RISK FACTORS OF HOOKWORM-RELATED CUTANEOUS LARVA MIGRANS AND DEFINITIVE HOST PREVALENCE ON A SETTLEMENTS AREA IN KULON PROGO DISTRICT,

INDONESIA
Lutvi Heryantoro, Soeyoko, R.A. Ahmad
1. Field Epidemiology and Training Program (FETP), Gadjah Mada University, Yogyakarta 2. Department of Parasitology, Faculty of Medicine, Gadjah Mada University, Yogyakarta 3. Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta)

BACKGROUND Hookworm-Related Cutaneous Larva Migrans (HrCLM) is skin abnormality which is linear or serpiginous, raised and progressive inflammation caused by invasion of hookworm deriving from cats and dogs. Cases of HrCLM in Kulon Progo District were reported increase since 2009 to 2011. Pruritic in the infected parts of body can disturb individuals to sleep, it could disturb physical growth and development of child. Hookworm-related cutaneous larva migrans also can disturb physical and mental condition and social interaction of patients in their environment. Prevalence of dogs and cats with ancylostomiasis was unknown. AIM OF RESEARCH To determine risk factors were associated with HrCLM and prevalence of cats and dogs with ancylostomiasis. METHODS Observational study with case-control design. Case was patients who diagnosed by medical doctor based on clinical manifestations. Control was person who visit primary health care and did not have HrCLM. Risk factors were behavior, environment and sociodemographic will be analysis by frequency distribution, chi-square test followed by logistic regression analysis. Total samples were 160 with ratio cases and controls 1:1. To examine the feces of dogs and cats used floating method.

Figure 3. Typical HrCLM Lesion on Patient in Kulon Progo District on Abdomen (A), Foot (B), Hand (C) and Buttocks (D) Table 1. Case Distribution of HrCLM Stratified by Gender, Age-Group, Number and Place of Lesion No of case With CLM Total Sex Male Female Age group (years) < 15 15 No of lesion 1 2 3 Place of lesion Foot Buttock Legs Hand Abdomen Other 80 54 26 46 34 68 8 4 35 17 15 13 6 9 % 100.00 67.50 32.50 57.5 42.5 85.00 10.00 5.00 43.75 21.25 18.75 16.25 7.50 11.25

Figure 5. Distribution of HrCLM Base on Buffer from Shoreline in Kulon Progo District on April June, 2012 Table 2. Result of Result of Multivarible Analysis (Multiple Logistic Regression) Variabel Walks barefoot Always Sometimes Contact with sand Soil texture Presence of cats Always Sometimes Presence of dogs or cats which were infected by Ancylostoma sp. Age Jobs DISCUSSION Contact with sand and presence of dogs or cats with ancylostomiasis surround their houses are variables which correlation to incidence of HrCLM on settlements area in Kulon Progo District (Table 2). It shows that HrCLM transmission can occur in settlement areas, as long as there were infected dogs or cats by Ancylostoma sp. and sand mound surround of houses on their settlements. The number of new building especially houses in settlements which there are dogs or cats with ancylostomiasis can support of high transmission of HrCLM in there, because of sand mound will be more prevalent. CONCLUSION Contact with sand activity and existence dogs or cats which were infected by Ancylostoma sp. were risk factors of HrCLM on a settlements area in Kulon Progo District. Prevalence of cats and dogs with ancylostomiasis is high on a settlements area in Kulon Progo District. P value 0.147 0.090 <0.001 0.201 0.122 0.234 0.012 OR 2.01 2.86 15.90 1.81 2.13 2.30 3.29 95% CI 0.775.29 0.839.42 5.2647.18 0.784.96 0.745.25 0.558.84 1.268.21

0.809 0.258

1,15 2.12

0.393.80 0.557.23

Glycerin giving and rectal swab

Fresh feces

Laboratory examination

Figure 1. Process of Collecting the Dogs and Cats Feces RESULT From 80 cases, 9 (11.25%) respondents said that got suffered HrCLM once previously. Larva track lines found in cases were ranged from 1 to 4 and most were found in part of foot (Table 1). All cases lived at four SubDistricts namely Galur, Panjatan, Wates and Temon, but most cases (56.25%) were found Sub-District of Panjatan.

One hundred and eighty-three feces of cats and 7 feces of dogs were examined in parasitological laboratory, 96 (52.5%) cats and 3 (42.9%) dogs were infected by Ancylostoma sp. Based on information gathering from people who lived surrounding location of presence dogs and cats, 122 (66.67%) cats were belonged and 61 (33.33%) have no owners, but all dogs had owners.

Figure 4. Ancylostoma sp. Eggs Examined on Wet Mount from Feces Sample of Dogs and Cats in Kulon Progo District Figure 2. Environment Observation (Sand Mound Surrounding Houses and Hoards His Yard with Sand) Distribution of cases of HrCLM by the distance to the shoreline grouped into 3 km, 6 km and 9 km, and most of cases found lived within 3 km from shoreline (Figure 5).

RECOMMENDATIONS Avoid contact with sand activity to prevent incidence of HrCLM, especially in places where dogs and cats presence. Prevention in order that children do not play in sand mound where dogs and cats frequently defecated. In addition, it is necessary to examine dogs and cats periodically for infection of Ancylostoma sp. hookworm and efforts to cure it.

ACKNOWLEDGEMENT: The authors thank the study community, Field epidemiology Training Program of Gadjah Mada University, Desease, Investigation Center Regional IV (BBVet) Wates-Yogyakarta, and Health Services of Kulon Progo District, Fishing Marine and Breeding Services of Kulon Progo District and all parties who participated in this research.