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.

In Vitro Anti-Leishmanial Activity of Glucosinolate Fraction from Alyssum linifolium Steph. ex Willd (Brassicaceae)

Objectives

The intracellular parasitic protozoan, Leishmania spp., causes several forms of diseases in humans. Cytotoxicity and emergence of new strains resistance to the current anti-leishmanial drugs have encouraged researchers to focus on new resources. Glucosinolates (GSL) are found mainly in the Brassicaceae family with potential cytotoxic and anti-parasitic properties. The present study reports in vitro antileishmanial activity of the GSL fraction from Alyssum linifolium seeds against Leishmania major.

Materials and Methods

The GSL fraction was prepared by ion-exchange and reversed-phase chromatography. For the assessment of antileishmanial activity, the promastigotes and amastigotes of L. major were treated with different concentrations of the fraction (75-625 μg/mL).

Results

The IC₅₀ was 245 µg/mL for anti-promastigote effect of the GSL fraction and 250 µg/mL for its anti-amastigote effect that had a significant difference (p<0.05) with both glucantime and amphotericin B. The selectivity index of the GSL fraction (15.8), to glucantime and amphotericin B, was greater than 10, indicating the selective effect of this fraction against L. major amastigotes. Glucoiberverin was the major constituent of the GSL fraction characterized using nuclear magnetic resonance and electron ionization-mass spectrometry spectra. Based on gas chromatography-mass spectrometry data, iberverin and iberverin nitrile, the hydrolysis constituents from glucoiberverin, included 76.91% of the total seed volatiles.

Conclusion

The results suggest that GSLs like glucoiberverin could be considered a new promising candidate for further studies on antileishmanial activity.

Anti-Toxoplasma gondii Activity of Curcumin: A Systematic Review of Pre-clinical Studies

OBJECTIVE

This study has focused on anti-Toxoplasma gondii activity of curcumin.

METHODS

In this systematic review, anti-parasitic activity of Curcuma longa on Toxoplasma gondii was assessed. Therefore, several databases, including PubMed, Scopus, Web of Science, Embase and Google Scholar, were searched from 2010 to 2020.

RESULTS

Of the 2200 papers retrieved between 2010 and 2020, six articles were reliable and were scrutinized. In 2 in vitro studies, the most used strain was the RH strain of Toxoplasma gondii, whereas among 4 in vivo studies, RH strain was found in 2 (50%) studies, Me49 strain in 1(25%) study, and RH and Me49 strain in 1 (25%) study. In four in vivo studies, the most used animal model was BALB/c, and Swiss albino was found in 1 study (25%) and Albino rats in 1 study (25%).

CONCLUSION

Curcumin and nanoparticles formulated with curcumin are new and useful agents for the treatment of parasitic diseases and reduction of drug resistance. The success of this therapeutic approach stems from the specific action of Curcuma longa against parasites and pathogens.

Prevalence of Toxoplasma gondii in HIV-Infected Individuals in Iran: A Systematic Review and Meta-Analysis

INTRODUCTION

Toxoplasma gondii is an obligate intracellular protozoan that can infect almost all warm-blooded animals, including humans. Patients with co-infection with toxoplasmosis and HIV have a 30-40% risk of developing toxoplasmosis encephalitis. This study aimed to describe the epidemiology and burden of Toxoplasma gondii in HIV-infected individuals in Iran.

METHODS

We searched the five English databases (Science Direct, PubMed, Scopus, Ovid, Embase, and Cochrane) and four Persian databases (Scientific Information Database (SID), Iran Medex, Iran Doc, and Magiran) with the terms of (Toxoplasma gondii OR "toxoplasmosis") AND (HIV OR "AIDS" OR immunodeficiency OR acquired immune deficiency syndrome) AND (Seroprevalence) AND (Seroepidemiologic Studies) AND (Elisa OR IgG) AND (PCR) AND (Iran) by two authors up to Feb 2021. Studies were included if they investigated people with HIV infection and presented data that allowed us to establish the prevalence of Toxoplasma gondii infection in Iran.

RESULTS

According to the inclusion/exclusion criteria, 15 studies were selected. A total number of 2275 HIV-infected individuals were tested and evaluated for toxoplasmosis from 2005 up to 2018 in different regions of Iran. The weighted overall prevalence of toxoplasmosis in HIV-infected individuals with Elisa was obtained using a random-effects model, which was estimated at 47% (95% CI = 31% - 62%). Also, the Weighted overall prevalence of toxoplasmosis in HIV-infected individuals with PCR was obtained using a random-effects model, which was estimated at 7% (95% CI = 3% - 12%).

