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Infectious Diseases of Poverty Oct 2023The complexity of the Chagas disease and its phases is impossible to have a unique test for both phases and a lot of different epidemiological scenarios. Currently,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The complexity of the Chagas disease and its phases is impossible to have a unique test for both phases and a lot of different epidemiological scenarios. Currently, serology is the reference standard technique; occasionally, results are inconclusive, and a different diagnostic technique is needed. Some guidelines recommend molecular testing. A systematic review and meta-analysis of available molecular tools/techniques for the diagnosis of Chagas disease was performed to measure their heterogeneity and efficacy in detecting Trypanosoma cruzi infection in blood samples.
METHODS
A systematic review was conducted up to July 27, 2022, including studies published in international databases. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA 2020 guidelines. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A random-effects model was used to calculate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Forest plots and a summary of the receiving operating characteristics (SROC) curves displayed the outcomes. Heterogeneity was determined by I and Tau statistics and P values. Funnel plots and Deek's test were used to assess publication bias. A quantitative meta-analysis of the different outcomes in the two different clinical phases was performed.
RESULTS
We identified 858 records and selected 32 papers. Studies pertained to endemic countries and nonendemic areas with adult and paediatric populations. The sample sizes ranged from 17 to 708 patients. There were no concerns regarding the risk of bias and applicability of all included studies. A positive and nonsignificant correlation coefficient (S = 0.020; P = 0.992) was obtained in the set of studies that evaluated diagnostic tests in the acute phase population (ACD). A positive and significant correlation coefficient (S = 0.597; P < 0.000) was obtained in the case of studies performed in the chronic phase population (CCD). This resulted in high heterogeneity between studies, with the master mix origin and guanidine addition representing significant sources.
INTERPRETATION/CONCLUSIONS AND RELEVANCE
The results described in this meta-analysis (qualitative and quantitative analyses) do not allow the selection of the optimal protocol of molecular method for the study of Trypanosoma cruzi infection in any of its phases, among other reasons due to the complexity of this infection. Continuous analysis and optimization of the different molecular techniques is crucial to implement this efficient diagnosis in endemic areas.
Topics: Adult; Child; Humans; Sensitivity and Specificity; Chagas Disease
PubMed: 37845734
DOI: 10.1186/s40249-023-01143-7 -
Cytokine Sep 2023The roles of interleukin-8 (IL-8) in malaria are inconsistent and unclear. This study synthesised evidence for differences in IL-8 levels in patients with malaria of... (Meta-Analysis)
Meta-Analysis
The roles of interleukin-8 (IL-8) in malaria are inconsistent and unclear. This study synthesised evidence for differences in IL-8 levels in patients with malaria of various levels of severity. Relevant studies were searched in Scopus, MEDLINE, Embase, CENTRAL and PubMed from inception to 22 April 2022. Pooled mean differences (MDs) and 95% confidence intervals (CIs) were estimated using the random effects model. Of 1083 articles retrieved from the databases, 34 were included for syntheses. The meta-analysis revealed increased IL-8 levels in individuals with uncomplicated malaria compared with those without malaria (P = 0.04; MD, 25.57 pg/mL; 95% CI, 1.70 to 49.43 pg/mL; I, 99.53, 4 studies; 400 uncomplicated malaria, 204 uninfected controls). The meta-analysis revealed comparable levels of IL-8 between the two groups (P = 0.10; MD, 74.46 pg/mL; 95% CI, -15.08 to 164.0 pg/mL; I, 9.03; 4 studies; 133 severe malaria cases, 568 uncomplicated malaria cases). The study found evidence of increased IL-8 levels in individuals with malaria compared with those without malaria. However, no differences were found in IL-8 levels between patients with severe and non-severe malaria. Further research is needed to investigate the IL-8 cytokine levels in patients with malaria of different levels of severity.
