Prevalence of cystic echinococcosis in Iran: a systematic review and meta-analysis

Identification and genotyping of Echinococcus granulosus from human clinical samples in Guilan province, north of Iran

Cystic echinococcosis (CE) is a significant health problem in both human and veterinary medicine. It is caused by the tapeworm Echinococcus granulosus (E. granulosus). The objective of this study was to investigate molecular diversity of E. granulosus from the paraffin-embedded human (FFPE) tissue samples using sequencing of mitochondrial genes. Thirty-five FFPE tissue samples were collected from different regions of Guilan province, north of Iran. Demographic data were recorded using a questionnaire. Five sections (1 mm) of the tissue were prepared and deparaffined using xylene and ethanol methods. Molecular analysis was performed using the Nad1 and Cox1 genes using PCR and DNA sequencing. Totally, 25 cases (71.43%) were women and 10 cases (28.57%) were men. The most affected age group was 21-30 yr old. The most of cysts were isolated from the liver (n = 19; 54.29%) and others in the lung (n = 16; 45.71%). The Cox1 and Nad1 genes were successfully amplified in 16 (45.71%) and 12 (34.28%) DNA samples from FFPE tissue. Sequencing analysis revealed that all samples were E. granulosus sensu stricto complex (G1 and G3). In this study, E. granulosus sensu stricto complex G1 and G3 were identified in human hydatid cysts and showed the presence of sheep/dog cycle in human infection. This finding confirmed and completed previous studies on the geospatial distribution of E. granulosus sensu stricto complex G1 and G3 in the southern and coastal areas of the Caspian Sea region.

Echinococcus granulosus sheep strain (G1) as the predominant genotype in definitive host (dogs) isolates in northeastern Iran

Echinococcus granulosus sensu lato (E. granulosus s.l.) is a zoonotic parasite, causing cystic echinococcosis in humans. In the present study, prevalence and genotypes of E. granulosus s.l. was assessed in stools collected from 244 dogs including 138 stray and 106 domestic animals using high resolution melting curve (HRM) method. Initially, to detect taeniid eggs in feces, all samples were examined using the formalin-ether techniques. Genomic DNA was extracted from the positive samples and E. granulosus s.l. was differentiated from other Taeniidae parasites using SSU-rDNA gene and E. granulosus s.l. was analyzed for genotyping using HRM based on the cox1 gene. In total, 12.7% (31/244) of the samples were positive for Taeniidae eggs. In addition, among the positive samples, 77.4% (24/31) were positive for E. granulosus s.l.. In details, 11.3% (12/106) of the domestic dogs and 8.7% (12/138) of the stray dogs were positive for E. granulosus s.l.. The results of HRM analysis showed that all E. granulosus s.l. isolates were G1 strain. Findings of the present study indicated a considerable prevalence of E. granulosus G1 among dogs in the northeast of Iran and imply a serious risk of transmitting to humans and livestock.

Genotyping of Echinococcus granulosus isolated from canine in Northwest Iran

Echinococcus granulosus is a parasitic tapeworm that causes cystic echinococcosis, a potentially life-threatening zoonotic infection affecting humans and animals across the globe. In Iran, the prevalence of this parasite remains a significant public health concern, particularly in the northwest region. This study aimed to investigate the genotypes of E. granulosus isolated from canines in the northwest of Iran. A total of 87 samples were collected from the Mughan plain area in Ardabil province, including 47 stray dogs (Canis familiaris), 25 golden jackals (Canis aureus), and 15 red foxes (Vulpes vulpes), and molecular analysis was performed for partial cytochrome c oxidase subunit 1 and nad1 genes. Phylogenetic analyses were carried out on the obtained sequence. The findings revealed that 9 out of 87 (10.3%) samples were infected with Echinococcus parasites, with a frequency of 1 (4%) and 8 (17%) among golden jackals and stray dogs, respectively. Overall, all (100%) E. granulosus adult samples were related to the G1 genotypes. This study provides comprehensive data regarding the epidemiological and molecular characteristics of echinococcosis in canines in northwest Iran.

In vitro and in silico scolicidal effect of sanguinarine on the hydatid cyst protoscoleces

We aimed to investigate the scolicidal effects of sanguinarine on hydatid cyst protoscoleces (PSCs) in vitro and in silico. Different targets were docked into the active sites of sanguinarine. Molecular docking processes and visualization of interactions were performed using AutoDock Vina and Discovery Studio Visualizer. Binding energy was calculated and compared (kcal/mol). PSCs were aspirated from the hydatid cysts and washed. The sediments of PSCs were then exposed to various concentrations (50, 25, 12, 6, 3, and 1 μg/mL) of sanguinarine. The viability test was finally evaluated by the Trypan blue solution 4%. Levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), glutathione peroxidase (GPX), and catalase were analyzed to assess the level of oxidative stress-treated PSCs. Caspase-3 activity rate was determined to evaluate cell apoptosis in treated PSCs. Among the receptors, acetylcholinesterase was identified as the excellent target, with Vina score of -11.8. Sanguinarine showed high scolicidal effects after 12, 24, and 48 h. Also, in the first hour of exposure to the drug, caspase-3 activity and MDA level significantly increased, but the levels of GSH and GPx had a significant reduction after 12, 24, and 48 h (P < 0.05). The findings of this study revealed that sanguinarine have potent scolicidal effects in vitro and in silico and could be considered an opportunity for the introduction of a novel and safe therapeutic agent for the treatment of cystic echinococcosis. However, supplementary studies will be desired to prove the current findings by examining sanguinarine in a clinical setting.

Primary hydatid cyst of the thyroid glands: two case reports and a review of the literature

INTRODUCTION

Although hydatid cyst remains one of the prevalent parasitic infections in humans, hydatid cyst of the thyroid is extremely rare, even in endemic areas. Here we present two cases of thyroid hydatid cysts.

CASE PRESENTATION

A 35 and a 50 year-old Iranian female with a positive history of animal contact were presented with a neck lump without any compressive symptoms. A physical exam revealed neck masses that elevated with swallowing. Thyroid gland ultrasonography showed cystic thyroid lesions, and fine needle aspiration (FNA) suggested a thyroid hydatic cyst. Thyroid lobectomy and isthmectomy were done for the first patient, and near-total thyroidectomy was done for the other. The pathology report confirmed the diagnosis of a hydatid cyst. None of the patients had hydatid cysts in other sites. Patients were discharged without an antiparasitic drug, and no recurrence was detected at the six-month follow-up.

