SPATIAL ANALYSIS AND RISK FACTORS OF HUMANTOXOPLASMOSIS AT SPECIAL PROVINCE OF YOGYAKARTATOXOPLASMOSIS AT SPECIAL PROVINCE OF YOGYAKARTA

TROUGHT ECOHEALTH APPROACHES

E H lth C f K i Chi 2012EcoHealth Conference, Kunming China 2012

Wayan T. Artama1. Sujono2, Dyah Ayu Widiasih4, Tjut Sugandawati Djohan6, Pande Made Kutanegara7, Adhiheru Sutomo3, Dewa Ayu Sri Laksmi5, Fihiruddin3,Kutanegara , Adhiheru Sutomo , Dewa Ayu Sri Laksmi , Fihiruddin ,

1. Department of Biochemistry Faculty of Veterinary Medicine, Universitas Gadjah Mada (UGM), 2. Health Polytechnic, Yogyakarta; 3. Department of Public Health Faculty of Medicine, UGM, 4. Department of Public Health Faculty of Vet. Medicine, UGM, 5. Department of

Parasitology University of Udayana, 6. Faculty of Biology, UGM, 7. Department of Anthropology Faculty of Social Culture, UGM,

Contents

1 TOXOPLASMOSIS

2 SURVEY ON TOXOObjectives, methodology, selected results

3 ECOHEALTH APPROACH

Classification and Taxonomy

SUB-PHYLUM: APICOMPLEXA

CLASS : COCCIDEA (“COCCIDIA“)

ORDER : EIMERIIDA

Family : Eimeriidae

F il S tidC t f i Family : SarcocystidaeToxoplasma gondiiNeospora

Cyst-forming coccidia

Hammondia BesnoitiaSarcocystis*yFrenkelia

Life cycle of Toxoplasma gondiiGamogony

Defenitive host Unsporulated host Unsporulated

oocyst in faeces

Endogenic cyst

S

Endogenic cyst with bradyzoites IH

SporogonyMerogony(ies)

Sporulated oocyst Sporulated oocyst with sporozoitesin environment

“Pseudocyst“ with tachyzoites

in tissue cells

facultative heteroxenic cycle

“Key figures“ (after 1st infection of DH*)

Pre-patent periodPre-patent period(time interval between infection and first oocyst shedding)

- after infection with tissue cysts = 3-10 daysf f y y

- after infection with sporulated oocysts = 3-5 weeks

• Patency: 1-21 days

• Oocyst output• Oocyst output

1.000.000 oocysts / g faeces

600 000 000 t i t t l d i t

Large contamination of 600.000.000 oocysts in total during patency contamination of the environment with oocysts

Life cycle of Toxoplasma gondii= the only DH shedding oocysts; gamogony (sexual development)

Oral infection of cat with (i) sporulated oocysts or (ii) endogenic cysts (sexual development)

in the intestines(ii) endogenic cysts

Development in the intestine of cat

Oral (horizontal) infection of IH with(i) sporulated oocysts (sporozoites) from environment or

P t l/di l t /i t t i ( ti l)

(i) sporulated oocysts (sporozoites) from environment or (ii) endogenic cysts (bradyzoites) in tissue

Prenatal/diaplacentar/intrauterine (vertical)infection of IH’s foetus with tachyzoites (in case of 1st infection of the mother during pregnancy)

Invasion of Invasion of T. gondiiT. gondii

Tachizoit T. gondii MicronemesMicronemesRhoptriesRhoptries

Dense granuleDense granule

Gp 22Gp 22

NucleusNucleus

Gp 22Gp 22

p 23p 23

Gp 30Gp 30

G 35G 35Gp 35Gp 35

Toxoplasma gondii

Cycle in humansCycle in humansInfected

• by ingesting infective oocysts (in >4 day old  cat  feces)

• by ingesting tachyzoites or bradyzoites in rare cooked or raw meat

• by receiving blood or tissues with “zoites”• congenitally by transplacental tachyzoitescongenitally by transplacental tachyzoites

Hydrocephalus

Survey on Toxoplasmosis 

Objective:Th i f thi h i t t d l i l lThe aims of this research is to study serological prevalence of toxoplasmosis in the population and get an overview of association between risk factors and human toxoplasmosisassociation between risk factors and human toxoplasmosis trough ecohealth approaches.

Material and methods:Material and methods:• Serological survey in Yogyakarta using GRA‐R bi P i i i ELISA b dRecombinant Protein as an antigen in ELISA based test

• Study in 5 District & 1050 human sera from population• QX 

PREVALENCE OF TOXOPLASMOSISIN ANIMAL – selected results

Study area: YogyakartaSt d i d 2011 2012

IN ANIMAL – selected results

Goat51%

Study period: 2011-2012Study type: Surveillance

Sheep49%

51%Pig?

49%Wild Cat

79%Dairy cow

ANIMAL

Bali cattle7,1%

Dairy cow21%

PREVALENCE OF TOXOPLASMOSISIN HUMAN selected results

Study area: Yogyakarta

IN HUMAN – selected results

Kodya54,7%

Study area: YogyakartaStudy period: 2011-2012Study type: Surveillance

Sleman60%

54,7%

K l P60% Kulon Progo77,1%

Bantul

Human

Gunung K20,5%

Bantul48,5%

Selected resultsMap of Seroprevalence for Toxoplasmosis at Yogyakarta in Humanp p p gy

Selected results from EcoZD projectMap of Seroprevalence for Toxoplasmosis in Human (Sleman District)Map of Seroprevalence for Toxoplasmosis in Human (Sleman District)

Spatial analysis of ToxoplasmosisSpatial analysis of Toxoplasmosis

ECOHEALTH APPROACH

1.Systems Thinking2.Transdisciplinary 3 P ti i ti3.Participation4.Sustainabilityy5.Gender and Social Equity6 K l d A i6.Knowledge to Action

Human-Animal-Ecosystem (Rural Ecosystem at Yogyakarta)The intact rural ecosystem is an unbroken chain linking nature, society and economy

Potential risk factor in correlation to Toxoplasmosis in the study area

No   Characteristic/Risk Factor (based on Logistic Binary Regression)Odds Ratio

1.     Gender                                                                                *1,1802.     Place where the respondent  stay                                  0,6463.     Have contact with cat                                                       *1,2614 Eat goat meat (not well cooked) *4 0874.     Eat goat meat (not well cooked)                                     4,0875.     Eat unwashed vegetable in the food vendor              *7,9276.     Occupation that is related to meat vendor                 *1,3937.     Source of water                                                                   0,8498.     Occupation that are related/ activities 

*that mostly contact to soil                                                *2,753

ConclusionToxoplasmosis in humans – Suggested Prevention measures

• Don‘t eat uncooked meat• Don t eat uncooked meat

• Wash fruits and vegatable carefully with d inkin t nd/ c k it

Prevention of accidental infection

drinking water, and/or cook it

• Drink mineral water onlyinfection

• Wear gloves when working in garden etc. and wash hands carefully

• Clean the cat toilet with hot water daily

• Feed your cat with can/dry food only and Prevention of environmental

• Do EcoHealth approachcontamination