Topics: Humans; Interleukin-8; Malaria; Cytokines
PubMed: 37327530
DOI: 10.1016/j.cyto.2023.156262 -
Memorias Do Instituto Oswaldo Cruz Aug 2011Despite not being a criterion for severe malaria, thrombocytopenia is one of the most common complications of both Plasmodium vivax and Plasmodium falciparum malaria. In... (Review)
Review
Despite not being a criterion for severe malaria, thrombocytopenia is one of the most common complications of both Plasmodium vivax and Plasmodium falciparum malaria. In a systematic review of the literature, platelet counts under 150,000/mm³ ranged from 24-94% in patients with acute malaria and this frequency was not different between the two major species that affected humans. Minor bleeding is mentioned in case reports of patients with P. vivax infection and may be explained by medullary compensation with the release of mega platelets in the peripheral circulation by megakaryocytes, thus maintaining a good primary haemostasis. The speculated mechanisms leading to thrombocytopenia are: coagulation disturbances, splenomegaly, bone marrow alterations, antibody-mediated platelet destruction, oxidative stress and the role of platelets as cofactors in triggering severe malaria. Data from experimental models are presented and, despite not being rare, there is no clear recommendation on the adequate management of this haematological complication. In most cases, a conservative approach is adopted and platelet counts usually revert to normal ranges a few days after efficacious antimalarial treatment. More studies are needed to specifically clarify if thrombocytopenia is the cause or consequence of the clinical disease spectrum.
Topics: Humans; Malaria, Falciparum; Malaria, Vivax; Thrombocytopenia
PubMed: 21881757
DOI: 10.1590/s0074-02762011000900007 -
Parasites & Vectors Oct 2021Malaria and visceral leishmaniasis (VL) co-infection can occur due to the overlapping geographical distributions of these diseases; however, only limited data of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Malaria and visceral leishmaniasis (VL) co-infection can occur due to the overlapping geographical distributions of these diseases; however, only limited data of this co-infection have been reported and reviewed. This study aimed to explore the pooled prevalence and characteristics of this co-infection using a systematic review approach.
METHODS
The PubMed, Web of Science and Scopus databases were searched for relevant studies. The quality of these studies was assessed in accordance with strengthening the reporting of observational studies in epidemiology (STROBE) guidelines. The numbers of individuals co-infected with Plasmodium and VL and the total numbers of individuals with VL were used to estimate the pooled prevalence using random-effects models. Differences in age, sex and the presence of anemia and malnutrition on admission were compared between co-infected individuals and individuals with VL using a random-effects model; the results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity among the included studies was assessed and quantified using Cochrane Q and I statistics.
RESULTS
Of the 3075 studies identified, 12 met the eligibility criteria and were included in this systematic review. The pooled prevalence of Plasmodium infection among the 6453 individuals with VL was 13%, with substantial heterogeneity of the data (95% CI 7-18%, I 97.9%). Subgroup analysis demonstrated that the highest prevalence of co-infection occurred in African countries, whereas the lowest prevalence occurred in Asian countries. Patients aged < 5 years had higher odds of having co-infection than having VL (co-infection, n = 202; VL, n = 410) (OR 1.66, 95% CI 1.37-2.01, I 0%; P < 0.0001), whereas patients aged 20-29 years had lower odds of having co-infection than having VL (co-infection, n = 170; VL, n = 699) (OR 0.75, 95% CI 0.60-0.93, I 18%; P = 0.01). Male patients had equivalent odds of having co-infection and having VL (co-infection, n = 525; VL, n = 2232) (OR 0.92, 95% CI 0.078-1.08, I 0%; P = 0.29). Patients with co-infection had lower odds of having anemia at admission than those with VL (co-infection, n = 902; VL, n = 2939) (OR 0.64, 95% CI 0.44-0.93, I 0%; P = 0.02). No difference in malnutrition at admission was found in the meta-analysis.
CONCLUSIONS
The prevalence of malaria co-infection among individuals with VL was heterogeneous and ranged from 7 to 18%, depending on geographical area. Age and anemia at admission were associated with co-infection status. Further longitudinal studies are needed to determine if co-infection with malaria has an impact on the severity of VL.
