Parasitic Disease and COVID-19 Syndemics in Indonesia: Biomedical Aspects


  • Reqgi First Trasia Universitas Sultan Ageng Tirtayasa



syndemics, Covid-19, biomedical, Parasitic Disease, Tropical disease


Background: Syndemics happened while two or more coinfections have dangerous interaction and lead to a harmful outcome than for either single infection. In Indonesia, during COVID-19 pandemic, it has deal with a doble burden presume to neglected tropical disese (NTD) control. Parasitic disease as a part of NTD must be a concern in Indonesia along pandemc. There are still few articles that review the biomedical aspects of co-infection COVID-19 with parasitic diseases in Indonesia, whereas an understanding of biomedical aspects can encourage knowledge about pathogenesis which will make an earlier diagnosis.

Results: This review summarize how parasites may serve as protective agents or risk factors in pandemic and, vice versa, how the COVID-19 may disturb the prevention and misdiagnosis of parasitic disease in Indonesia. Co-infection COVID-19 with malaria increass the burden of severe clinical manifestations and poor prognosis due to exaggerated proinflammatory response. Coinfection triggers TNF and IL-6 to activate coagulation cascade leading to micro-thrombosis and coagulopathy. Besides, helminthiasis causes vary configuration of immune-modulation, thereby lowering susceptibility to other infections and tolerating COVID-19 better. They modify Th2 respons to limit pro-inflammatory cytokines, such as IL-6 which is observed in severe cases of COVID-19. T-cell hypoactivation in SARS-CoV-2 and W.bancrofti will cause  relatively mild manifestation of COVID-19.

Conclusions: In parasite infection, the IL-4 may elevate and induce shadow memory CD8+ T-cell (TVM cell) for CD8 response rapidly agains virus. It control human IL-4 or IL-10 that leads to the maturation of Th2 cells and down-regulation of the inflamation respons of IFN-g, IL-17 and TNF-a. These mechanisms allow us to blockade the cytokines storms observed in COVID-19 cases.


Download data is not yet available.


Ajibola O, Gulumbe BH, Eze AA, Obishakin E. Tools for detection of schistosomiasis in resource limited settings. Med Sci (Basel) 6: 39 (2018)

Centres for Disease Control and Prevention. Parasite Schistosomiasis. Accessed September 7th, 2022

Cheepsattayakorn A, Cheepsattayakorn R. Parasitic pneumonia and lung involvement. Biomed Res Int. (2015) 874021

Cimino RO, Fleitas P, Fernandez M, Echazu A, Juarez M, Floridia-Yapur N, Cajal P, et al. Seroprevalence of the Strongyloides stercoralis infection in human from Yungas Rainforest and Gran Chaco Region from Argentina and Bolivia. Pathogens (2020) 9, 394

Colley DG, Bustinduy AL, Secor WE, King CH. Human schistosomiasis. Lancet 383: 2253-64 (2015)

Fauziah S, Putri SMD, Salma Z, Wardhani HR, Hakim FKN, Sucipto TH, Aquaresta F, et al. How should Indonesia consider its neglected tropical diseases in the COVID-19 era? Hopes and challenges (Review). Biomed Rep 14:53 (2021)

Fonte L, Acosta A, Sarmiento ME, Ginori M, Garcia G, Norazmi MN. COVID-19 Lethality in Sub-Saharan Africa and Helminth Immune modulation. Front Immunol (2020) 11, 574910

Gluchowska K, Dzieciatkowski T, Sedzikowska A, Deniziak AZ, Mlociki D. The new status of parasitic disease in the COVID-19 pandemic – Risk factors or protective agents? J Clin Med (2021) 10:2533

Gomes LR, Martins YC, Ferreira-Da-Cruz MF, Daniel-Ribeiro CT. Autoimmunity, phospholipid-reacting antibodies and malaria immunity. Lupus. (2015) 23:1295-8

Gostic KM, Gomez ACR, Mummah RO, Kucharski AJ, Lloyd-Smith JO. Estimated effectiveness of symptom and risk screening to prevent the spread of COVID-19. Elife (2020) 9:e55570

Gutman JR, Lucchi NW, Cantey PT, Steinhardt LC, Samuels AM, Kamb ML, Kapella BK, et al. Malaria and parasitic neglected tropical disease: potential syndemics with COVID-19? Am J Trop Hyg 103: 572-7 (2020)

Hussein MIH, Albashir AAD, Elawad OAMA, Homeida A. Malaria and COVID-19: unmasking their ties. Malar J (2020) 19:457

Indonesia Ministry of Development Planning and Agency: Bappenas. Siaran Pers Roadmap Eradikasi Schistosomiasis (2018) Wujud komitmen Pemerintah atasi penyakit demam keong, Jakarta, Indonesia.

Indonesian Ministry of Health: COVID-19, Accessed September 1st, 2022

Indonesian Ministry of Health: Data dan Informasi Profil Kesehatan Indonesia 2020. Jakarta, pp1-213 (2021)

Indonesian Ministry of Health: Profil Kesehatan Indonesia tahun 2019, pp107-8 (2019)

Indonesian Ministry of Health: Situasi Filariasis di Indonesia. Infodatin Pusat Data dan Informasi Kementerian Kesehatan RI. Pp1-12 (2020)

Indonesian Ministry of Health. Panduan pelayanan kesehatan balita pada masa tanggap darurat COVID-19. Kementerian kesehatan Indonesia, pp 1-30, 2020.

Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses (2020) 12;372

Karanam LSK, Basavraj GK, Papireddy CKR. Strongyloides stercoralis hyper infection syndrome. Indian J Surg (2020) 12,1-5

Kurniati M, Budiono B, Sulistyawati SW: Intestinal protozoa infection in relation to nutritional status of the students Mandangin Island elementary school 6 in Sampang Regency. JUXTA J Ilm Mhs Kedokt Univ Airlangga 10: 25 (2020)

Lamberton PHL, Jourdan PM. Human ascariasis: Diagnostic update. Curr Trop Med Rep. (2016) 2, 189-200

Lier AJ, Tuan JJ, Davis MW, Paulson N, McManus D, Campbell S, Peaper DR, et al. Case report: Disseminated Strongyloidiasis in a patient with COVID-19. Am J Trop Med Hyg (2020) 103, 1590-2

Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe COVID-19 infections: a meta-analysis. Clin Chim Acta (2020) 506;145-8

lyazar IR, Surendra H, Ekawati L, Djaafara BA, Nurhasim A, Hidayana I, Widyastuti W, et al. Excess mortality during the first ten months of COVID-19 Epidemic at Jakarta, Indonesia. medRxiv 69:1-13, (2022)

Maizels RM. Regulation of immunity and allergy by helminth parasites. Allergy (2020) 75, 524-34

Malizia V, Giardina F, Vegvari C, Bajaj S, McRae-McKee K, Anderson RM, de Vlas, et al. Modelling the impact of COVID-19 related control programme interruptions on progress towards the WHO 2030 target for soil transmitted helminths. Trans R Soc Trop Med Hyg. (2021), 115, 253-60.

Marchese V, Crosato V, Gulletta M, Castelnuovo F, Cristini G, Matteelli A, Castelli F. Strongyloides infection manifested during immunosuppresive therapy for SARA-CoV-2 penumonia. Infection (2020) 1-4

Martindale S, Mableson HE, Kebede B, Kiros FH, Tamiru A, Mengistu B, Krueger A, et al. A comparison between paper-based and m-Health tools for collecting and reporting clinical cases of lymphatic filariasis and podoconiosis in Ethiopia. mHealth 4: 49 (2018)

Mau F. Prevalence and intensity of soil-transmitted helminth infections among elementary school students in West Sumba and Central Sumba districts East Nusa Tenggara, Indonesia. J Med Sci Clin Res 5 (2018)

Mohamed MFH, Mohamed SF, Yousaf Z, Kohla S, Howady F, Imam Y. COVID-19 unfolding filariasis: The first case of SARS-CoV-2 and Wuchereria bancrofti coinfection. Plos Negl Trop Dis. (2020) 14, e0008853.

Mullerpattan JB, Udwadia ZF, Udwadia FE. Tropical pulmonary eosinophilia – A review. Indian J Med Res. (2015), 138, 295-302

Nelwan ML. Schistosomiasis: Life cycle, diagnosis, and control. Curr Ther Res Clin Exp 91: 5-9 (2019)

Niemann T, Marti H, Duhnsen S, Bongartz G. Pulmonary schistosomiasis – Imaging features. J Radiol Case Rep (2011) 4, 37-43

Nurwidayati A, Frederika PP, Sudomo M. Fluktuasi schistosomiasis di daerah endemis provinsi Sulawesi Tengah tahun 2011-2018. Buletein penelitian kesehatan 47: 199-206 (2019)

Sanklecha M, Mehta N, Bagban H. Varied presentation of complicated falciparum malaria in a family. Indian Pediatrics (2013) 49, 413-4

Scheer S, Krempl C, Kallfass C, Frey S, Jakob T, Mouahid G, Mone H, et al. Schistosoma mansoni Bolsters Anti-viral immunity in the murine respiratory tract. PLoS ONE. (2015)

Sherrad-Smith E, Hogan AB, Hamlet A, Watson OJ, Whittaker C, Winskill P, Ali F, Mohammad AB, et al. The potential public health consequences of COVID-19 on malaria in Africa. Nat Med (2020) 26,1411-6.

Siles-Lucas M, Gonzalez-Miguel J, Geller R, Sanjuan R, Perez-Arevalo J, Martinez-Moreno A. Potential influence of Helminth moleculeson COVID-19 pathology. Trends Parasitol. (2021) 37, 11-4

Ssebambulidde K, Segawa I, Abuga KM, Nakate V, Kayiira A, Ellis J, Tugume L, et al. Parasites and their protection against COVID-19, Ecology or Immunology? MedRxiv (2020)

Stauffer WM, Alpern JD, Walker PF. COVID-19 and Dexamethasone: a potential strategy to avoid steroid-related strongyloides hyperinfection. JAMA (2020) 324, 623

Tan X, Cheng M, Zhang J, Chen G, Liu D, Liu Y, Liu H. Hookworm infection caused acute intestinal bleeding diagnosed by capsule: a case report and literature review. Korean J Parasitol. (2018) 55, 417-20.

Trasia RF. Covid-19 dan Koinfeksi Penyakit Parasit. Med Hospitalia J Clin Med 7: 298-303 (2020)

WHO: 2030 Targets for soil-transmitted helminthiasis control programmes. 2021.

WHO: Lymphatic Filariasis. Accessed September 4th, 2022.

WHO: WHO issues interim guidance for implementation of NTD programmes. Accessed September 6th, 2022.

WHO. Coronavirus Disease 2019 situation report, 48. WHO 19:1-20, (2022)

WHO. Responding to community spread of COVID-19. Interim Guide 8 March 2020;1-6

WHO. Tailoring malaria interventions in the COVID-19 response.

World Health Organization and the United Nations Children’s Fund (UNICEF): Community-Based Health Care, including Outreach and Campaigns, in the context of the COVID-19 Pandemic. Geneva, p39, 2020.

World Health Organization. Neglected tropical disease. Accessed August 2022




How to Cite

Trasia, R. F. (2023). Parasitic Disease and COVID-19 Syndemics in Indonesia: Biomedical Aspects. International Islamic Medical Journal, 5(1), 58–77.