CONCLUSION

According to the results of this study, it can be clearly understood that a large population of HIV patients living in Iran have toxoplasmosis. Therefore, due to the high susceptibility of these groups to toxoplasmosis, healthcare professionals must consider measures such as training in the ways of transmission and prevention of the infection to this high-risk group in order to reduce the risk of infection.

New strategies in the treatment of diseases caused by Acanthamoeba based on nanoparticles: a systematic review

BACKGROUND

Acanthamoeba is one of the opportunistic parasites with a global prevalence. Currently, due to the side effects and the emergence of drug resistance to this parasite, much research has been performed on the use of nano-drugs to treat Acanthamoeba-caused diseases. Therefore, this systematic review study aims to evaluate new strategies for treating diseases caused by Acanthamoeba based on nanoparticles (NPs).

METHODS

We designed a systematic review based on the articles published in English between 2000 and 2022. Our search strategy was based on syntax and specific tags for each database, including ScienceDirect, PubMed, Scopus, Ovid, and Cochrane. From the articles, those that had inclusion criteria were selected, and their data were extracted and analyzed.

RESULTS

In this study, 26 studies were selected. Metallic nanoparticles were mostly used against the Acanthamoeba species (80.7%). 19.2% of the studies used polymeric nanoparticles, and 3.8% used emulsion nanoparticles. Most studies (96.1%) were performed in vitro, and only one study (3.8%) was carried out in vivo. Silver NPs were the most used metallic nanoparticles in the studies. The best effect of the anti-Acanthamoeba compound was observed for green synthesized nanoparticles based on stabilization by plant gums, loaded with citrus fruits flavonoids hesperidin (HDN) and naringin (NRG) with a 100% growth inhibition at a concentration of 50 μg/mL.

CONCLUSION

This study showed that chlorhexidine and other plant metabolites loaded with silver and gold nanoparticles increase the anti-Acanthambae activity of these nanoparticles. However, green synthesized nanoparticles based on stabilization by plant gums, loaded with citrus fruits flavonoids hesperidin (HDN) and naringin (NRG), showed the best anti-Acanthambae effect. Nevertheless, further studies should be performed to determine their safety for human use.

Current challenges and nanotechnology-based pharmaceutical strategies for the treatment and control of malaria

Malaria is one of the prevalent tropical diseases caused by the parasitic protozoan of the genus Plasmodium spp. With an estimated 228 million cases, it is a major public health concern with high incidence of morbidity and mortality worldwide. The emergence of drug-resistant parasites, inadequate vector control measures, and the non-availability of effective vaccine(s) against malaria pose a serious challenge to malaria eradication especially in underdeveloped and developing countries. Malaria treatment and control comprehensively relies on chemical compounds, which encompass various complications, including severe toxic effects, emergence of drug resistance, and high cost of therapy. To overcome the clinical failures of anti-malarial chemotherapy, a new drug development is of an immediate need. However, the drug discovery and development process is expensive and time consuming. In such a scenario, nanotechnological strategies may offer promising alternative approach for the treatment and control of malaria, with improved efficacy and safety. Nanotechnology based formulations of existing anti-malarial chemotherapeutic agents prove to exceed the limitations of existing therapies in relation to optimum therapeutic benefits, safety, and cost effectiveness, which indeed advances the patient's compliance in treatment. In this review, the shortcomings of malaria therapeutics and necessity of nanotechnological strategies for treating malaria were discussed.

A Systematic Review on Curcumin and Anti-Plasmodium berghei Effects

BACKGROUND

Turmeric (Curcuma longa L.) is a popular spice, containing curcumin that is responsible for its therapeutic effects. Curcumin with anti-inflammatory, antioxidant, anti-cancer, and antimicrobial activities has led to a lot of research focusing on it over the years. This systematic review aimed to evaluate researches on anti-Plasmodium berghei activity of curcumin and its derivatives.

METHODS

Our study was performed according to PRISMA guidelines and was recorded in the database of systematic review and preclinical meta-analysis of CAMARADESNC3Rs (SyRF). The search was performed in five databases, namely Scopus, PubMed, Web of Science, EMBASE, and Google Scholar from 2010 to 2020. The following keywords were searched: "Plasmodium berghei", "Medicinal Plants", "Curcumin", "Concentration", Animals kind", "Treatment Durations", "Routes of Administration" and "in vivo".

RESULTS

Of the 3,500 papers initially obtained, 14 articles were reliable and were thus scrutinized. Animal models were included in all studies. The most commonly used animal strain were Albino (43%) followed by C57BL/6 (22%). The other studies used various murine strains, including BALB/c (14%) and ICR (7%). Two (14%) studies did not mention the strain of animal model used. Curcumin alone or in combination with other compounds depending on the dose used, route of administration, and animal model showed a moderate to strong anti-Plasmodium berghei effect.