Topics: Africa; Asia; Coinfection; Humans; Leishmaniasis, Visceral; Malaria; Odds Ratio; Prevalence
PubMed: 34688312
DOI: 10.1186/s13071-021-05045-1 -
Microbial Pathogenesis Dec 2020Toxoplasma gondii, the etiological agent of toxoplasmosis, can cause serious public health problems. Although Toxoplasma gondii tends more to neurotropic and ocular... (Meta-Analysis)
Meta-Analysis Review
Toxoplasma gondii, the etiological agent of toxoplasmosis, can cause serious public health problems. Although Toxoplasma gondii tends more to neurotropic and ocular organs, some existing evidence suggest that this disease might induce serious pathological effects on liver. Hence, this study aimed to evaluate the relationship between chronic liver diseases and toxoplasmosis. Meanwhile, it attempted to assess whether patients with toxoplasmosis are susceptible to chronic liver diseases. To achieve this aim, the published studies related to the subject were systematically searched in five major electronic databases between the January 1, 1950 and October 1, 2019. The meta-analysis was carried out using the StatsDirect statistical software and a p-value less than 0.05 was considered significant for any test. Out of 691 identified studies, 10 studies met our inclusion criteria and entered this systematic review. The pooled prevalence rates of Toxoplasma gondii in patients with liver diseases (35.97%; 95% CI: 28.38-43.93) were higher than those in the control group (18.24%; 95% CI: 13.85-23.09). The meta-analysis indicated that the common Odd Ratio by a random effect model was 2.7 (95% CI: 2.30-3.24), revealing a significant association between chronic liver diseases and anti-Toxoplasma IgG antibody. The results of this systematic review confirmed the positive connection between toxoplasmosis and chronic liver diseases. Nonetheless, more studies are needed to clarify the detailed association between these diseases.
Topics: Antibodies, Protozoan; Humans; Liver Diseases; Risk Factors; Seroepidemiologic Studies; Toxoplasma; Toxoplasmosis
PubMed: 33069795
DOI: 10.1016/j.micpath.2020.104578 -
Journal of Medical Microbiology Apr 2018Approximately one-third of the world's population has Toxoplasma gondii infection, and one of the main routes of transmission is organ transplantation. The aim of this... (Review)
Review
PURPOSE
Approximately one-third of the world's population has Toxoplasma gondii infection, and one of the main routes of transmission is organ transplantation. The aim of this study was to evaluate the impact of Toxoplasma infection on liver transplantation patients.
METHODOLOGY
We searched PubMed, Lilacs, Medline, Science direct, Scielo, Ebsco, Springer, Wiley, Ovid and Google Scholar for reports published up to June 2017, and a systematic review was performed.
RESULTS
Twenty cases were analysed before and after liver transplantation. Primary and reactivated infections were investigated. Before transplantation, positive IgG antibodies were the predominant serological markers in donors and recipients: 40 % (D+/R-), 20 % (D+/R+) and 20 % (D-/R+). IgM was present in only 5 % of the donors (D+/R-). In four cases, the serological markers were not specified or were negative (D?/R? or D?/R-). After transplantation, IgM anti-Toxoplasma antibodies were found in 30 % of the recipients, and in 67 % of the seronegative recipients the presence of Toxoplasma DNA or tachyzoites was reported, suggesting a primary infection. Clinical symptoms were meningitis, massive cerebral oedema, encephalitis and seizures. Treatment was administered in 70 % of the patients, and 40 % died after presenting symptoms associated with Toxoplasma infection.
CONCLUSIONS
Although we review Toxoplasma infection and liver transplantation cases, problems associated with the parasite may be greater than identified. Hence, follow-up studies on Toxoplasma infection in liver transplantation patients are recommended.
Topics: Antibodies, Protozoan; Humans; Liver Transplantation; Postoperative Complications; Toxoplasma; Toxoplasmosis
PubMed: 29458555
DOI: 10.1099/jmm.0.000694 -
Journal of Infection and Public Health Feb 2023Leishmaniasis is a highly prevalent neglected tropical disease. It mainly presents as two forms: cutaneous and visceral leishmaniasis, the latter being the most severe... (Review)
Review
BACKGROUND
Leishmaniasis is a highly prevalent neglected tropical disease. It mainly presents as two forms: cutaneous and visceral leishmaniasis, the latter being the most severe form. However, asymptomatic cases of Leishmania infection result in an increase in the underreporting and transmission of the protozoan OBJECTIVES: In this study, articles on the incidence of asymptomatic Leishmania infection were systematically reviewed.
METHODS
The publications identified in the Medline/PubMed and Science Direct databases included 4568 articles. Inclusion, exclusion, and eligibility criterion analysis resulted in 83 articles being retained. These studies were mostly performed in Brazil (n = 26) and India (n = 15).
