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PLoS Neglected Tropical Diseases May 2024Francisella tularensis, the bacterium that causes tularemia, has been a persistent and widespread pathogen in various regions of the world for centuries. Francisella... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Francisella tularensis, the bacterium that causes tularemia, has been a persistent and widespread pathogen in various regions of the world for centuries. Francisella tularensis can affect humans and various domestic and wild animals. The current study aimed to determine the epidemiological status of tularemia in countries of the WHO Eastern Mediterranean Region (EMRO) through a systematic review and meta-analysis.
METHODS
All included studies were identified through a systematic search of online databases, including Scopus, PubMed, Web of Science, and EMBASE, through July 26, 2022, using keywords and suitable combinations. We focused on cross-sectional studies investigating the prevalence of F. tularensis. The weighted pooled prevalence was calculated using a random-effects model.
RESULTS
A total of 206 studies were identified, of which 20 were finally included in the analysis. The human seroprevalence of tularemia in WHO-EMRO countries was 6.2% (95% CI, 4.2 9.2). In the subgroup analysis, anti-F. tularensis antibodies were found in 6.92% and 5.5% of the high-risk individuals and Iran, respectively. The pooled prevalence of F. tularensis in environmental samples (water and soil) from the WHO-EMRO countries was 5.8% (9.4% by PCR and 0.5% by culture). In addition, 2.5% (95% CI, 0.2 0.22.7) of ticks in WHO-EMRO countries were positive for F. tularensis. The pooled prevalence of F. tularensis in rodents is 2.0% (1.1% by PCR and 3.7% by serology). In addition, 0.6% of domestic ruminants (0.4% by PCR and 2.4% by serology) were positive for F. tularensis in WHO-EMRO countries.
CONCLUSION
According to the results of the present study, tularemia is an endemic but neglected disease in the WHO-EMRO region. However, most studies on tularemia are limited to a few countries in this region. Studies on tularemia in human populations, reservoirs, and vectors have been conducted in all countries in the WHO-EMRO region to obtain more detailed information about the epidemiology of tularemia in these regions.
Topics: Tularemia; Humans; Animals; Francisella tularensis; Mediterranean Region; Prevalence; Seroepidemiologic Studies; World Health Organization; Cross-Sectional Studies; Ticks
PubMed: 38728365
DOI: 10.1371/journal.pntd.0012141 -
Brain Sciences Nov 2023Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published... (Review)
Review
Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published literature to understand effective approaches to and implementation of these practices. PubMed and ScienceDirect were searched to identify clinical trials evaluating isolated breathing-based interventions with psychometric stress/anxiety outcomes. Two independent reviewers conducted all screening and data extraction. Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies' 72 interventions were effective. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness. Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice. Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective. Following this evidence-based framework can help maximize the stress/anxiety reduction benefits of breathing practices. Future research is warranted to further refine this easily accessible intervention for stress/anxiety relief.
PubMed: 38137060
DOI: 10.3390/brainsci13121612 -
Current Research in Immunology 2023Plague remains endemic in many parts of the world, and despite efforts, no preventative vaccine is available. We performed a systemic review of available randomised... (Review)
Review
Plague remains endemic in many parts of the world, and despite efforts, no preventative vaccine is available. We performed a systemic review of available randomised controlled trials (RCTs) of live, attenuated, or killed plague vaccines vs. placebo, no intervention, or other plague vaccine to evaluate their efficacy, safety, and immunogenicity. Data sources included MEDLINE, Embase, and the Cochrane Library; clinical trial registers; and reference lists of included studies. Primary outcomes were efficacy, safety, and immunogenicity. Risk of bias was assessed using the Cochrane Collaborations tool. Only 2 RCTs, both on subunit vaccines, were included out of the 75 screened articles. The 2 trials included 240 participants with a follow-up of 3 months and 60 participants with a follow-up of 13 months, respectively. Safety evidence was limited, but both vaccines were well tolerated, with only mild to moderate adverse events. Both vaccines were immunogenic in a dose-dependent manner. However, given the limited data identified in this systematic review, we are unable to quantify the efficacy of vaccines to prevent plague, as well as their long-term safety and immunogenicity. More trials of plague vaccines are needed to generate additional evidence of their long-term effects.
PubMed: 37954941
DOI: 10.1016/j.crimmu.2023.100072 -
PLoS Neglected Tropical Diseases Nov 2023Plague is a zoonotic disease that, despite affecting humans for more than 5000 years, has historically been the subject of limited drug development activity. Drugs that...