CONCLUSION

According to the studies, curcumin has anti-malarial effects on Plasmodium berghei and, however, its effect on human Plasmodium is unclear. Due to the side effects and drug resistance of current drugs in the treatment of human malaria, the use of new compounds with few or no side effects such as curcumin is recommended as an alternative or complementary treatment.

In vivo and in vitro anti-hydatidosis effect of garlic: a systematic review

Background:

Hydatidosis is a parasitic disease caused by the larval stage of Echinococcus granulosus sensu lato. The aim of the current systematic review study was to clarify the effect of garlic on hydatid cyst in vivo and in vitro.

Method:

We performed our analyses up to Feb 20, 2021, in accordance with the PRISMA guideline. We systematically searched five English databases (Science Direct, PubMed, Scopus, Ovid and Cochrane) and four Persian databases (Scientific Information Database [SID], Iran Medex, Iran Doc, and Magiran) with appropriate syntax. The data was extracted from the relevant articles and analyzed.

Results:

From 160 studies obtained by initial search, nine studies were selected for further analysis. Among 6 in vitro study, 3 (50%) used methanolic extract, 2 (34%) hydroalcoholic and chloroformic extract, and 1 (16%) chloroformic extract. Two (67%) studies used BALB/c mice, and one study (33%) used Swiss albino mice. The method of treatment of mice in all studies was oral. The results showed that garlic has mild to potent effect on hydatidosis and this effect was more considerable in vitro than in vivo.

Conclusion:

Based on the results of various studies, it can be concluded that Allium sativum extract can be used as a suitable alternative to drugs such as Albendazole or can be used as complementary treatment to reduce the dose of the current drugs.

In Vivo and In Vitro Anti-schistosomiasis Effect of Garlic: A Systematic Review

BACKGROUND

Garlic (Allium sativum) is used as a natural supplement for the treatment of various diseases and disorders because it has antibacterial, antiviral, antifungal, antiparasitic, antioxidant, and anti-inflammatory properties. This systematic review aimed to evaluate in vitro and in vivo effects of garlic against Schistosoma spp.

METHODS

The current study was carried out according to the PRISMA guidelines and registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-analysis Facility [SyRF] database. The literature search was conducted using five databases, including Scopus, PubMed, Web of Science, Embase, and Google Scholar, from January 2008 to January 2021. The search was restricted to articles published in the English language. Syntax was performed based on each database tag.

RESULTS

Out of 2,600 studies, 10 met the eligibility criteria for review. The examined parasite in all studies was Schistosoma mansoni. Ten studies (90%) were performed in vivo and one study in vitro. Studies have shown that garlic compounds can activate immune system factors, thereby damaging the parasite structure or its eggs.

CONCLUSION

Given the increase in using plants in the treatment of many diseases and the fact that plants can be a good alternative to chemical drugs in many cases, more comprehensive research is needed to introduce effective medicinal plants to treat diseases such as schistosomiasis.

Peganum harmala and Nigella sativa: anti-leishmanial activity against Leishmania major promastigotes and amastigotes: in vitro and ex vivo experiment

Leishmaniosis is one of the most important vectors borne disease that is endemic in tropical and subtropical areas. There are many approved treatment for different types of leishmaniosis but all are with some adverse side effects that limited its uses. Here, we attempt to evaluate in vitro and ex vivo anti-leishmanial activities of Peganum harmala (P. harmala) and N. sativa (Nigella sativa) on promastigotes and amastigotes of L. major. The plants were extracted by maceration method and prepared in concentrations of 7.8, 3.9, 1.9, and 0.9 μg. L. major were cultured in RPMI-1640 medium alone and in J774 cell line separately. The extracts at different concentrations were assessed against promastigote (in vitro assay) and amastigotes (ex vivo assay) of L. major for 72 h at 22 and 37°C, respectively. In current work, N. sativa at highest concentration (7.8 μg/ml) showed 54.4 and 60% anti-leishmanial activity with IC50 of 5.3 and 3.278 μg/ml, respectively. Also, P. harmala at highest concentration (7.8 μg/ml) showed 68.9 and 58.6% antileishmanial activity with IC50 of 2.4 μg/ml for both of them, respectively. The SI value was 38.22 for N. sativa, 25.9 for P. harmala, 19.4 for Amphotericin B, and 16.33 for Glucantime. The results of our study indicated that N. sativa and P. harmala are effective against L. major promastigotes and amastigotes and could be consider as an alternative treatments for leishmaniosis. Therefore, it is recommended that further studies be performed to confirm the efficacy and evaluate the toxicity of the herbal extracts.