RESULTS
Several detection techniques have been used for diagnosis. Among the species found were L. infantum and L. donovani, which result in visceral leishmaniasis, and L. amazonensis, L. braziliensis, and L. panamensis. The incidence rates varied between the analyzed locations, largely due to sampling and the presence or absence of endemism in the regions. The largest populations analyzed were in two studies performed in India and Nepal. One of these studies evaluated 32,529 people and the incidence rate was 8.3% (n = 2702), while the other study evaluated 21,267 people and the incidence rate was 1.76% (n = 375). Only 14.28% of the studies investigated leishmaniasis in blood donors. Preexisting diseases have also been reported.
CONCLUSION
The findings of this systematic review present the incidence of cases of asymptomatic Leishmania infection worldwide, in addition to detailing the studies and offering information for researchers and health authorities to seek alternatives to reduce the number of leishmaniasis cases.
Topics: Humans; Leishmaniasis, Visceral; Leishmania infantum; Leishmaniasis; Brazil; Blood Donors
PubMed: 36630836
DOI: 10.1016/j.jiph.2022.12.021 -
The Cochrane Database of Systematic... Oct 2022Malaria remains an important public health problem. Research in 1900 suggested house modifications may reduce malaria transmission. A previous version of this review... (Review)
Review
BACKGROUND
Malaria remains an important public health problem. Research in 1900 suggested house modifications may reduce malaria transmission. A previous version of this review concluded that house screening may be effective in reducing malaria. This update includes data from five new studies.
OBJECTIVES
To assess the effects of house modifications that aim to reduce exposure to mosquitoes on malaria disease and transmission.
SEARCH METHODS
We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Centre for Agriculture and Bioscience International (CAB) Abstracts (Web of Science); and the Latin American and Caribbean Health Science Information database (LILACS) up to 25 May 2022. We also searched the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry to identify ongoing trials up to 25 May 2022.
SELECTION CRITERIA
Randomized controlled trials, including cluster-randomized controlled trials (cRCTs), cross-over studies, and stepped-wedge designs were eligible, as were quasi-experimental trials, including controlled before-and-after studies, controlled interrupted time series, and non-randomized cross-over studies. We sought studies investigating primary construction and house modifications to existing homes reporting epidemiological outcomes (malaria case incidence, malaria infection incidence or parasite prevalence). We extracted any entomological outcomes that were also reported in these studies.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected eligible studies, extracted data, and assessed the risk of bias. We used risk ratios (RR) to compare the effect of the intervention with the control for dichotomous data. For continuous data, we presented the mean difference; and for count and rate data, we used rate ratios. We presented all results with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach.
MAIN RESULTS
One RCT and six cRCTs met our inclusion criteria, with an additional six ongoing RCTs. We did not identify any eligible non-randomized studies. All included trials were conducted in sub-Saharan Africa since 2009; two randomized by household and four at the block or village level. All trials assessed screening of windows, doors, eaves, ceilings, or any combination of these; this was either alone, or in combination with roof modification or eave tube installation (an insecticidal "lure and kill" device that reduces mosquito entry whilst maintaining some airflow). In one trial, the screening material was treated with 2% permethrin insecticide. In five trials, the researchers implemented the interventions. A community-based approach was adopted in the other trial. Overall, the implementation of house modifications probably reduced malaria parasite prevalence (RR 0.68, 95% CI 0.57 to 0.82; 5 trials, 5183 participants; moderate-certainty evidence), although an inconsistent effect was observed in a subpopulation of children in one study. House modifications reduced moderate to severe anaemia prevalence (RR 0.70, 95% CI 0.55 to 0.89; 3 trials, 3643 participants; high-certainty evidence). There was no consistent effect on clinical malaria incidence, with rate ratios ranging from 0.38 to 1.62 (3 trials, 3365 participants, 4126.6 person-years). House modifications may reduce indoor mosquito density (rate ratio 0.63, 95% CI 0.30 to 1.30; 4 trials, 9894 household-nights; low-certainty evidence), although two studies showed little effect on this parameter.
AUTHORS' CONCLUSIONS
House modifications - largely screening, sometimes combined with insecticide and lure and kill devices - were associated with a reduction in malaria parasite prevalence and a reduction in people with anaemia. Findings on malaria incidence were mixed. Modifications were also associated with lower indoor adult mosquito density, but this effect was not present in some studies.