CONCLUSION

It is necessary to consider hydatid cysts in the differential diagnosis of cystic lesions of the thyroid gland in endemic areas, especially in people with a positive history of animal contact.

Status of human cystic echinococcosis based on hospital records in Mazandaran Province: A first registry-based evidence

Background

Human cystic echinococcosis, as an emerging neglected parasitic disease, is caused by tapeworms of the genus Echinococcus spp. Because of the medical and economic importance, this study aims to review the epidemiology and clinical features of hydatidosis in patients admitted to medical and surgical wards in three referral teaching hospitals over 15 years in Mazandaran Province, northern Iran.

Methods

Data were collected from hospital records that were accessible via the hospital information system (HIS) between 2005 and 2019 (15 years).The demographic information (age, sex, living area, and occupation), dog contact, number of the cysts, types of organs involved, and history of disease recurrence were assessed.

Results

One hundred twenty-one patients with human cystic echinococcosis (CE) were involved in the study, from whom 58 patients (47.93%) were male and 63 (52.07%) were female. The majority of patients were rural residents (64.46%) and also housewife (28.10%). Based on the results, only about 16.53% of the patients had history of close contacts with dogs. The liver was the organ involved in the most cases of CE. There were statistically significant differences between residence, occupation, history of close contacts with dogs, type of organs involved, number of cysts and history of disease recurrence (P < 0.05).

Conclusions

Our data provides valuable registry-based information about CE in an endemic region. The data highlights that most patients lived in rural areas and were housewives. Additionally, they had a low rate of disease recurrence but a high rate of close contact with dogs. Moreover, further monitoring on registry-based program and strengthening the HIS in the provincial hospitals in the studied area are required.

Molecular characterization and serodiagnostic evaluation of the Echinococcus ortleppi recombinant glutaredoxin 1 protein for cystic echinococcosis in buffalo (Bubalus bubalis)

Cystic echinococcosis (CE), caused by the metacestode of Echinococcus granulosus sensu lato (s.l.), adversely affects the physiology of the vital organs in which they grow. Condemnation of meat causes substantial economic loss to the livestock industry. Conventionally the infection is detected by necropsy as serological diagnosis of the infection in livestock is ambiguous. Identification of specific diagnostic antigens would be a substitute for the cyst fluid antigens which lack adequate diagnostic sensitivity and specificity. BLAST analysis supported by the negligible pairwise nucleotide distance of the 389 nt COX1, 489 nt NAD1, and 425 nt ITS1 with the related sequences of E. ortleppi ascertained the association of E. ortleppi with CE in buffaloes. Given the extensive distribution of glutaredoxin 1 in every developmental stage of Echinococcus granulosus s.l that makes it an ideal serodiagnostic antigen for CE, we expressed the 14 kDa E. ortleppi glutaredoxin 1 (rEoGrx1) protein in E. coli BL21 (DE3) and tested a total of 225 sera samples, including 126 sera samples from the necropsy-positive buffalo, by the rEoGrx1 IgG-ELISA. The ELISA could detect a total of 82/126 sera samples as positive. The diagnostic sensitivity and specificity of the rEoGrx1 IgG-ELISA were 65.1 % and 51.5 %, respectively. The protein showed serological cross-reaction against Fasciola gigantica, Toxoplasma gondii, and Sarcocystis sp. The in silico bioinformatics analysis of the E. ortleppi, F. gigantica, and T. gondii glutaredoxin sequences revealed fully conserved amino acids at positions 11 and 21, the substitution of conserved amino acids at positions 14 and 6, and semi-conserved substitutions at positions 3 and 4, respectively. The findings partly explain the molecular basis of the serological cross-reactivity of the protein.

A century of the Journal of Helminthology

The Journal of Helminthology (JHL) was first published in 1923 and was originally created as a house journal of the London School of Hygiene and Tropical Medicine. The JHL was devised by its first Editor, Robert Leiper, to allow for rapid publication of results from the Department of Helminthology and its offshoot the Institute of Agricultural Parasitology. From this initial narrow focus the JHL has subsequently become not only internationally recognized but also retained its original emphasis on morphological, taxonomic and life cycle studies while embracing the emergence of new fields and technological advancements. The present review covers the historical development of the JHL over the last century from 1923 to 2023.

Africa-wide meta-analysis on the prevalence and distribution of human cystic echinococcosis and canine Echinococcus granulosus infections

BACKGROUND

Echinococcosis is a neglected zoonosis of increasing public health concern worldwide. According to the World Health Organization, 19,300 lives and 871,000 disability-adjusted life-years are lost globally each year because of cystic echinococcosis. Annual costs associated with cystic echinococcosis were estimated at US$ 3 billion because of treatment of cases and losses in the livestock industry.

METHODS

We performed the random-effects model of meta-analysis using 51-year (1970-2021) data available from AJOL, Google Scholar, PubMed, Science Direct, Scopus and Web of Science. We also applied the Joanna Briggs Institute critical appraisal instrument for studies reporting prevalence data, the Cochran's Q-test, Egger's regression test and the single study deletion technique to respectively examine within-study bias, heterogeneity, across-study bias and sensitivity.

RESULTS

Thirty-nine eligible studies on human cystic echinococcosis (HCE) from 13 countries across the five African sub-regions showed an overall prevalence of 1.7% (95% CI 1.1, 2.6) with a statistically significant (P < 0.001) sub-group range of 0.0% (95% CI 0.0, 14.1) to 11.0% (95% CI 7.6, 15.7). Highest prevalences were observed in Eastern Africa (2.7%; 95% CI 1.4, 5.4) by sub-region and Sudan (49.6%; 95% 41.2, 58.1) by country. Another set of 42 studies on Echinococcus granulosus infections (EGI) in dogs from 14 countries across the five African sub-regions revealed an overall prevalence of 16.9% (95% CI 12.7, 22.3) with a significant (P < 0.001) variation of 0.4 (95% CI 0.0, 5.9) to 35.8% (95% CI 25.4, 47.8) across sub-groups. Highest prevalences of E. granulosus were observed in North Africa (25.6%; 95% CI 20.4, 31.6) by sub-region and Libya (9.2%; 95% CI 5.7, 13.9) by country.

CONCLUSION

Human cystic echinococcosis and EGI are respectively prevalent among Africans and African dogs. We recommend a holistic control approach that targets humans, livestock, dogs and the environment, which all play roles in disease transmission. This approach should involve strategic use of anthelminthics in animals, standardized veterinary meat inspection in abattoirs, control of stray dogs to reduce environmental contamination and proper environmental sanitation. Mass screening of humans in hyper-endemic regions will also encourage early detection and treatment.