Seroprevalence of toxoplasmosis in Kermanshah City, west of Iran

It is estimated that one-third of the world's population is infected with Toxoplasma gondii. The purpose of this study was to evaluate the latest status of toxoplasmosis seroprevalence in the general population and pregnant women in the west of Iran. This retrospective cross-sectional study was conducted in 2018. Accordingly, data associated with serodiagnosis of toxoplasmosis, age, sex, anti-toxoplasmosis IgG and IgM, and pregnancy status in women were collected from 6 health centers of Kermanshah City, the west of Iran, during 2016-2017. In total, 1228 people referred to the health centers in Kermanshah City. Of 1228 people, 359 (29.23%) individuals were seropositive for toxoplasmosis, of them 294 (81.89%) individuals were seropositive only for IgG, and 65 (18.11%) individuals were both IgG and IgM seropositive. The seropositivity in men was 29.3% (n = 63), in women was 29.2% (n = 296), and in pregnant women was 25.9% (n = 44). All individuals were examined using ELISA kit. This study showed that the prevalence of this disease in the west of Iran has been decreased in comparison with the previous studies. Therefore, regular epidemiological studies of in different regions seem to be necessary in order to conclude on the decrease or increase trend of this disease in an area.

Comparative evaluation of amniotic fluid as an alternative to fetal bovine serum in the maintenance of Leishmania major and Toxoplasma gondii

This study aimed to evaluate the efficacy of amniotic fluid (AF) as an alternative to fetal bovine serum (FBS) in the maintenance of Leishmania major promastigotes and Toxoplasma gondii tachyzoites. AF was collected by an obstetrician using sterile syringes during a cesarean section. The culture medium was supplemented with 5 different concentrations of FBS or AF including 2, 5, 10, 20, and 30%. These concentrations were used to maintain both mentioned parasites. L. major was maintained at temperatures 4 and 24 °C and examined once a week for 4 weeks, while T. gondii was maintained at temperatures 4, 24, and 37 °C and examined at hours 24, 48, 72, and 96. For L. major, at both 4 and 24 °C, we observed no significant difference between FBS and AF on day 7. However, on days 14, 21, and 28, the difference between FBS and AF was significant at both temperatures. For T. gondii, no significant difference was observed between FBS and AF at hour 24 and all temperatures. However, this difference was significant at hours 48, 72, and 96 and all temperatures. According to our results, although FBS had a greater efficacy than AF in the growth of L. major and the survival of T. gondii, the number of promastigotes increased over time in AF-containing medium and the number of tachyzoites reduced slowly with a mild slop. Therefore, AF can be a potential alternative to FBS.

Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.

METHODS

GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden.

FINDINGS

The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older.

INTERPRETATION

Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public.

FUNDING

Bill & Melinda Gates Foundation.

Antileishmanial and antibacterial activities of the hydroalcoholic extract of Rhus coriaria L

Leishmaniosis is one of the most serious public health concern with a worldwide distribution. Since the current treatments of leishmaniosis are toxic and expensive, frequent studies have been conducted to investigate the benefits of new resources such as medicinal plants for treatment of this infectious disease. Recent studies revealed the antiparasitic potential of Rhus coriaria. Here we investigated the potential antileishmanial and antibacterial activities of the hydroalcoholic extract of R. coriaria fruits. The fruits were extracted using 80% methanol by maceration method. The concentrations of 312, 156, 78, and 37 μg/ml of the extract were added separately to the wells containing Leishmania major (L. major) promastigotes and amastigotes. Amphotericin B was considered as positive control. Finally, the death rate was determined for the extract-treated parasites as compared to the non-treated parasite. The antibacterial activity was evaluated by measurement of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the extract against a set of Gram-positive and Gram-negative bacteria. The extract significantly inhibited the growth of both promastigotes (60,7%) and amastigotes (59%) at the concentration of 312 μg/ml with the IC50 values of 147 μg/ml and 233 μg/ml, respectively. The extract showed bactericidal effects against Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, and Acinetobacter baumannii. Totally, Grampositive bacteria were more susceptible to the extract. Our findings show that the hydroalcoholic extract of R. coriaria fruits are rich in tannins and can be considered for further in vivo studies on the antileishmanial and antibacterial activities especially on dermal lesions caused by L. major.

