Neurocysticercosis (NCC), which is caused by accidental ingestion of eggs of the pork tapeworm, Taenia solium, was common in Bali, Indonesia until the early 1990s. However, improved education on hygiene and sanitation, a move to keeping pigs indoors, and improvement of economic and living conditions have substantially reduced the occurrence of NCC in Bali. Since 2011, T. solium tapeworm carriers (T. solium taeniasis) and heavily infected pigs and dogs have exclusively been detected from villages in mountainous regions of northeastern Bali where NCC and ocular cysticercosis (OCC) cases have also been identified. In response to this continued area of high infection, a one-day workshop was convened to discuss how to prevent and control this potentially lethal zoonotic parasitic infection in Bali. This review presents an overview of the current status of T. solium taeniasis and cysticercosis in Indonesia and proposes a strategy for the prevention and control of this zoonosis in Bali.

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IntroductionTaeniasis/cysticercosis, caused by the pork tapeworm, Taenia solium, is a parasitic zoonosis found primarily in countries where pigs are raised and meat inspection is lacking [1,2]. The potential for a tapeworm carrier to infect another individual (or themselves via autoinfection), resulting in cysticercosis or neurocysticercosis (NCC), is a risk not only in endemic areas, but also in areas with immigrants from endemic countries [1,[3][4][5]]. An example of such an outbreak occurred in an Orthodox Jewish community in New York City when family members were infected by a domestic employee from a T. solium endemic country [6]. Such NCC outbreaks have occurred in other developed countries, including countries in the Middle East where people do not consume pork [4,5,[7][8][9][10][11][12][13].In Asia, there are three Taenia tapeworms that infect humans; T. solium, Taenia saginata and Taenia asiatica [4,5,[14][15][16][17][18][19][20][21][22][23][24]. Although adult T. solium worms with scoleces are easily differentiated morphologically from other taeniids, it is almost impossible to differentiate adult T. asiatica and T. saginata [5,22,25,26]. Therefore, molecular differentiation is often required to correctly identify the infecting species [27]. Recent studies have also reported hybrids of T. saginata and T. asiatica in Thailand and China [5,25,[28][29][30][31][32]. This makes mitochondrial and nuclear gene analyses even more important for the differentiation of T. saginata, T. asiatica, and hybrids of these two species [30][31][32].In Indonesia, T. solium, T. saginata and T. asiatica are distributed according to livestock rearing and local food consumption practices [33][34][35][36][37][38][39][40]. Both T. saginata and T. solium have been confirmed from the island of Bali, where the local inhabitants are known to eat dishes that contain undercooked beef and pork, such as the traditional dish Lawar. NCC was considered endemic on Bali more than 20 years ago [41,42]. However, education programs aimed at keeping pigs indoors to prevent access to human faeces and the introduction of improved sanitation systems and practices have substantially reduced the prevalence of NCC during the past 2 decades [35,37,43]. Nevertheless, there are still sporadic NCC cases identified on Bali [40,[42][43][44][45]. Case ReportFieldwork conducted on Bali from 2002-2007 resulted in the identification of 69 taeniasis carriers who were treated with a single dose of praziquantel (PZQ) at 15 mg/kg body weight (Table 1). All worms were confirmed to be T. saginata by multiplex PCR [36]. In August 2007, a 47-year-old male taeniasis carrier from the Gianyar district suffered a single tonic-clonic seizure within a few hours of PZQ administration. The patient was subsequently admitted to the Sanglah Hospital in Denpasar. A computed tomography (CT) scan revealed one viable cystic lesion and one calcified lesion in the right frontal lobe of the brain. At this time, serology (ELISA) was also carried out using partially purified antigens by c...

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Abstract-Intestinal protozoa infections are still a major health concern in tropical countries and considered one of neglected tropical infections. Giardia lamblia as one of the human protozoa can cause significant morbidity. It is associated with lack of personal hygiene and environmental sanitation, such as inadequate toilet, lack of hand washing habit, unimproved water supply, and insufficient handling of foods. Some other protozoa such as Balantidium coli and Blastocystis hominis are correlated with the farming. However, data on the prevalence and risk factors is still scarce in Indonesia, Hence, this study was aiming to determine the correlation between the risk factors and the prevalence of protozoa infections among the community in Samosir Island, the island in the centre of Lake Toba, North Sumatera, Indonesia.This was an analytical study using cross-sectional design, conducted in 2015. Faecal samples were collected from 368 participants and then examined microscopically for qualitative analysis. Demographic data and risk factors were also collected using questionnaires, which was then analysed using computer statistical analysis program for data description and correlation.The study found that 23.1% of faecal samples were positive for intestinal protozoa. Giardia lamblia was the most common infection (12.23%), followed by Blastocystis spp. (4.89%) and Entamoeba coli (4.35%). There were also mix infections between species, each comprises around 1%. Indiscriminate defecation, lack of sufficient hand washing, unprocessed drinking water, and swine farming showed strong correlation, all of which with p value < 0.05. However, there was no correlation showed with cattle farming and water source.