Serosurvey of Cystic Echinococcosis and Related Risk Factors for Infection in Fars Province, Southern Iran: A Population-Based Study

Cystic echinococcosis (CE) is a common zoonotic infection in all provinces of Iran, especially in areas where people live on agriculture and animal husbandry. The current cross-sectional population-based study is aimed at determining the seroprevalence of CE in Kavar County, Fars province, southern Iran. Blood samples were collected from 1500 individuals (749 males and 751 females). Anti-hydatid cyst antibodies were detected, using a recombinant B8/1 antigen of Echinococcus graunlosus in an ELISA system. Multivariate logistic regression analysis was used to find out the independent risk factor for CE seropositivity. Anti-hydatid cyst antibodies were detected in the sera of 131 out of 1500 participants, corresponding to a seroprevalence rate of 8.73%. With a statistically significant difference ( $p<0.05$ ), the seroprevalence of hydatid cyst in males and females was 5% and 7%, respectively. Differences in the seropositivity of hydatid cysts were also statistically significant by occupation ( $p<0.05$ ). The seroprevalence of hydatid cyst was significantly higher in the age group of 35-45 years than in other age groups ( $p<0.05$ ). Multivariate logistic regression showed that only age was associated with seropositivity to CE ( $\text{OR}=2.23$ , 95% CI: 1.33-3.72). Moreover, there was a statistically significant association between seropositivity to hydatid cysts and underlying diseases such as hypertension ( $p=0.049$ ) and fatty liver ( $p=0.048$ ). The findings of this study indicate that the seroprevalence rate of CE is relatively high in the Fars province, southern Iran, and this high rate of infection is mainly linked to people’s jobs and lifestyles.

Global distribution of Echinococcus granulosus genotypes in domestic and wild canids: a systematic review and meta-analysis

The current systematic review and meta-analysis demonstrate the genotypic distribution of canine echinococcosis worldwide. Studies published from the inception until 21 May 2021 were screened, relevant articles were selected and the random-effect model was used to draw forest plots with 95% confidence intervals (CIs). Totally, 44 articles were included, mostly examined dogs (37 records), followed by wolf (8 records), jackal (7 records), fox (3 records), pump fox (3 records) and coyote (1 record). Echinococcus granulosus sensu stricto (G1–G3) and G6/7 cluster of Echinococcus canadensis were the most common genotypes among canids. Most studies were conducted in Asia and Europe with 17 and 15 datasets, respectively. Exclusively, Iran possessed the highest number of studies (10 records). Meta-analysis showed that the pooled molecular prevalence of echinococcosis was 33.82% (95% CI 24.50–43.83%). Also, the highest and lowest prevalence of canine echinococcosis was calculated for South America (66.03%; 95% CI 25.67–95.85%) and Europe (19.01%; 95% CI 9.95–30.16%). Additionally, there were statistically significant differences between the global prevalence of echinococcosis in canines and publication year, continent, country, sample type, host and molecular test. These findings will elevate our knowledge on the poorly known canine echinococcosis worldwide.

Bacterial and Fungal Occurrence in Hydatid Cysts from Livestock in Central Iran

Echinococcus granulosus sensu lato causes Cystic echinococcosis. This study investigated the bacterial and fungal species in the liver and lung hydatid cysts obtained from sheep, goats, cattle, and camels slaughtered in Yazd abattoir, Central Iran. In this study, 84 hydatid cysts were obtained from 20 sheep, 13 goats, 25 cattle, and 26 camels. The fertility and viability rates were assessed using light microscopy and eosin staining, respectively. The aspirated hydatid cysts were cultured to detect the presence of any bacteria and fungi. Bacterial isolates were identified by biochemical tests. DNA was also extracted from germinal layers, and then genotyping was carried out targeting the cox 1 gene. The statistical analysis was performed by SPSS version 16.0. This study showed that 22.62% (19/84) of hydatid cysts had bacterial occurrence, and none of the samples had fungal species. Among the fertile cysts, 52.6% had bacterial occurrence, of which 40% were viable. Most bacteria detected in hydatid cysts included Staphylococcus saprophyticus, Escherichia coli, and S. epidermidis. Hydatid cysts with bacterial occurrence were identified as G1-G3, G5, and G6/G7. The bacterial species occurrence in hydatid cysts had no significant relationship with fertility and viability (P > 0.05), without any significant relation with viability (P > 0.05), animal species (P > 0.05), involved organ in animals (P > 0.05), and hydatid cyst genotypes (P > 0.05). It should also be mentioned that this is the first study to assess the relationship between hydatid cyst genotyping and the occurrence of fungal and bacterial species.

A Multi-diagnostic Screening Study of the Prevalence and Risk Factors of Echinococcosis in First-degree Family Members of Infected Patients Undergoing Surgical Treatment

Background: Echinococcosis is a zoonotic infection caused by Echinococcus tapeworms. About 60% of patients remain asymptotic until severe stages. Early diagnosis of the infection in high-risk populations is of medical importance. Objectives: This study was designed to investigate the prevalence of echinococcosis among first-degree family members of the infected patients who underwent surgical treatment. Methods: A cross-sectional study was conducted to screen the first-degree family members of 96 patients who underwent surgical intervention at Imam Reza hospital, Mashhad, Iran, from September 2016 to March 2017. All family members were invited by phone calls to perform the serologic test, ultrasound examination, and chest X-ray test. Results: Forty-six (47.9%) patients participated in the study. A total of 114 family members performed the screening tests. Seven participants from five families (6.14%) were found to be infected in ultrasound examination (five females with a mean age of 36 years). There were no significant differences between the infected and non-infected groups concerning age (P = 0.921) and gender (P = 0.457). Conclusions: Screening the first-degree family members of patients with a confirmed echinococcosis infection results in the early diagnosis of infected patients, which is economically significant, especially in endemic areas.

Screening of Cystic Echinococcosis and Toxocariasis in Urmia Municipal Workers, Northwest Iran

BACKGROUND

Echinococcus granulosus and Toxocara spp., the causative agents of hydatid cyst and toxocariasis in humans and animals, are zoonotic infections with medical and veterinary significance respectively.

AIM

Herein, we aimed to investigate the seroprevalence of toxocariasis and cystic echinococcosis in Urmia municipal workers (gardeners and sweepers) in 2018 using ELISA assay.