Apoptotic blebs from Leishmania major-infected macrophages as a new approach for cutaneous leishmaniasis vaccination

We focused on apoptotic blebs from Leishmania major-infected macrophages as a vaccine for cutaneous leishmaniasis. Apoptosis was induced in L. major-infected J774A.1 cells in order to prepare apoptotic blebs. Test groups of BALB/c mice were immunized with these at doses of 1 × 10⁶, 5 × 10⁶ or 1 × 10⁷ blebs. An immunization control group received Leishmania lysate antigens. The results showed that as the number of apoptotic bodies increased, the lymphocyte proliferation index increased, and this was proportional to IFN-γ level in the test groups. Additionally, the difference of IFN-γ, IL-4, IFN-γ/IL-4 ratio, or total IgG (p < 0.0001) in all groups was statistically significant compared to the negative control group. The highest IFN-γ (514.0 ± 40.92 pg/mL) and IFN-γ/IL-4 ratio (2.94 ± 0.22) were observed in the group that received 1 × 10⁷ apoptotic blebs. The highest levels of IL-4 (244.6 ± 38.8 pg/mL) and total IgG (5626 ± 377 μg/mL) were observed in the immunization control group. Reflecting these data, no lesions were observed in any of the groups vaccinated with apoptotic blebs after 12 weeks. In summary, the use of apoptotic blebs from L. major-infected macrophages is protective against the challenge with L. major in this animal model.

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017

BACKGROUND

Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea.

METHODS

We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates.

FINDINGS

The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage.

INTERPRETATION

By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health.

FUNDING

Bill & Melinda Gates Foundation.

Status of fasciolosis among domestic ruminants in Iran based on abattoir data: a systematic review and meta-analysis

Fasciolosis is considered as an ongoing neglected zoonotic disease in tropical regions of the world, relating to notable financial and public health issues. The current systematic review and meta-analysis was planned to determine the status of fasciolosis among domestic ruminants, including cattle, buffalo, goat, and sheep at the industrial slaughterhouses in Iran, between the years 2000 and 2016. Eight databases, four English and four Persian, were searched. Our findings demonstrated that 2.6% of all inspected livers of slaughtered ruminants were infected with Fasciola spp. during 2000–2016. The mean prevalence of fasciolosis for cattle, buffalo, goat, and sheep was 21%, 4.2%, 2%, and 2.4%, respectively. Additionally, most studies were performed on cattle 25 (39.6%), sheep 24 (38 %), and goat 12 (19%), respectively, and just 2 (3.1%) studies were performed on buffalo. The prevalence of animal fasciolosis has significantly decreased among domestic ruminants in Iran except for cattle. In addition, the prevalence of this disease in Northern and Western regions of the country has remained at hypo-endemic level. The results present updated gathered information on the epidemiology of fasciolosis in domestic ruminants in Iran, and will expand the screening strategies to improve health and reduce economic impacts among farm animals.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

A new effective antiplasmodial compound: Nanoformulated pyrimethamine

OBJECTIVES

The aim of this study was to evaluate the efficacy of pyrimethamine-loaded poloxamer 407 nanomicelles on Plasmodium berghei strain NICD in vivo.

METHODS

Pyrimethamine-loaded nanomicelles were prepared and their zeta potential, particle size and polydispersity index were measured. For antiplasmodial assessment, 54 mice were randomly divided into six groups. Four groups were infected intraperitoneally with P. berghei, whereas the two remaining groups did not receive the parasite (negative controls). Three of the P. berghei-infected groups received treatment with either pyrimethamine-loaded nanomicelles (2 mg/kg), pyrimethamine (2 mg/kg) or empty nanomicelles (2 mg/kg); the fourth group remained untreated (positive control). The parasitaemia rate, survival rate and histopathological changes in the liver, spleen and kidneys were examined and were compared with the negative and positive control groups.

RESULTS

The mean parasitaemia rate differed significantly between the nanoformulated pyrimethamine group and each of the other groups (P<0.05). Moreover, the survival rate of mice in the nanoformulated pyrimethamine group (7/9; 78%) was significantly higher compared with each of the other groups (P<0.01). The main histopathological changes, including hepatic necrosis in the liver, lymphoid hypoplasia in the spleen, and tubular nephrosis and perivascular and interstitial lymphocytic infiltration in the kidneys, were considerably lower in the nanoformulated pyrimethamine group than in the pyrimethamine and positive control groups.

CONCLUSION

Pyrimethamine-loaded nanomicelles showed potent antimalarial activity and can be considered as a potential candidate for further examination of their suitability as an antimalarial drug.