BACKGROUND
Plague is a zoonotic disease that, despite affecting humans for more than 5000 years, has historically been the subject of limited drug development activity. Drugs that are currently recommended in treatment guidelines have been approved based on animal studies alone-no pivotal clinical trials in humans have yet been completed. As a result of the sparse clinical research attention received, there are a number of methodological challenges that need to be addressed in order to facilitate the collection of clinical trial data that can meaningfully inform clinicians and policy-makers. One such challenge is the identification of clinically-relevant endpoints, which are informed by understanding the clinical characterisation of the disease-how it presents and evolves over time, and important patient outcomes, and how these can be modified by treatment.
METHODOLOGY/PRINCIPAL FINDINGS
This systematic review aims to summarise the clinical profile of 1343 patients with bubonic plague described in 87 publications, identified by searching bibliographic databases for studies that meet pre-defined eligibility criteria. The majority of studies were individual case reports. A diverse group of signs and symptoms were reported at baseline and post-baseline timepoints-the most common of which was presence of a bubo, for which limited descriptive and longitudinal information was available. Death occurred in 15% of patients; although this varied from an average 10% in high-income countries to an average 17% in low- and middle-income countries. The median time to death was 1 day, ranging from 0 to 16 days.
CONCLUSIONS/SIGNIFICANCE
This systematic review elucidates the restrictions that limited disease characterisation places on clinical trials for infectious diseases such as plague, which not only impacts the definition of trial endpoints but has the knock-on effect of challenging the interpretation of a trial's results. For this reason and despite interventional trials for plague having taken place, questions around optimal treatment for plague persist.
Topics: Humans; Animals; Plague; Zoonoses; Outcome Assessment, Health Care
PubMed: 37943880
DOI: 10.1371/journal.pntd.0011509 -
Pathogens (Basel, Switzerland) Aug 2023To prevent and/or control infectious diseases in animal and human health, an appropriate surveillance system based on suitable up-to-date epidemiological data is... (Review)
Review
To prevent and/or control infectious diseases in animal and human health, an appropriate surveillance system based on suitable up-to-date epidemiological data is required. The systematic review protocol was designed according to the PRISMA statement to look at the available data on infectious diseases of livestock in Cameroon from 2000-2020. Data were searched through online databases. Grey literature was comprised of dissertations and theses from veterinary higher education institutions in Cameroon. A random-effects model was used to calculate pooled prevalence using Comprehensive Meta-Analysis Software. Based on disease prevalence, major infectious diseases of livestock in Cameroon were gastrointestinal parasitosis (57.4% in cattle, 67.2% in poultry, 88% in pigs), hemoparasites (21.6% in small ruminants, 19.7% in cattle), bovine pasteurellosis (55.5%), fowl salmonellosis (48.2%), small ruminant plague (39.7%), foot-and-mouth disease (34.5% in cattle), and African swine fever (18.9%). Furthermore, other important endemic zoonoses in the country included: Rift Valley fever (10.9% in cattle, 3.7% in small ruminants), brucellosis (7% in cattle, 8% in pigs), bovine tuberculosis (4.7% in cattle), hepatitis E virus (8.4% in pigs) and bovine leptospirosis (2.5%). Most of the retrieved research were carried out in the Adamawa, Northwest, and West regions of Cameroon. The evaluation of existing data as evidence, albeit publication-specific, is an important step towards the process of prioritizing animal diseases, including zoonoses.
PubMed: 37764884
DOI: 10.3390/pathogens12091076 -
Health Security 2023Plague meningitis is a serious and often fatal manifestation of infection. In the aftermath of a bioweapon attack with , this typically rare manifestation may develop...
Plague meningitis is a serious and often fatal manifestation of infection. In the aftermath of a bioweapon attack with , this typically rare manifestation may develop in a substantial number of patients, particularly if treatment delays occur. Risk factors, clinical evolution, and optimal treatment strategies for plague meningitis are not well understood. We searched PubMed Central and other databases for reports of plague meningitis in any language. Articles containing descriptions of patients with plague meningitis and their treatment and outcomes were included. Among 1,496 articles identified in our search, 56 articles describing 84 cases from 1898 to 2015 met inclusion criteria. The median age of patients was 16 years (range 6 weeks to 64 years); 68% were male. Most patients (n = 50, 60%) developed meningitis following primary bubonic plague. Common signs and symptoms included fever (n = 56, 66%), nuchal rigidity (n = 38, 45%), and headache (n = 33, 36%); 29% (n = 24) of patients had focal neurologic deficits such as cranial nerve abnormalities. Almost all (n = 23, 96%) of the 24 patients who did not receive antimicrobials died, and 42% (n = 25) of the 59 patients treated with antimicrobials died. The case fatality rate of patients grouped by antimicrobial received was 50% (1 out of 2) for fluoroquinolones, 19% (4 out of 21) for aminoglycosides, 14% (2 out of 14) for sulfonamides, 11% (2 out of 18) for chloramphenicol, and 0% (0 out of 13) for tetracyclines. Plague meningitis most often occurs as a complication of bubonic plague and can cause focal neurologic deficits. Survival is more likely in patients who receive antimicrobials; tetracyclines, aminoglycosides, and chloramphenicol had the lowest associated case fatality rates.