OBJECTIVE

There is no precise report on the seroprevalence of toxocariasis and cystic echinococcosis in Urmia municipal workers using ELISA assay. Therefore, this study found an opportunity to investigate this subject.

METHODS

A total of 220 blood samples were obtained from municipal workers with an average age of 41.31 ± 9.42. Commercial anti-Toxocara canis and hydatid cyst ELISA kits were used to assess the seroprevalence rates.

RESULTS

Approximately, 14.5% and 2.3% of individuals were seropositive for toxocariasis and hydatidosis, respectively. Consuming unboiled milk and/or raw/uncooked meat and rural conditions are risk factors for toxocariasis. Regarding hydatidosis, consuming unwashed vegetables was the only statistically significant risk factor. Toxocara infection (p = 0.01), but not hydatid cyst (p = 0.05), is more prevalent among sweepers than municipal gardeners.

CONCLUSION

Due to the occupational condition of municipal workers, they are exposed to many infectious agents; thus, more researches should be done on these populations.

Prevalence of cystic echinococcosis in slaughtered livestock in Iran: a systematic review and meta-analysis

BACKGROUND

Hydatidosis is a zoonotic disease and has a great general and economic health importance in both developed and developing countries. Therefore, this systematic and meta-analytic study was conducted to determine the prevalence of cystic echinococcosis in slaughtered livestock in Iran.

METHODS

The present study was conducted as a systematic review and meta-analysis. The SID & Magiran, MEDLINE (PubMed), ScienceDirect, Scopus, and Google Scholar databases were searched with a view to selecting relevant research works. As a result, 31 articles published from April 1970 to April 2020 were selected. The heterogeneity of the studies was assessed using the I² index. Data analysis was conducted within the Comprehensive Meta-Analysis software (CMA) v.3.0 (Biostat, Englewood, NJ, USA) and Arc map (ArcGIS 10.3) software.

RESULTS

The heterogeneity of the studies was evaluated using the I² test which value was 99% showing a high heterogeneity in the studies. The results of publication bias in studies were evaluated by the Egger test, which were not statistically significant (P = 0.144). The overall prevalence of cystic echinococcosis in slaughtered livestock in Iran is 13.9% (95%CI: 10.7-17.7%). The results of the meta-regression analysis indicate the increasing trend of the hydatid cyst prevalence with the increase of sample size and publication year (P < 0.05).

CONCLUSION

According to the results of this study and the relatively high prevalence of cystic echinococcosis in slaughtered livestock in Iran, health policy makers should make effective decisions in this regard, and implement careful inspections and interventions by experts and health authorities.

Evaluation of zoonotic platyhelminthe infections identified in slaughtered livestock in Iran, 2015-2019

Background

Platyhelminth infections of livestock can result in considerable economic losses. This study aims to evaluate the spatial frequency of cystic echinococcosis (CE), dicrocoeliasis, and fascioliasis in livestock slaughtered in Iran during the years 2015–2019 and estimate direct costs associated with organ condemnation due to these parasites.

Methods

Abattoir data from 413 abattoirs representing all 31 Iranian provinces were collected from the Iran Veterinary Organization. Infection prevalence was calculated per year at the province level. The Local Moran’s I statistic was performed to evaluate spatial autocorrelation of animals positive at slaughter for the years 2015–2019. Direct costs associated with condemned livers were calculated for each parasitic condition, with costs associated with condemned lungs also included for CE.

Results

Overall prevalence values for the study timeframe were as follows: sheep and goat fascioliasis 1.56% (95% CI: 1.56–1.56%), cattle fascioliasis 3.86% (95% CI: 3.85–3.88%), sheep and goat dicrocoeliasis 4.63% (95% CI: 4.62–4.63%), cattle dicrocoeliasis 3.08% (95% CI: 3.07–3.09%), sheep and goat CE 5.32% (95% CI: 5.32–5.33%), and cattle CE 7.26% (95% CI: 7.24–7.28%). Northwest Iran had the highest prevalence of CE and fascioliasis. High infection areas for Dicrocoelium spp. included the provinces of Zanjan, Gilan, Qazvin, and Tehran, which are located in northern Iran. Direct economic losses for sheep and goat fascioliasis, dicrocoeliasis, and CE for the study period were US$13,842,759, US$41,771,377, and US$22,801,054, respectively. Direct economic losses for cattle fascioliasis, dicrocoeliasis, and CE for the study period were US$1,989,200, US$1,668,986, and US$2,656,568, respectively.

Conclusion

Our findings provide valuable data for future monitoring of these important parasitic diseases in Iranian livestock. Disease control strategies are required to reduce the economic and public health impact of these platyhelminths.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-02888-9.

Cystic Echinococcosis: Knowledge, Attitude, and Practices (KAP) among Surgically Operated Cases in Fars Province, Southern Iran

Introduction

Cystic echinococcosis (CE) is a neglected zoonotic disease caused by Echinococcus granulosus with major health and economic burden. The information on how the community members perceive the disease is crucial in order to recommend an effective preventive and control plan. The current study is aimed at finding out knowledge, attitude, and practices (KAP) of surgically operated cases of hydatid cyst in educational hospitals of Shiraz in Fars Province, southern Iran, toward the CE.

Methods

A cross-sectional survey was conducted among 180 CE patients who underwent surgery due to CE. Using a well-designed questionnaire, a telephone-based survey was carried out to collect the data. The contents of the questionnaire included basic personal information and questions related to the participants' knowledge, attitude, and behavioral patterns toward CE. Univariate and then multivariate linear regression analyses were used to identify factors associated with the KAP. Unstandardized regression coefficients (β) and odds ratios (ORs) and their 95% confidence intervals (CIs) were used to quantify the associations between variables and KAP.

Results

A total of 180 CE patients with a mean age of 35.64 (±17.59) years were recruited. The mean score of participant's knowledge was 8.7 (SD = 2.8, range: 0-17), whereas these scores were 1.3 (SD = 0.7, range 0-2) for attitude and 1.2 (SD = 1.0, range 0-4) for practice. Findings of the study demonstrated that 20 of the participants (11.1%) had good knowledge towards CE, 82 (45.6%) demonstrated a positive attitude, and 57 (47.5%) without having dogs demonstrated a good practice towards CE (score = 2/2), while from 60 dog owners, only 7 (11.6%) participants demonstrated good practice (score 3 and 4/4). Factors that were associated with knowledge were age (OR = −0.49, P value = 0.001) and educational level (OR = 0.668, P value = 0.001), where higher age was associated with lower knowledge and also higher educational levels were associated with higher knowledge regarding hydatid cyst. Regarding attitude, only living location had a significant association with participants' attitude where those who were living in urban areas demonstrating a more positive attitude towards CE (OR = 0.261, P value = 0.022). The practice of the participants was grouped into dog owners and participants with no dogs, in which among participants who did not own a dog, those living in urban areas demonstrating weaker practice towards CE (OR = −0.491, P value>0.001). Moreover, a lack of counseling of patients after the surgery on how to prevent reinfection was noticed.