Evaluating of Wistar rat and BALB/c mouse as animal models for congenital, cerebral and ocular toxoplasmosis

This study was conducted to evaluate the potential of cyst production by Toxoplasma (T.) gondii, RH strain, in Wistar rat and BALB/c mouse and the purpose of this study was to introduce an animal model suitable for congenital, cerebral, and ocular toxoplasmosis. The mice and rats, considered as cerebral and ocular toxoplasmosis models, were intraperitoneally infected by different number of the parasite and their eyes and brain were evaluated for the presence of T. gondii cyst using the microscopic examination and the bioassay method. Moreover, the pregnant mice and rats, considered as congenital toxoplasmosis models, were intraperitoneally infected by different number of the parasite and their infants were examined by the method mentioned above. The best result for the cerebral toxoplasmosis model was observed in the rats infected with the 107 parasites, so that all infants (100%) were infected with the parasite when examined using the bioassay method. Furthermore, the best result was observed for the congenital cerebral toxoplasmosis model with 100% infection rate in the infants born to mothers infected with the 107 parasites. Overall, just few the ocular samples were positive using bioassay method. The best result in the current study was for the congenital cerebral toxoplasmosis model where the pregnant rats were infected with the 107 parasites and all infants were infected (100%). Therefore, these infants can be used as a congenital cerebral toxoplasmosis model when they are in the fetal stage, and can be used as a cerebral toxoplasmosis model one month after birth.

Vaccination against Toxoplasma gondii using rhoptry antigens: a systematic review

Toxoplasma gondii is an obligate intracellular parasitic protozoan that infects a wide variety of vertebrates as intermediate hosts. The aim of the current systematic review study is to clarify the latest status of studies in the literature regarding rhoptry-associated recombinant proteins or rhoptry-associated recombinant DNAs as potential vaccines against toxoplasmosis. The search was performed systematically in 8 databases, four in English and four in Persian, up to February 2017. Overall, ROP2 was the most commonly used ROPs in DNA vaccines (27.27%) and protein vaccines (6.81%). Furthermore, regarding the type of adjuvants, route and dose of vaccination, animal models, challenge methods, and measurement of immune responses has been discussed in the text. It is hoped that this article help researchers to conduct more effective studies in the field of immunization against T. gondii.

Investigating in vitro anti-leishmanial effects of silibinin and silymarin on Leishmania major

Cutaneous leishmaniosis is an important zoonotic disease caused by various Leishmania species. The aim of this study was to investigate the effects of silibinin and silymarin on the in vitro growth and proliferation of promastigotes and amastigotes of Leishmania major compared to glucantime-treated parasites. The promastigotes and amastigotes of this parasite were treated with the two drugs, silibinin and silymarin, in several concentrations (25–100 μM). The highest effect on promastigotes was for silymarin in concentration of 100 μM with 90% and 91% death rate at hours 48 and 72, respectively. Regarding amastigotes, the highest effect at 48 hours was for silibinin in concentration of 100 μM with 35% death rate. However, at 72 hours, silymarin showed the highest effect with 63% death rate in concentration of 100 μM. The highest observed maximal 50% lethal concentration (LC50) for promastigotes was for silymarin with 19.34 μM at 48 hours and 18.22 μM at 72 hours. Likewise, maximal LC50 for amastigotes was for silymarin with 191 μM at 48 hours and 24.27 μM at 72 hours. Our findings demonstrated that both medications have suitable effects like Glucantime® on the parasite in vitro. Therefore, clinical assessment of the anti-leishmanial activity of silibinin and silymarin for treating the dermal lesions caused by L. major is recommended.

Prevalence and clinical features of Cryptosporidium infection in hemodialysis patients

AIM

This cross-sectional study aims to assess the prevalence of Cryptosporidium in hemodialysis patients compared with healthy individuals in central Iran from August 2014 to January 2015.

BACKGROUND

Cryptosporidiosis is a major cause of acute and persistent diarrhea with significant morbidity and mortality in immunocompromised patients such as those undergoing renal dialysis.

METHODS

Three stool samples were collected from 330 hemodialysis patients and 150 healthy individuals on 3 consecutive days. The samples were screened for Cryptosporidium infection using formalin-ether sedimentation and modified Ziehl-Neelsen staining. Demographic variables as well as risk factors were recorded.

RESULTS

Out of 330 dialysis patients and 150 healthy individuals, 10 (3%) and 1 (0.7%) were infected with Cryptosporidium, respectively. We found statistically significant differences between infection and place of residency, hygiene status, education level, diarrhea, and abdominal pain in the two groups (p<0.05). On the other hand, there was no relationship between infection and sex, contact with domestic animals, fever, vomiting, nausea, flatulence, anorexia, duration of dialysis and underlying disorders in the two groups. Also, there was a statistically significant difference between age and infection in hemodialysis patients (p=0.003). A higher infection rate was observed in patients under 20 years of age.

CONCLUSION

Risk factors for Cryptosporidium infection must be controlled. We strongly recommended that stool samples from such patients, especially those with severe or prolonged diarrhea, should be examined with modified Ziehl-Neelsen staining for appropriate and timely treatment.

