (plerocercoids) of Spirometra tapeworm located in (A) muscular and (B) subcutaneous tissue of Najasputatrix. Arrows point to spargana 2260 Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03 A B Figure 2. Photomicrograph of spargana from Najasputatrix. (A) anterior side and (B) posterior side using carmine staining (100x magnification). Discussion In addition, ingesting copepods in natural water could also cause human infection. Therefore, attention should Najasputatrix or commonly known as javan spitting be given to sparganosis transmission caused by drinking cobra snake was strongly associated with wetlands, where unboiled water from the fields or other unhealthy water they can most likely become infected with procercoids sources.15 Moreover, it is necessary to strengthen food by swallowing water copepods or consuming amphibians safety inspections of restaurants which provides snake such as wild frogs.10Moreover, they can be hunting meat. It should be emphasized that all restaurants provide living prey upon by several species of mammals and only the meat of farmed snakes or frozen snake meat birds that are known to occasionally eaten by reptiles.11 to the customer, in order to reduce the risk of human This report also confirms the role of reptiles as parasite sparganosis. transmitters in Asia and reveals additional routes of sparganosis transmission in Indonesian wildlife. Further When humans are infected by plerocercoid, studies are recommended to provide a deeper explanation commonly known as spargana, the larvae can perform of the role of non-mammalian hosts in the spread of visceral migration, infect many tissues and shows several Spirometra sp. in the natural environment. Spargana of clinical signs. Spargana has been reported to migrate Spirometra tapeworm can parasitize humans and result into subcutaneous tissues and peripheral muscles such as in sparganosis, which is an important zoonotic disease. abdominal walls, lower extremities, scrotums and chest Sparganosis mainly occurs in east and south Asia, but walls. Subcutaneous sparga nosis is the most common has been reported in several countries worldwide,12 form among type of sparganosis in humans.16 Under the including Europe, America, Africa and Australia.13 In skin, the lesions look like rubbery