Conclusion

Findings of the study revealed that the CE patients in southern Iran had poor knowledge and attitude toward the disease, and their practice may help in maintaining the disease in the community. Health education is highly needed to increase community awareness and to prevent and control this neglected parasitic infection in the area.

Immunological detection of human and camel cystic echinococcosis using different antigens of hydatid cyst fluid, protoscoleces, and germinal layers

BACKGROUND AND AIM

Cystic echinococcosis (CE)/hydatidosis is one of the most prevalent neglected zoonotic diseases. It is initially asymptomatic and does not produce any clinical signs until the cyst becomes enlarged, causing localized pressure on internal organs and tissues. Therefore, the detection of Echinococcus granulosus antibodies is highly essential. This study evaluated the antigens of hydatid cyst fluid, protoscoleces, and germinal layers for efficient immunological diagnosis of CE in humans and camels.

MATERIALS AND METHODS

Hydatid cyst fluid (FLc), protoscoleces (Psc), and the germinal layer (GLc) antigens were prepared from camel-lung hydatid cysts. In the same way, hydatid cyst fluid (FLh) and protoscoleces (Psh) antigens from human-liver cyst aspirate were produced. The comparative immunodiagnostic efficacy of the prepared antigens was verified using indirect enzyme-linked immunosorbent assay (ELISA), SDS-PAGE, and immunoblotting.

RESULTS

ELISA proves that FLc and GLc antigens were higher than FLh and Psh antigens. This shows that binding reactivity in naturally infected human sera, camel sera, and Psc is the most potent, exhibiting 100% sensitivity with 78.26% and 76.47% specificity in camel and human sera, respectively. The CE prevalence using diagnostic Psc was 54.79% and 61.32% in tested human and camel sera, respectively. The electrophoretic profiles of all shared antigens showed similarities at 52, 41, and 22 kDa. Immunoblotting demonstrated common immune-reactive bands in all antigen types at 52 and 41 kDa against positive human and camel sera.

CONCLUSION

This immunological study introduces camel hydatid cyst Psc as a potent diagnostic antigen and new immune-reactive fractions of 52 and 41 kDa for diagnosing hydatidosis in humans and camels.

Concomitant Pulmonary Cystic Echinococcosis and Aspergillosis in a Male Child

Co-infection of cystic echinococcosis and aspergillosis is a rare finding. The patient was a 10-year-old boy complaining of chest pain and malaise with a cyst in the right lung who underwent surgical resection of the cyst. Medical therapy with albendazole was started for the patient with the initial clinical impression of cystic echinococcosis. Later, the microscopic evaluation revealed a laminated layer of cystic echinococcosis involved by acute angle branching hyaline hyphae with septate. Thus, the diagnosis of a cystic echinococcosis and aspergillosis co-infection was established. Surgery is the mainstay of treatment along with anthelminthic and anti-fungal therapy, especially in immunocompromised patients.

Assessment of Knowledge, Attitudes and Practices Relating to Parasitic Diseases and Anthelmintic Resistance Among Livestock Farmers in Hamedan, Iran

Iranian studies have shown a high prevalence of broad spectrum anthelmintic resistance (AR) in gastrointestinal helminths of ruminants. However, there is a lack of information about levels of knowledge, attitudes and practices among livestock farmers in Iran regarding the concept of parasite control and AR. This study aimed to evaluate the knowledge, attitudes and practices of livestock farmers of Hamedan, Iran, regarding parasitic diseases and AR by interviewing 150 farmers using a structured questionnaire. Most of farmers had some knowledge of the clinical signs associated with helminth parasitism, but more than half were unaware of the existence of zoonotic parasites. More than half of the participants had never heard about AR, but were interested to learn about it through their veterinarians. Those who were aware of the problem considered non-prescribed anthelmintic drugs to play a role in its emergence, while several of the participants believed that “more expensive” and “foreign-branded” drugs worked best. Almost all of the farmers reported that they frequently consulted with a veterinarian about anthelmintic treatments, but very few adhered to recognized principles of responsible and sustainable drug use. About half of the participating farmers treated their sheepdogs for helminth parasites, despite the common practice of regularly feeding likely infected livestock offal. Education had a significantly positive association with farmers' knowledge, attitudes, and best practice scores, while knowledge was significantly associated with both attitudes and practices. Based on these results, we recommend that regular country-wide classes should be held to educate farmers on the evidence-based principles of sustainable helminth control and prevention of zoonotic helminth diseases.

Current situation and future prospects of Echinococcus granulosus vaccine candidates: A systematic review

Cystic echinococcosis is a worldwide zoonotic disease, represents a threat for livestock and humans, manifests as a quiescent, subclinical and chronic hydatid cyst infection. The disease imposes high expenditures and economic losses in medical and veterinary. Prophylactic vaccination would be one of the effective preventive health care against echinococcosis. During the last decades, many studies have characterized the protective antigens of Echinococcus granulosus and their role in immunization of various animal host species. Herein, we aimed to systematically evaluate and represent the best antigens as possible vaccine candidates for cystic echinococcosis. Data were systematically searched from five databases including ProQuest, PubMed, Scopus, ScienceDirect and Web of Science, up to 1 February 2020. Two reviewers independently screened and assessed data extraction and quality assessment. A total of 47 articles were eligible for inclusion criteria in the current study. The most common antigens used for vaccination against E. granulosus were EG95 and antigen B. Freund's adjuvant and Quil A have been predominantly utilized. In addition, regarding the antigen delivery, animal models, measurement of immune responses and reduction in hydatid cyst have been discussed in the text. The data demonstrated that DNA vaccines with antigen B and recombinant protein vaccines based on EG95 antigen have the best results and elicited protective immune responses.

Evaluation of Prognostic Factors Associated with Postoperative Complications Following Pulmonary Hydatid Cyst Surgery

Background:

Hydatid cysts are one of the serious complications following echinococcus infection. The liver and the lungs are the most affected organs, respectively. The severity of the disease is associated with the increase in the number and the size of the cysts, cysts rupture, and systemic effects. The aim of this study is to evaluate prognostic factors that are associated with the increased incidence of postoperative complications following pulmonary hydatid cyst surgery.