Manipulation of IL-10 gene expression by Toxoplasma gondii and its products

BACKGROUND

This study was designed to evaluate whether or not T. gondii and its derivatives can change the gene expression level of IL-10 in murine leukocytes in vivo.

METHODS

Fifty BALB/c mice were divided into 5 groups, four of which received the excretory/secretory product (ESP) from cell culture medium, the ESP from cell free medium, the Toxoplasma lysate product (TLP) and the active tachyzoites, respectively. The fifth group was considered as control and received PBS. The peritoneal leukocytes from the mice were collected. Their total RNA were extracted and converted to cDNA and the gene expression levels of IL-10 in the samples were evaluated by quantitative real time-PCR using the REST-2009 software.

RESULTS

The findings showed a decrease in the expression level of IL-10 in the TLP group (p=0.004). Moreover, the IL-10 gene expression level was upregulated in the group of the ESP from cell culture medium (p=0.04) and the active tachyzoite group (p=0.04). The expression of IL-10 gene in the group of ESP from cell-free medium was not significant compared to the control one (p=0.45).

CONCLUSION

T. gondii and its derivatives are able to increase (the active T. gondii tachyzoite and the ESP from cell culture medium) and decrease (the TLP) the gene expression level of IL-10 in a murine model. The question remains to be examined in further study about which molecules are involved in this process.

In vitro anti-leishmanial activity of Satureja hortensis and Artemisia dracunculus extracts on Leishmania major promastigotes

Cutaneous leishmaniasis is one of the important skin diseases with diverse clinical manifestations. With an incidence of 0.7-1.3 million cases annually, this disease is often reported from six countries, including Iran. Accordingly, the purpose of this study was to evaluate the anti-leishmanial effect of the three plant hydroalcoholic extracts including fleawort (Plantago psyllium L.), savory (Satureja hortensis L.) and tarragon (Artemisia dracunculus L.) on Leishmania major promastigotes. The hydroalcoholic extract from each plant was extracted and its anti-leishmanial effect was evaluated in different concentrations (100-1000 µg/ml) and at various hours (24, 48 and 72 h). Savory herb inhibitory concentration 50 % (IC₅₀) at 24, 48 and 72 h was 790.81, 398.11 and 298.42 µg/ml, respectively. In addition, tarragon herb IC₅₀ at 24, 48 and 72 h was 962.03, 688.36 and 585.51 µg/ml, respectively. Moreover, the fleawort extract was showed the lowest effect, considering that its effect at the concentration of 1000 µg/ml was 48 % after 72 h (P > 0.05). Furthermore, the statistical analysis showed a significant difference for interaction between concentration and time regarding the tarragon and savory extracts with a P value of lower than 0.05. According to the results, the anti-leishmanial effect of the tarragon and savory extracts may make it possible to use them in the treatment of cutaneous leishmaniasis as a complementary or alternative therapy; however, further studies are necessary and should be evaluated in cell culture and in vivo conditions to confirm it.

The gene expression level of IFN-γR1 and IFN-γR2 in a murine model treated with Toxoplasma gondii and its products

AIM

To evaluate the effect of active T. gondii tachyzoites and its products on the gene expression level of IFN-γR1 and IFN-γR2 in a murine model.

BACKGROUND

Many studies have shown that the parasite Toxoplasma gondii utilizes different mechanisms to inhibit the function of IFN-γ, but the parasite effect on the function of IFN-γR1 and IFN-γR2 is still unclear.

PATIENTS AND METHODS

Toxoplasma lysate product (TLP), excretory/secretory products (ESPs) obtained from cell free and cell culture media as well as active tachyzoites were injected separately to their respective group each consisted of 10 BALB/c mice. One control group of 10 mice received phosphate buffered saline (PBS). All of the mice were euthanized three days after the last injection and then their peritoneal leukocytes were harvested separately. The total RNA was extracted from the samples, converted to cDNA, and the gene expression level of IFN-γR1 and IFN-γR2 was assessed in all of the treated groups relative to the control one.

RESULTS

There was no significant difference between each of the treated groups relative to the control group concerning the gene expression level of IFN-γR2 (P> 0.05). Furthermore, the gene expression level of IFN-γR1 in two groups of TLP (P= 0.04) and ESP obtained from cell free medium (P= 0.008) showed a significant difference relative to the control group.

CONCLUSION

Findings of this study revealed a new aspect of host-T. gondii interaction in that this parasite is able to downregulate IFN-γR1 to reduce the IFN-γ effects on the infected cell.