Topics: Humans; Male; Infant; Female; Plague; Anti-Bacterial Agents; Chloramphenicol; Aminoglycosides; Meningitis; Disease Progression
PubMed: 36576503
DOI: 10.1089/hs.2022.0081 -
Epidemiology and Health 2022Q fever, caused by the bacterium, is a major zoonotic disease around the world. This disease is common in the Eastern Mediterranean region; therefore, we conducted the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Q fever, caused by the bacterium, is a major zoonotic disease around the world. This disease is common in the Eastern Mediterranean region; therefore, we conducted the first systematic review and meta-analysis on its prevalence in humans, animals, and ticks in the Eastern Mediterranean region.
METHODS
Major Iranian and international databases were searched from 2000 to 2021. We extracted the prevalence of Q fever in blood samples from animals and milk samples from animals, ticks, and humans as the main outcome. We reported the prevalence of seropositivity and molecular positivity as point estimates and 95% confidence intervals (CIs).
RESULTS
In this review, 112 papers were identified. The overall seroprevalence of Q fever was 22.4% (95% CI, 19.8 to 25.1). The pooled prevalence of Q fever in ticks was 17.5% (95% CI, -1.3 to 36.4). The prevalence was 25.5% (95% CI, 16.1 to 34.9) in humans. The prevalence of Q fever in animal blood samples from goats, sheep, camels, cattle, cats, dogs, horses, and buffalo were 28.1%, 25.1%, 25.0%, 20.1%, 9.8%, 8.4%, 6.5%, and 6.3%, respectively. Furthermore, the prevalence of Q fever in milk samples of animals was higher in cattle (20.3%) than in sheep (20.0%), goats (16.4%), and camels (3.3%).
CONCLUSIONS
Coxiella burnetii infections are common in humans and in a wide range of animal species, but they are still not recognized in many countries in the Eastern Mediterranean region, thus presenting a significant threat to human and animal health in the region.
Topics: Cattle; Humans; Animals; Sheep; Dogs; Horses; Q Fever; Coxiella burnetii; Prevalence; Seroepidemiologic Studies; Camelus; Iran; Goats
PubMed: 36317399
DOI: 10.4178/epih.e2022097 -
International Journal of Colorectal... Aug 2022Haemorrhoidal disease (HD) plagues one in every ten people, with a plethora of surgical treatment modalities, of which laser haemorrhoidoplasty (LHP) is a relatively... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard.
PURPOSE
Haemorrhoidal disease (HD) plagues one in every ten people, with a plethora of surgical treatment modalities, of which laser haemorrhoidoplasty (LHP) is a relatively novel option. This systematic review and meta-analysis objectively evaluated the efficacy, safety, and tolerability of LHP compared against conventional (Milligan-Morgan) open haemorrhoidectomy (CoH).
METHOD
A comprehensive search of MEDLINE, EMBASE, CENTRAL, and Google Scholar was conducted. Randomised controlled trials (RCTs) and comparative cohort studies (CCSs) which compared LHP against CoH were included, with postoperative pain as the primary outcome. Secondary outcomes included intraoperative characteristics, short- and moderate-term outcome, and complications.
RESULTS
A total of 12 studies (6 RCTs and 6 CCSs), with a total of 1824 patients, were analysed. LHP resulted in reduced postoperative pain for the first day (mean difference of 2.07 visual analogue scale units), week, and month. The mean dosage and duration of postoperative analgesia use was similarly lower, with a mean difference of 4.88 mg (morphine) and 2.25 days, respectively. Crucially, recurrence was equivocal (HR: 0.72, CI: 0.21-2.40) at a mean follow-up duration of 8.58 ± 9.55 months. LHP resulted in lower blood loss and was 12.74 min shorter on average. LHP's postoperative recovery time was 9.03 days less with equivalent or decreased risk of most short- and moderate-term complications except anal thrombosis.