Methods:

Patients referred to Madani hospital from 2014-2018, presenting pulmonary hydatid cysts were included in this study. All the patients were evaluated based on the following parameters: age, gender, location and size of the cysts, rupture status of the cysts (intact or perforated), type of surgical intervention (capitonnage or segmentectomy) and Erythrocyte Sedimentation Rate (ESR). The factors were then compared with postoperative complications. Statistical analysis of the data obtained was conducted using R-software

Results:

Of 76 patients enrolled in our study, 52.63% were males and 47.36% were female. Air leak complication was reported in 13.15% of the patients and 3.94% of the patients were presented with pleural effusion. Postoperative complications were significantly associated with the perforated (ruptured) cysts p= 0.001, segmentectomy p= 0.013, giant hydatid cysts p= 0.007 and ESR p= 0.014. However, the side of the lung was not significantly related to postoperative complications.

Conclusion:

Our study reports that perforated cysts, increased size, segmentectomy and abnormal ESR are likely to increase postoperative complications following pulmonary hydatid cysts surgery. Prospective studies with perioperative parameters and greater sample size can help to deduce better inferences.

Human cystic echinococcosis in southwest Iran: a 15-year retrospective epidemiological study of hospitalized cases

Background

Cystic echinococcosis (CE) is considered as a neglected disease with significant mortality and morbidity in most of the developing countries. The current study aimed to retrospectively assess the demographic and epidemiologic features of human CE surgical cases in a 15-year period in Fars province, southwestern Iran.

Methods

A 15-year (2004–2018) retrospective study was conducted to find out the epidemiological and clinical picture of CE in patients who undergone surgeries for CE in two main hospitals in Fars Province, southwestern Iran. Hospital records were reviewed, and data were retrieved from each CE patient’s record.

Results

A total of 501 CE surgical cases were recorded during a 15-year period, corresponding to an average annual incidence of 33.4 and a surgical incidence rate of 0.74/100,000 population. Of these, 242 (48.6%) were male, and 256 (52.4%) were female. Patients’ age ranged from 2 to 96 years, with a mean age of 34.92 (± 19.87) years. A significantly higher rate of CE cases was noted in subject’s ≥ 50 years of age. The highest frequency of cases (62:12.5%) was recorded in the year 2017. The most commonly involved organs were liver (339 cases; 57.8%) and lung (279 cases; 47.6%). Concurrent involvement of two organs was seen in 58 (9.9%) cases of both lung and liver, 10 (1.6%) cases of lung and other locations (but not liver), and 23 (3.9%) cases of liver and other locations (but not lung). Reoperation was noted in 67 (13.4%) of the cases. The size of the lung hydatid cyst varied, ranging between 2 and 24 cm (mean = 7.33, SD = 3.737). The size of liver hydatid cysts ranged from 1 to 26 cm (mean 9.04, SD = 4.275).

Conclusion

The findings of the current study demonstrated a nearly constant prevalence of CE during the last 15 years in southern Iran. Further studies are needed to find out the reasons behind the recurrence of the disease, which is substantial, in surgically-treated patients.

In Vitro Antigenotoxic, Antihelminthic and Antioxidant Potentials Based on the Extracted Metabolites from Lichen, Candelariella vitellina

Lichens have recently received great attention due to their pharmacological potentials. The antigenotoxic potential of C. vitellina extract (25 and 50 µg/mL) was assessed in normal human peripheral blood lymphocytes (HPBL) against Mitomycin C (MMC) co-treatments. Flow cytometric analyses of cell cycle distribution, as well as apoptosis (Annexin V/PI), revealed that the extract had significantly (p ≤ 0.05) ameliorated the MMC toxicity by reducing the apoptotic cells and normalized the cell cycle phases. C. vitellina exhibited antigenotoxicity by ameliorating the diminished mitotic index and DNA single-strand breaks caused by MMC. Herein, the hydromethanolic extract (80%) of Candelariella vitellina (Japan) lichen, exhibited very low cytotoxicity towards normal human peripheral lymphocytes (HPBL) with IC₅₀ >1000 µg/mL. In order to explore the antihelminthic effect, Echinococcus granulosus protoscoleces were used in vitro. Eosin staining revealed significant (p ≤ 0.05) dose and time-dependent scolicidal effects of the extract confirmed by degenerative alterations as observed by electron scan microscopy. Furthermore, primary and secondary metabolites were investigated using GC-MS and qualitative HPLC, revealing the presence of sugars, alcohols, different phenolic acids and light flavonoids. Significant antioxidant capacities were also demonstrated by DPPH radical-scavenging assay. In conclusion, the promising antigenotoxic, antihelminthic and antioxidant potentials of C. vitellina extract encourage further studies to evaluate its possible therapeutic potency.

Sero-epidemiology of Hydatidosis Among General Population of Jolfa County, Northwestern Iran Using IHA, ELISA and Western Blot (2017-2018)

BACKGROUND

Human hydatidosis is mostly a latent and neglected disease with known endemicity in Iran.

AIMS

Due to the importance of this infection in the country and its latent nature, we aimed to evaluate the serological status of hydatid cyst in northwestern Iran.

OBJECTIVES

Herein, we evaluated the serological status of hydatid cyst in urban and rural inhabitants of Jolfa county, northwestern Iran during 2017-2018.

METHODS

In total, 1296 blood samples were obtained from human individuals and the presence of anti-E. granulosus antibodies was investigated using IHA, ELISA and WB.

RESULTS

Based on results, 25 IHA positive person were detected in the examined population, however ELISA test showed 14 of 25 IHA positive patients as negative. Also, 269 IHA negative fellows were shown as negative by ELISA. WB analysis of sera from 25 IHA positive subjects revealed consistent results with the ELISA test, and the most reactive SHCF Ag was a 37 KDa protein. The age-standardized seroprevalence of hydatidosis among Jolfa's general population was 1.12% with 95%CI: 1.02-1.20. Moreover, there existed a significant association between keeping/- contact with dogs (P = 0.022) as well as vegetable consumption (P < 0.001) with ELISA positive test results.

CONCLUSION

Along with such serological evidence in this region, we highly suggest physical examination and applying imaging techniques for suspected cases in the area for a better understanding of CE.

Control of Cystic Echinococcosis in Iran: Where Do We Stand?

