Foroutan-Rad Masoud, Khademvatan Shahram, Majidiani Hamidreza, Aryamand Safa, Rahim Fakher, Malehi Amal Saki
Student Research Committe, Urmia University of Medical Sciences, Urmia, Iran; Department of Medical Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Cellular and Molecular Research Center & Department of Medical Parasitology and Mycology, Urmia University of Medical Sciences, Urmia, Iran.
Acta Trop. 2016 Jun;158:160-169. doi: 10.1016/j.actatropica.2016.03.003. Epub 2016 Mar 4.
Toxoplasmosis is a common and serious parasitic disease with high prevalence and global distribution in human and other warm-blooded vertebrates. Though the infection of Toxoplasma gondii is usually asymptomatic in healthy people, it can lead to severe pathological effects to the fetus of infected women and immunocompromised patients. So pinpointing the risk factors and control procedures are of important works among these populations. In order to reach this goal, we conducted a systematic review and meta-analysis to identify the seroprevalence rate of T. gondii infection among Iranian pregnant women population to achieve a comprehensive explanation of the disease condition in Iran for future use. English electronic databases (PubMed, Science Direct, Scopus, Ovid and Cochrane) and Persian language databases (Scientific Information Database, Iran Medex, Magiran and Iran Doc) were searched. Furthermore, the proceedings of Iranian parasitology congresses were explored manually. Our review resulted in a total of 50 publications meeting the inclusion criteria during Jan 1990-June 2015. Totally, 20221 women had been tested during this period of which 7724 women had seropositivity for IgG. According to results of heterogeneity test, either Der Simonian and Laird's random-effects method or Mantel-Haenszel's fixed-effects method were used to pool the estimations. Weighted overall prevalence of toxoplasmosis in pregnant women were obtained using random-effects model, which was estimated 41% (95% CI=36-45%). Also IgG and IgM antibodies was obtained 38% (95% CI=34-42%) and 4% (95% CI=3-5%), respectively. The highest and the lowest seroprevalence of toxoplasmosis in five geographical zones of Iran were observed in South 53% (95% CI=30-77%) and East 33% (95% CI=23-42%), respectively. In order to detect publication bias, Egger's regression test was done which revealed that publication bias might not have a significant influence on overall prevalence estimate (P=0.89). Multivariate analysis showed that there's a statistically significant correlation between toxoplasmosis and two risk factors including "place of residence" (P=0.005) and "contact with cat" (P=0.002). There was no significant difference between toxoplasmosis and the other surveyed risk factors. It is highly recommended to further study for the aim of better disease management and developing more efficient diagnostic tests.
弓形虫病是一种常见且严重的寄生虫病，在人类和其他温血脊椎动物中普遍存在且分布于全球。虽然健康人感染刚地弓形虫通常无症状，但它会对受感染妇女的胎儿和免疫功能低下的患者造成严重的病理影响。因此，确定这些人群中的危险因素和控制措施是重要工作。为了实现这一目标，我们进行了一项系统评价和荟萃分析，以确定伊朗孕妇人群中弓形虫感染的血清阳性率，以便全面了解伊朗的疾病状况供未来使用。我们检索了英文电子数据库（PubMed、Science Direct、Scopus、Ovid和Cochrane）以及波斯语数据库（科学信息数据库、伊朗医学数据库、Magiran和伊朗文档）。此外，还手动查阅了伊朗寄生虫学大会的会议记录。我们的综述共筛选出1990年1月至2015年6月期间符合纳入标准的50篇出版物。在此期间，共有20221名女性接受了检测，其中7724名女性IgG呈血清阳性。根据异质性检验结果，采用Der Simonian和Laird随机效应法或Mantel-Haenszel固定效应法合并估计值。使用随机效应模型得出孕妇弓形虫病的加权总体患病率为41%（95%CI = 36 - 45%）。IgG和IgM抗体的患病率分别为38%（95%CI = 34 - 42%）和4%（95%CI = 3 - 5%）。在伊朗的五个地理区域中，弓形虫病血清阳性率最高和最低的分别是南部的53%（95%CI = 30 - 77%）和东部的33%（95%CI = 23 - 42%）。为检测发表偏倚，进行了Egger回归检验，结果显示发表偏倚可能对总体患病率估计没有显著影响（P = 0.89）。多变量分析表明，弓形虫病与包括“居住地点”（P = 0.005）和“接触猫”（P = 0.002）在内的两个危险因素之间存在统计学显著相关性。弓形虫病与其他调查的危险因素之间没有显著差异。强烈建议进一步开展研究，以更好地管理疾病并开发更有效的诊断测试。