CONCLUSION
Our study suggests that LHP is more tolerable than CoH, providing patients with superior postoperative quality of life at equivalent moderate-term efficacy. These findings contribute to improved understanding of LHP and its potential at enhancing the quality of HD care.
Topics: Hemorrhoidectomy; Hemorrhoids; Humans; Lasers; Pain Measurement; Pain, Postoperative
PubMed: 35906356
DOI: 10.1007/s00384-022-04225-4 -
Archives of Razi Institute Dec 2021Peste des petits ruminants (PPR) or goat plague is considered a leading, highly contagious, and most lethal infectious viral disease of small ruminants affecting the... (Meta-Analysis)
Meta-Analysis Review
Peste des petits ruminants (PPR) or goat plague is considered a leading, highly contagious, and most lethal infectious viral disease of small ruminants affecting the worldwide livestock economy and international animal trade. Although sheep and goats are the primarily affected, the PPR Virus (PPRV) host range has expanded to other livestock (large ruminants) and wildlife animals over the last few decades, resulting in serious concern to the ongoing PPR global eradication program, which is primarily optimized, designed, and targeted towards accessible sheep and goat population. A systematic review and meta-analysis study was conducted to estimate the prevalence and spill-over infection of PPRV in large ruminants (bovine and camel) and wildlife. Published articles from 2001 to October 2021 on the "PPR" were searched in four electronic databases of PubMed, Scopus, Science direct, and Google Scholars. The articles were then selected using inclusion criteria (detection/prevalence of PPRV in bovine, camel, and wildlife population), exclusion criteria (only sheep or goats, lack of prevalence data, experimental trial, test evaluation, and reviews written in other languages or published before 2001), and the prevalence was estimated by random effect meta-analysis model. In the current study, all published articles belonged to Africa and Asia. The overall pooled prevalence of PPR estimates was 24% (95% CI: 15-33), with 30% in Asia (95% CI: 14-49) and 20% in Africa (95% CI: 11-30). The overall estimated pooled prevalence at an Africa-Asia level in bovine and camel was 13% (95% CI: 8-19), and in wildlife, it was 52% (95% CI: 30-74) with significant heterogeneity (I = 97%) in most pooled estimates with a high prevalence in atypical hosts and wildlife across Asia and Africa. Over the last two decades, the host range has increased drastically in the wildlife population, even for prevalent PPR in the unnatural hosts only for a short time, contributing to virus persistence in multi-host systems with an impact on PPR control and eradication program. This observation on the epidemiology of the PPRV in unnatural hosts demands appropriate intervention strategies, particularly at the livestock-wildlife interface.
Topics: Animals; Animals, Wild; Camelus; Cattle; Cattle Diseases; Goat Diseases; Goats; Livestock; Peste-des-Petits-Ruminants; Peste-des-petits-ruminants virus; Prevalence; Sheep; Sheep Diseases
PubMed: 35546985
DOI: 10.22092/ari.2021.356900.1939 -
Osong Public Health and Research... Feb 2022Yersinia pestis, the cause of plague and a potential biological weapon, has always been a threatening pathogen. Some strains of Y. pestis have varying degrees of...
Yersinia pestis, the cause of plague and a potential biological weapon, has always been a threatening pathogen. Some strains of Y. pestis have varying degrees of antibiotic resistance. Thus, this systematic review was conducted to alert clinicians to this pathogen's potential antimicrobial resistance. A review of the literature was conducted for experimental reports and systematic reviews on the topics of plague, Y. pestis, and antibiotic resistance. From 1995 to 2021, 7 Y. pestis isolates with 4 antibiotic resistance mechanisms were reported. In Y. pestis 17/95, 16/95, and 2180H, resistance was mediated by transferable plasmids. Each plasmid contained resistance genes encoded within specific transposons. Strain 17/95 presented multiple drug resistance, since plasmid 1202 contained 10 resistance determinants. Strains 16/95 and 2180H showed single antibiotic resistance because both additional plasmids in these strains carried only 1 antimicrobial determinant. Strains 12/87, S19960127, 56/13, and 59/13 exhibited streptomycin resistance due to an rpsl gene mutation, a novel mechanism that was discovered recently. Y. pestis can acquire antibiotic resistance in nature not only via conjugative transfer of antimicrobial-resistant plasmids from other bacteria, but also by gene point mutations. Global surveillance should be strengthened to identify antibiotic-resistant Y. pestis strains by whole-genome sequencing and drug susceptibility testing.
PubMed: 35255676
DOI: 10.24171/j.phrp.2021.0288