**2. Indonesia**

Human echinococcosis in Indonesia was first reported in nonindigenous people, in a European with liver hydatidosis in 1885 [7]. Subsequent cases were also confirmed in four European and an Indian in the 1920s [8]. In the late 1930s, a 45-yearold European female was also suspected with *Echinococcus* infection after stayed for almost 17 years which much contact with dogs in Indonesia [9].

The first indigenous case was diagnosed in a female aged 23 years from the northern part of South Sulawesi in 1988. She was admitted to the hospital with pain in the right under quadrant of the abdomens and in the right part of the hypochondrium, below the right rib. Hepatomegaly or tumor in the right upper quadrant of the abdomen was not found by physical examination. However, a hypoechoic, oval image, with a clear acoustic image on the right, was identified by using ultrasonography. Serological test was not performed, and the diagnosis was confirmed by radiological image examination. The patient has a history of keeping a dog [10].

Another echinococcosis case was reported in a 90-year-old female from Java in 1988. She was hospitalized in Ujung Pandang (Makassar), South Sulawesi with complaint of severe weakness, fainting, and no appetite. A tumor with no malignant cells was identified in the lower right part of the abdomen. Cysts with hypoechoic image on the walls were detected in the pelvis, right upper liver, and upper left abdomen. Fluid aspiration and serological test were not carried out during patient treatment at the hospital. The hydatidosis was confirmed in the right diaphragm arc/liver, omentum, and adnexa by radio-image. She had not kept dog at home [11].

In 1997, subsequent indigenous case, a 26-year-old female from Palu, Central Sulawesi, was administered in the Cipto Mangunkusumo Hospital in Jakarta with chronic and progressive headache, space-occupying lesion, blurred vision since the last 6 months, and vomiting. Bilateral edema of the papilla of the eyes was found without other neurological deficits. Cysts were found in many parts of organs. A hypodense, cystic lesion in the left parietal region of the brain divided by several septa with calcifications was discovered by radio-image with tomography (CT) scan. Historically, he lived in an area that kept many dogs, including her house.

In animals, echinococcosis is reported from goat, sheep, pig, water buffalo, and monkey from Sumatra, Madura, Bali, and Sulawesi. A case with liver, lung, and spleen hydatidosis was first identified in a cattle in Buitenzorg (Bogor, West Java) during meat inspection on 1906. Hydatid cysts were subsequently found from the lungs and liver of cattle in North Sumatra in 1907 [12]. At that time, the hydatid cysts were only detected from imported Australian cattles (nonindigenous echinococcosis was also reported among 46 cattles and 3 pigs in Medan, North Sumatra, in 1916) [13]. In 1929, hydatid cysts in indigenous cattle were found for the first time from Bali. This finding was considered that dogs from Bali were probably reservoirs for the adult worm *Echinococcus granulosus.* However, the lack of study has caused this to never to be proven [14]. Further cases of echinococcosis in animals were reported back in 1940. A single cyst of *Echinococcus* was found in the lung of the goat (*Capra hircus*) and the lung of the buffalo (*Buffelus sondaicus*) in the

Netherlands Indies [15]. In 1947, a total of 45 cysts of *Echinococcus unilocularis* (*E. granulosus*) were found in the lungs, kidney, stomach wall, and liver on an old monkey *Cynopithecus niger* (later on as *Macaca tonkeana*) from Sulawesi (Celebes) that suddenly died. The first evidence of *E. granulosus* infection in domestic dogs in Indonesia was reported from the Lindu Valley, Central Sulawesi, in 1972. The dog died suddenly after 18 months with numerous necropsies due to *E. granulosus.* Subsequent dog with echinococcosis was reported on the shore of Lake Lindu at Tomado village in 1973. The positive eggs of *E. granulosus* were confirmed by direct smear and formaldehyde-ether from the dog stools. The adult worms of *E. granulosus* were also identified during the study. The worms were collected from a dead dog on the shore of Lake Lindu at Tomado [16]. Since then, hundreds of dogs have been examined to identify the infection rate of *E. granulosus* in this area. However, hydatid cysts and adult *E. granulosus* have not been discovered until now [13].
