Scabies infection among boarding school students in Medan, Indonesia: Epidemiology, Risk Factors, and Recommended Prevention.

Introduction: Scabies has been a continuous health concern in residential institutions including boarding schools in Indonesia. The disease easily spreads in overcrowding residences. Using one of several boarding schools in Medan, Indonesia, as study site, we conducted this study to better understand the underlying factors behind scabies incidence in boarding schools. We hoped to be able to promote more effective preventive measures toward the disease. Materials and Methods: We included all of 220 students (115 males and 105 females) in a cross-sectional descriptive analytical study, whose ages were ranging from 10 to 18 years. The diagnosis of scabies was made based on interview and physical examination. Skin scraping followed by microscopic assessment was carried out upon finding scabies-related lesion. Data on risk factors were collected using a set of pretested questionnaire and direct observation. Data were analyzed using bivariate and multivariate analysis the with Chi square and logistic regression. Results: We found a high prevalence clinical scabies, i.e., 81 (36.8%) students, yet only one came out positive with skin scraping and microscopic examination. The factors associated with the infection were found to be younger age (odds ratio [OR]: 2.95, 95% confidence interval [CI] 0.97-6.09), sharing clothes (OR: 8.22, 95% CI 2.37-28.48), sharing bed (OR: 17.53, 95% CI 5.55-56.02), and unhygienic bedroom condition (OR: 8.18, 95% CI 3.30-20.28). Conclusions: The results imply the need for better strategies to prevent the transmission of astigmatid mites within the risky populations. We promote six recommendations for a more applicable approach toward scabies prevention in boarding schools and other institutional facilities alike.

Overview of Immunological Responses and Immunomodulation Properties of Trichuris sp.: Prospects for Better Understanding Human Trichuriasis.

Trichuris sp. infection has appeared as a pathological burden in the population, but the immunomodulation features could result in an opportunity to discover novel treatments for diseases with prominent inflammatory responses. Regarding the immunological aspects, the innate immune responses against Trichuris sp. are also responsible for determining subsequent immune responses, including the activation of innate lymphoid cell type 2 (ILC2s), and encouraging the immune cell polarization of the resistant host phenotype. Nevertheless, this parasite can establish a supportive niche for worm survival and finally avoid host immune interference. Trichuris sp. could skew antigen recognition and immune cell activation and proliferation through the generation of specific substances, called excretory/secretory (ESPs) and soluble products (SPs), which mainly mediate its immunomodulation properties. Through this review, we elaborate and discuss innate-adaptive immune responses and immunomodulation aspects, as well as the clinical implications for managing inflammatory-based diseases, such as inflammatory bowel diseases, allergic, sepsis, and other autoimmune diseases.

Prevalence of Cryptosporidium spp. and Blastocystis hominis in faecal samples among diarrheic HIV patients in Medan, Indonesia.

Aim To investigate the prevalence of Cryptosporidium sp. and B. hominis among human immunodeficiency virus (HIV) positive patients in two different outpatient clinics, Haji Adam Malik General Hospital and Primary Care Centre of Padang Bulan, Medan, Indonesia, between two interval periods. Method Cryptosporidium spp. microscopic examination, as well as Jones' medium for B. hominis, were conducted in the Parasitology Laboratory, enzyme-linked immunosorbent assay (ELISA) was done in the Multidisciplinary Laboratory, Faculty of Medicine, Universitas Sumatera Utara. This was a cross-sectional study, involving 54 diarrheic HIV positive patients (44 males, 10 females). The data were analysed by Spearmen rank correlation, interrater agreement, and 2 tests. Results Infection rate for Cryptosporidium spp. and B. hominis was 24% (13 patients) and 9% (five patients), respectively. The prevalence of CD4 cell count below 200 cell/mm3 was relatively high, 29.6% (16 patients). There was a significant relationship between cryptosporidiosis and CD4 cell count (p=0.01; OR 1.57; 95% CI 1.25-1.99). Microscopic examination was superior over ELISA, whose diagnostic value for sensitivity and specificity was 46.15% and 100.0%, respectively, and Kappa (K) coefficient of 0.56. Conclusion The prevalence of cryptosporidiosis among HIV patients was still relatively high. CD4 count showed a significant relationship with Cryptosporidium spp. infection, but not with Blastocystic hominis. Microscopic examination is still the most reliable technique to diagnose the parasites in faecal samples.

Soil-transmitted helminth infections and taeniasis on Samosir Island, Indonesia.