Topics: Adult; Anemia; Animals; Child; Culicidae; Humans; Insecticides; Malaria; Permethrin
PubMed: 36200610
DOI: 10.1002/14651858.CD013398.pub4 -
Acta Parasitologica Sep 2021In recent years, antimonial agents and other synthetic antileishmanial drugs, such as amphotericin B, paromomycin, and many other drugs, have restrictions in use due to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In recent years, antimonial agents and other synthetic antileishmanial drugs, such as amphotericin B, paromomycin, and many other drugs, have restrictions in use due to the toxicity risk, high cost, and emerging resistance to these drugs. The present study aimed to review the antileishmanial effects of curcumin, its derivatives, and other relevant pharmaceutical formulations on leishmaniasis.
METHODS
The present study was carried out according to the 06-preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline and registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-Analysis Facility (SyRF) database. Some English-language databases including PubMed, Google Scholar, Web of Science, EBSCO, Science Direct, and Scopus were searched for publications worldwide related to antileishmanial effects of curcumin, its derivatives, and other relevant pharmaceutical formulations, without date limitation, to identify all the published articles (in vitro, in vivo, and clinical studies). Keywords included "curcumin", "Curcuma longa", "antileishmanial", "Leishmania", "leishmaniasis", "cutaneous leishmaniasis", "visceral leishmaniasis", "in vitro", and "in vivo".
RESULTS
Out of 5492 papers, 29 papers including 20 in vitro (69.0%), 1 in vivo (3.4%), and 8 in vitro/in vivo (27.6%) studies conducted up to 2020, met the inclusion criteria for discussion in this systematic review. The most common species of the Leishmania parasite used in these studies were L. donovani (n = 13, 44.8%), L. major (n = 10, 34.5%), and L. amazonensis (n = 6, 20.7%), respectively. The most used derivatives in these studies were curcumin (n = 15, 33.3%) and curcuminoids (n = 5, 16.7%), respectively.
CONCLUSION
In the present review, according to the studies in the literature, various forms of drugs based on curcumin and their derivatives exhibited significant in vitro and in vivo antileishmanial activity against different Leishmania spp. The results revealed that curcumin and its derivatives could be considered as an alternative and complementary source of valuable antileishmanial components against leishmaniasis, which had no significant toxicity. However, further studies are required to elucidate this concluding remark, especially in clinical settings.
Topics: Antiprotozoal Agents; Curcumin; Humans; Leishmania; Leishmaniasis, Cutaneous; Leishmaniasis, Visceral
PubMed: 33770343
DOI: 10.1007/s11686-021-00351-1 -
The Journal of Infectious Diseases Nov 2009Light microscopy examination of blood slides is the main method of detecting malaria infection; however, it has limited sensitivity. Low-density infections are most... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Light microscopy examination of blood slides is the main method of detecting malaria infection; however, it has limited sensitivity. Low-density infections are most likely to be missed, but they contribute to the infectious reservoir. Quantifying these submicroscopic infections is therefore key to understanding transmission dynamics and successfully reducing parasite transmission.
METHODS
We conducted a systematic review of endemic population surveys in which P. falciparum prevalence had been measured by both microscopy and a more-sensitive polymerase chain reaction (PCR)-based technique. The combined microscopy:PCR prevalence ratio was estimated by random-effects meta-analysis, and the effect of covariates was determined by meta-regression.
RESULTS
Seventy-two pairs of prevalence measurements were included in the study. The prevalence of infection measured by microscopy was, on average, 50.8% (95% confidence interval [CI], 45.2%-57.1%) of that measured by PCR. For gametocyte-specific detection, the microscopy prevalence was, on average, 8.7% (95% CI, 2.8%-26.6%) of the prevalence measured by PCR. A significantly higher percentage of total infections was detected by microscopy in areas of high, compared with low, transmission (74.5% when the prevalence determined by PCR was >75% versus 12.0% when the prevalence determined by PCR was <10%).
DISCUSSION
Microscopy can miss a substantial proportion of P. falciparum infections in surveys of endemic populations, especially in areas with low transmission of infection. The extent of the submicroscopic reservoir needs to be taken into account for effective surveillance and control.
Topics: Disease Reservoirs; Endemic Diseases; Humans; Malaria, Falciparum; Polymerase Chain Reaction; Prevalence
PubMed: 19848588
DOI: 10.1086/644781