Cystic echinococcosis (CE) is an important public health challenge in Iran that requires a One Health approach to control. Filling information gaps and research needs on different aspects of the disease, including parasite biology, disease ecology, human/animal infection, and administrative issues, is essential to address challenges faced by CE control programs.

Epidemiological and molecular studies on Echinococcus granulosus from free-roaming dogs in Southeast Iran

Background and Aim:

Cystic echinococcosis (CE), as a major zoonotic helminth infection, imposes remarkable socioeconomic burden on many endemic countries across the world, including Iran. Due to the high importance of free-roaming dogs in the transmission of CE, epidemiological and molecular studies in this type of hosts are required in the endemic regions. This study aimed to investigate the epidemiology and genotyping of Echinococcusgranulosus isolated from stray dogs in Kerman, Southeast Iran.

Materials and Methods:

Eighty-four samples were isolated from stray dogs in the city and suburbs of Kerman in coordination with the health authorities and the municipality office for rabies control and dog population management. Dog demographic data, including age and sex were collected. The worm was isolated by necropsy and genomic DNA was extracted and partial cytochrome c oxidase subunit 1 gene was amplified using specific primers. Phylogenetic and Templeton-Crandall-Sing (TCS) network analyses were carried out on the sequence data.

Results:

The overall prevalence of CE in the surveyed dogs was 10.7% (9/84 cases). Out of 84 stray dogs, 33 (39.3%) and 51 (60.7%) cases were male and female, respectively. There was not a statistically significant difference between the infection and gender of dogs. However, infection is shown more in dogs under one year of age with a statistically significant difference (p<0.05). The results of molecular studies indicated E. granulosus G1 genotype for all isolates. The high presence of free-roaming dogs in urban and peri-urban areas and high frequency of parasite in this animal is a risk factor for humans in the region. Haplotype sequence analysis on the dog isolates revealed a close relationship with other E. granulosus isolates in Kerman.

Conclusion:

The findings of this study provide evidence-based data about the epidemiological and molecular characteristics of CE in dog definitive hosts of Southeast Iran. Further studies are required to understand the prevalence and parasite genotypes in dogs in Iran.

Successful Management of a Huge Pulmonary Hydatid Cyst with Lung-Preserving Surgery

The lung is the second most commonly involved organ in humans by hydatid disease. Management of large pulmonary hydatid cysts is a great challenge for thoracic surgeons. Lung resections should be considered the last choice for huge pulmonary hydatid cysts when the lung expansion is not optimal after cyst removal. Here, we present a case of huge lung hydatid cyst involving the entire right lower lobe which was successfully managed by lung-preserving surgery in which the postoperative course showed gradual resolution of the involved lobe during a one-year follow-up.

Epidemiology, burden, and geographical distribution of cystic echinococcosis in Central Iran

Background and Aim: Human cystic echinococcosis (CE) is an important, neglected zoonotic disease with worldwide distribution which has been reported in different regions of Iran, including the central areas (e.g. Qom Province). The disease is caused by the Echinococcus granulosus parasite living in the intestine of dogs and other canids as definitive hosts. This study aimed to investigate the epidemiology, burden, and geographical distribution of CE in Qom Province, Central Iran. Materials and Methods: In this descriptive-analytic study, the data of patients with diagnosed CE during 2011-2018 were collected from all urban and rural areas of Qom Province. The data of the epidemiological status of CE cases were extracted from the CE surveillance system in the Centers for Disease Control and Prevention in the Qom University of Medical Sciences which is owned and run by Iran's Ministry of Health and Medical Education. In addition, the economic burden of the disease was evaluated by Azarakhsh and Roozamad financial software; the geographical distribution of CE was obtained by ArcGIS 10.3 software (IBM Corp., Chicago, USA). Results: The results reveal that the incidence rate of CE was 6.81/100,000 people over the 8-year period of the study. More than half of the cases were females (57.95%), housewives (57.47%), and residents (89.77%). The majority of the cases were Iranian (88.77%) and the rest were from the two neighboring countries: Afghanistan and Pakistan. The economic burden of the human CE in the 8 years was estimated to be 3,761,352,526 rials (75,227 $). In terms of spatial distribution, the highest incidence rate of CE was observed in Salafchegan District in the southwest of Qom Province. Conclusion: The economic burden of human CE infection provided by governmental health-care systems or as out-of-pocket expenses is relatively high, and housewives, especially those living in Salafchegan District, are more likely to be affected. More studies are recommended on different epidemiological aspects and the definitive hosts of the parasite; besides, people at risk need to be warned and educated so that the incidence rate of the disease is reduced.

Prevalence and economic impact of cystic echinococcosis and liver fluke infections in slaughtered sheep and goat in north-central Iran, 2008-2018

Cystic echinococcosis (CE) and liver fluke infections as important zoonotic infections impose a large socioeconomic impact on societies. As an endemic region for these infections, slaughterhouse inspections should be more considered in Iran. This study aimed to analyze the 11-year record of offal condemnation due to CE, fascioliasis, dicrocoeliasis infections in sheep and goat and its economic impact at Alborz slaughterhouse, north-central Iran. The prevalence rate was calculated as the infected organs (as nominator) divided by the slaughtered cases (as the denominator) in each year and month. The annual percent changes was used to determine trends of parasitic diseases over time. The relationship between metrological indexes and the prevalence of parasitic diseases was determined by the linear regression model. Statistical analyses were done using STATA software 14. For an estimate, the economic impact, the total numbers of offal condemnation were calculated. The overall prevalence rate of fascioliasis, dicrocoeliasis, and CE was 0.95%, 2.17%, and 12.74%, respectively. There was a declining trend in the prevalence of fascioliasis and dicrocoeliasis, whereas, the prevalence of CE increased from 7.57% in 2008 to 9.53% in 2018, representing an annual change of + 0.02%. The direct economic impact was estimated at US$ 1,670,977 and US$ 25,148 for liver and lung, respectively. The number of condemned organs due to these infections is noticeable in Alborz Province, north-central, Iran. The high economic impact of these infections showed the necessity of implementing a continuously infected animal's trace-back and disease control in the site of infection.

Epidemiology of echinococcosis in Iran: a systematic review and meta-analysis

BACKGROUND

Echinococcosis is a zoonotic disease caused by the larval stages of taeniid cestodes of the genus Echinococcus. The two major types of infection in humans are cystic echinococcosis (CE) or hydatidosis and alveolar echinococcosis (AE). It is endemic in some parts of the world, such as the Middle East, with Iran being a part of it. This systematic review and meta-analysis were conducted to determine the prevalence of CE and AE echinococcosis and their epidemiological and clinical aspects in Iran.