Soil-transmitted helminth (STH) infections are important causes of morbidity in poorer areas of developing countries, with high endemicity in Southeast Asia. Humans are most often exposed to the infective forms of STHs in areas with sub-standard sanitation. The number of STH infections globally was estimated at 1.5 billion in 2018. In Indonesia, the prevalence of STH infections ranges from 2.5% to 62.0%. STH and taeniasis infections were evaluated on Samosir Island, North Sumatra, Indonesia. Field surveys were conducted in January 2003, February 2005, and February 2006 in Simanindo Subdistrict, with a subsequent survey conducted in the subdistricts of Simanindo and Ronggurnihuta in September 2015. A total of 371 individuals were screened between 2003 and 2006 and 368 were screened in 2015 (314 from Simanindo and 54 from Ronggurnihuta). Fecal samples were collected and examined microscopically by the Kato-Katz technique. The prevalence of STH infections in Simanindo for the years 2003, 2005, 2006, and 2015 was 41.4%, 52.2%, 55.7%, and 46.8%, respectively. The 2015 prevalence of STH infections in Ronggurnihuta was 66.7%. Taenia asiatica taeniasis prevalence was 3.4% and 2.2% for the years 2003 and 2005, respectively, with no cases detected in 2006 or 2015. The prevalence of STH infections in Simanindo and Ronggurnihuta was similar to other STH prevalence values reported for Indonesia. Country-level values have not changed substantially from those reported in the 1980s and 1990s, where prevalence ranged from 40% to 70%. Improvement of personal hygiene and environmental sanitation for control of STH infections on Samosir Island will require collaboration among multiple sectors.

Cryptosporidium Sp. Findings and Its Symptomatology among Immunocompromised Patients.

BACKGROUND: Cryptosporidium sp. is an apicomplexan protozoa, and it is related to an immunocompromised state. As it develops diverse clinical manifestations, mild to life-threatening conditions, administration of anti-parasitic medication and its management remain problematic. AIM: The study aimed to provide Cryptosporidiosis symptomatology and its prevalence among HIV-infected patients in a tertiary referral hospital, Haji Adam Malik General Hospital, Medan, Indonesia. MATERIAL AND METHODS: Symptomatology was noted using short-questionnaire, and laboratory findings were obtained from the hospital medical record registry on the same day of admission. We enrolled 24 patients were suffered from HIV infection for a certain period and more than one-week diarrhoea including 18 males and 6 females. Routine faeces examination using wet mount, Kinyoun-gabet, and trichrome staining was performed for all samples in Parasitology Department, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia. Numerical data were evaluated using the Mann-Whitney test while Fisher Exact test was used to determine any association between categorical variables. RESULTS: Our study found that 8 of 24 patients were positive with Cryptosporidium sp. while its symptomatology including abdominal cramp (66.7%), nausea and vomiting (70.8%), and fever (62.5%) is prevalent from our study. We obtained significant association between CD4 cell count (p = 0.006), diarrhea duration (p = 0.007), abdominal pain (p = 0.005), and nausea and vomiting (p = 0.021) with cryptosporidiosis. CONCLUSION: High consideration of several symptoms related to cryptosporidiosis leads a clinician to initiate prompt management particularly in a high-risk population.

Taeniasis/cysticercosis in Bali, Indonesia.

Taenia solium and Taenia saginata are found in humans in Bali, Indonesia. During a field survey of 660 people in Bali from 2002-2009 of taeniasis/cysticercosis cases using mitochondrial DNA confirmation of the species, we detected 80 cases of T. saginata taeniasis, 2 dual T. saginata/T. solium infections with T. solium metacestodes in the brain and 12 neurocysticercosis (NCC) cases at Sanglah Hospital, Denpasar. Although the prevalence of NCC in Bali is low, sporadic cases are still present. There is no Taenia asiatica in Bali. We summarize here the field survey findings of taeniasis, including 1 dual infection with taeniasis and cysticercosis in 2007, and the reason why there are no T. asiatica cases and we describe 3 NCC cases admitted to Sanglah Hospital, Denpasar, Bali in 2004. Diagnosis was based on anamnesis, clinical examination, including CT Scan, histopathological, serological and mitochondrial DNA examinations. In order to prevent unexpected symptomatic NCC after treatment with praziquantel, we recommend introducing a rapid test to confirm taeniasis carriers and cysticercosis cases as a tool for real time diagnosis.