From the Guidelines
Gastrointestinal parasitic infections are common in Indonesia, and prompt treatment is recommended for travelers or residents experiencing symptoms, with the most prevalent being soil-transmitted helminths and protozoan infections like giardiasis and amoebiasis. The most recent and highest quality study 1 recommends treatment for schistosomiasis, which is prevalent in Indonesia, with praziquantel 60 mg/kg in two divided doses for S. japonicum infections. For roundworm (Ascaris) infections, albendazole 400mg as a single dose is effective, as recommended by 1. Hookworm infections require albendazole 400mg daily for 3 days. Giardiasis should be treated with metronidazole 250mg three times daily for 5-7 days or tinidazole 2g as a single dose. Amoebiasis treatment involves metronidazole 750mg three times daily for 5-10 days, followed by paromomycin 25-35mg/kg/day in three doses for 7 days to eliminate cysts.
- Prevention is crucial and includes:
- Drinking only bottled or purified water
- Avoiding raw vegetables unless personally cleaned with purified water
- Thoroughly cooking food
- Practicing good hand hygiene
- Wearing shoes in rural areas
- These parasites spread through fecal-oral routes via contaminated food, water, or soil, with poor sanitation facilitating transmission, as noted in 1 and 1.
- Symptoms may include diarrhea, abdominal pain, bloating, nausea, and fatigue, though some infections remain asymptomatic. Treatment should be guided by the most recent and highest quality evidence, with a focus on reducing morbidity, mortality, and improving quality of life.
From the Research
Gastrointestinal Parasites in Indonesia
- The prevalence of intestinal parasitic infections (IPIs) is a significant public health concern in Indonesia, with factors such as water access, sanitation, and hygiene practices (WASH) influencing the risk of infection 2.
- A study conducted in North Jakarta, Indonesia, found that the overall prevalence of intestinal protozoa parasitic infection (IPPI) was 18.3% and 52.4% by microscopy and real-time polymerase chain reaction (rt-PCR), respectively 2.
- The most common intestinal parasites found in the study were Blastocystis spp., Giardia intestinalis, Cryptosporidium spp., and Entamoeba histolytica/dispar 2.
Treatment Options
- Albendazole and mebendazole are commonly used to treat intestinal nematode infections, including ascariasis, hookworm infections, trichuriasis, strongyloidiasis, and enterobiasis 3, 4, 5.
- Albendazole is also used to treat filarial infections, such as lymphatic filariasis, onchocerciasis, and loiasis, alone or in combination with other drugs 3, 5.
- Ivermectin is preferred for treating Strongyloides stercoralis, while praziquantel is effective against most nematodes and trematodes 4, 5.
- Nitazoxanide, metronidazole, and tinidazole are used to treat Giardia infection, while sulfamethoxazole/trimethoprim may be used to treat Cyclospora infections 6.
Risk Factors
- School children aged 5-10 years old and those who drink unprocessed cooking water are significantly associated with IPPI 2.
- Poor WASH practices and facilities can increase the risk of IPIs, even in areas with improved water access and sanitation 2.
- Immunocompromised individuals, children, and older adults are more susceptible to severe symptoms and complications from intestinal parasitic infections 6.