METHODS

Electronic databases, including MEDLINE (via PubMed), SCOPUS, Web of Science, SID and Mag Iran (two Persian scientific search engines) were searched from 1 January 1990 to 8 August 2017. The prevalence of CE and AE echinococcosis was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 12.

RESULTS

Of the 2051 records identified in the mentioned electronic databases, Seventy-eight articles met our eligibility criteria, with a total of 214124individuals. The meta-analysis was performed on only 37 out of 78 included studies. The pooled prevalence of CE and AE in Iran was 5% [95% confidence interval )CI(: 3-6%] and 2% [95% CI: 0-5%], respectively. Subgroup meta-analysis revealed that the prevalence of CE was significantly higher in North [9%, 95% CI: 4-18%] and West of Iran [6%, 95% CI: 3-11%], patients younger than 40 years of age [7%, 95% CI: 4-12%], villagers and nomads [6%, 95% CI: 2-12%], and studies that used the combination of serological, clinical, and imaging diagnostic methods [7%, 95% CI: 5-9%]. There were no significant differences between the prevalence of CE among low and high-quality studies. Housewives were the most affected group by hydatidosis (n=24/77, 31%), followed by illiterate people (n=11/77, 14%) and farmers (n= 9/77, 12%). Liver [55%, 95% CI: 46-65%] and lung [28%, 95% CI, 22-35%] were the most common sites of cyst formation.

CONCLUSIONS

Given to the importance of echinococcosis on human health and domestic animals industry, it is necessary to implement monitoring and control measures in this regard.

Prevalence and risk factors associated with human cystic echinococcosis in Iran

Cystic echinococcosis (CE), as a zoonotic helminthic infection, imposes a large socioeconomic burden to societies throughout the world. This study aimed to analyze the demographic, clinical, diagnostic and therapeutic data of CE patients across all provinces in Iran. In this cross-sectional study, the mentioned data were routinely collected by provincial medical universities during the time from March 2016 to March 2017. The provincial population census was used to calculate the prevalence of CE per 1,000,000 populations for all provinces. T test and Chi squared test were used to compare variables between genders. Statistical analysis was done at 95% significant level using STATA 14 software. The overall prevalence of CE was 6.8 cases per 1,000,000 populations in Iran. The highest and lowest prevalence was reported for Northeast (15.2) and southeast (0.7) of Iran, respectively. There was a significant difference in the prevalence between male and female (5.8 vs. 7.9, p < 0.001). An increasing trend of the prevalence was found by age in both males and females. Abdominal pain was reported as the highest proportion of symptom (39.0%) and the liver was a commonly infected organ (62.7%). CT scan (39.0%) and MRI (1.9%) had the highest and lowest proportion among types of CE diagnosis, respectively. About 67% of the patients washed the vegetable by water without any disinfectant. Due to global efforts on the control and prevention of CE, it still remains endemic in many countries throughout the world. Incidence trend of CE in Iran showed being endemic for CE and more investigations are needed on all aspects of the disease.

In vitro evaluation on the scolicidal effect of Myrtus communis L. and Tripleurospermum disciforme L. methanolic extracts

Hydatid disease, a zoonotic disease, is still endemic in many developing countries that is caused by the metacestode of Echinococcus (E.) granulosus. Surgical management is one of the best choices for the treatment of the hydatidosis and using effective scolicidal agents during hydatid surgery is essential to prevent the secondary infection. The aim of the present in vitro study was to evaluate the scolicidal effect of the methanolic extract of Myrtus communis and Tripleurospermum disciforme against protoscoleces of hydatid cyst. Protoscoleces of E. granulosus were aspirated aseptically from infected livers. Various concentrations of M. communis and T. disciforme extracts at different exposure times were examined for their scolicidal activity. Normal saline and silver nitrate were used as negative and positive groups, correspondingly. The viability of protoscoleces was evaluated by 0.1% eosin. The result of the current study indicated that the highest scolicidal effect (100%) of M. communis was obtained at 100 and 50 mg/ml concentrations and LC50 in 10, 20 and 30 min were 11.64 mg/ml, 7.62 mg/ml, and 6.47 mg/ml respectively. The scolicidal activity of T. disciforme was negligible even at high concentration. The findings have shown that the scolicidal activity of M. communis against echinococcosis protoscoleces was strong, while the T. disciforme extract showed fewer effects. However, further studies are required for identification of the active ingredients in the extract and its safety on cells in effective concentrations.

Cystic echinococcosis in unaccompanied minor refugees from Afghanistan and the Middle East to Germany, July 2016 through June 2017

Cystic echinococcosis (CE) is not covered by current refugee screening protocols. After we had detected CE among several refugees attending our clinic from Afghanistan and the Middle East, serological examinations for CE were performed for apparently healthy unaccompanied minor refugees from these regions.

A systematic review and meta-analysis of the prevalence of toxoplasmosis in hemodialysis patients in Iran

OBJECTIVES

Toxoplasmosis is a parasitic disease that occurs worldwide, with a wide range of complications in immunocompromised patients. This systematic review and meta-analysis was performed to evaluate the seroprevalence of Toxoplasma gondii among patients undergoing hemodialysis in Iran.

METHODS

We searched English and Persian databases for studies reporting T. gondii seroprevalence in Iranian hemodialysis patients through December 31, 2017. Inclusion and exclusion criteria were applied.

RESULTS

A total of 10 studies containing 1,865 participants (1,048 patients and 817 controls) met the eligibility criteria. Immunoglobulin G (IgG) antibodies against T. gondii were found in 58% (95% confidence interval [CI], 46 to 70) of hemodialysis patients and 40% (95% CI, 31 to 50) of healthy controls, while immunoglobulin M (IgM) antibodies were found in 2% (95% CI, 0 to 6) of hemodialysis patients and 0% (95% CI, 0 to 1) of healthy controls. The meta-analysis showed that hemodialysis patients were significantly more likely to be seropositive for IgG (odds ratio [OR], 2.04; 95% CI, 1.54 to 2.70; p<0.001) and IgM (OR, 2.53; 95% CI, 1.23 to 5.22; p<0.001) antibodies against T. gondii infection than healthy individuals.

CONCLUSIONS

The current study revealed a high prevalence of T. gondii infection in hemodialysis patients. Since hemodialysis patients are immunocompromised and T. gondii can cause serious clinical complications, we recommend that periodic screenings for T. gondii infection should be incorporated into the routine clinical care of these patients.