SEROPREVALENCE OF TOXOPLASMA GONDII INFECTION AMONG PATIENTS ADMITTED TO AL-ZAHRA HOSPITAL, ISFAHAN, IRAN

BACKGROUND

Toxoplasma gondii (T. gondii) infection is one of the most common parasitic infections among humans and other warm-blooded animals worldwide. The aim of this study was to evaluate toxoplasmosis status in patients admitted to Al-Zahra hospital, Isfahan, Iran.

METHODS

This cross-sectional study was conducted from October 2012 to January 2015. During this period, 716 patients referred to AI-Zahra hospital in Isfahan city, Iran, were studied to investigate the IgG and IgM antibodies against T. gondii using ELISA kit. The data were analysed by Chi-square and Fisher's exact tests. In addition, the relation of data with age and sex were also examined.

RESULTS

Among 716 patients, 21 patients (2.9%) had positive IgM and 288 patients (40.2%) had positive IgG titer against T. gondii. Data analysis by Chi-square and Fisher's exact tests revealed that there was no significant relationship between IgG titer and age (p > 0.05). Additionally, there was no relationship between IgM titer and age (p > 0.05). The data showed that there was no relationship between IgG and IgM antibody titer and sex (p > 0.05).

CONCLUSION

The prevalence of toxoplasmosis in Isfahan inhabitants seems fairly high but it can be concluded that the rate of seropositive patient is moderate comparing to other regions of country. Accordingly, the authors propose that all sensitive patients have to be tested for T. gondii antibody in order to prevent the consequences of disease.

Determination of parasitic load in different tissues of murine toxoplasmosis after immunization by excretory-secretory antigens using Real time QPCR

Excretory-secretory antigens (ESAs) of Toxoplasma gondii are one of the candidates for immunization against toxoplasmosis. For evaluation of immunization, we determined the kinetics of the distribution of Toxoplasma and parasite load in different tissues of mice immunized by ESAs. In this experimental study, 36 mice in case (n=18) and control (n=18) groups were immunized with ESAs and PBS, respectively. After 2weeks, mice were challenged intraperitoneally with Toxoplasma virulent RH strain. Blood and different tissues (brain, spleen, liver, heart, kidney, and muscle) were collected daily after challenge (1, 2, 3 and last day before death). Parasite load was calculated using Real time QPCR targeted at the B1 gene. ESAs as vaccine in different tissues showed various effects. However, infected mice which received the vaccine in comparison with control group, displayed a drastically decreasing in parasite burden, in their blood and tissues (P=0.000). These results indicated that ESAs with reduction of parasite load in different tissues of host could be evaluable candidate for the development of immunization strategies against toxoplasmosis.

Electrophoretic Patterns of Toxoplasma gondii Excreted/Secreted Antigens and Their Role in Induction of the Humoral Immune Response

Background:

Toxoplasma gondii is an obligatory intracellular protozoan parasite on which studies are pending regarding production of vaccine. To date, the production of human vaccine has not been successful where approximately one third of the world’s population is thought to be infected with T. gondii.

Objectives:

The present study was designed to compare the electrophoretic patterns of T. gondii excreted/secreted antigens (ESAs) and determine their role in the stimulation of the humoral immune response.

Materials and Methods:

T. gondii ESAs were prepared from cell cultures (albino rat fibroblast) and cell-free mediums (RPMI-1640). Next, the SDS-PAGE technique was used for comparing molecular weights of the antigens. Forty C57BL/6 mice were divided randomly into four groups (n = 10). Immunization was performed subcutaneously at an interval of 2 weeks in two groups by injecting 100 µg of each of the above-mentioned antigens. Two groups, as negative control, also received fibroblast lysate proteins or adjuvant separately. All of the groups were then challenged with the T. gondii RH strain. Serum samples were collected from all mice and measured by immunoblotting technique for detection of immunogenic antigens.

Results:

The electrophoretic mobility of the prepared antigens/proteins from cell culture, cell-free media, Fibroblast Lysate Proteins and Toxoplasma Lysate Antigens (TLA) showed 13, 12, 8 and 8 bands, respectively. The case groups, in challenge with T. gondii (RH strain), showed more survival prolongation than the control groups. Furthermore, the survival period was identical for both case groups with a tendency for slightly higher survival of mice receiving ESA from cell-free medium. Analysis of sera by immunoblotting also revealed one band of 65 KDa in sera from both case groups.

Conclusions:

We suggest that this band be extracted and its amino acids sequence determined to produce Synthetic Polypeptide for immunization studies.

Association of herpetic encephalitis with acute retinal necrosis syndrome

Bilateral acute retinal necrosis syndrome developed shortly after a severe acute encephalitis in two previously healthy adults. The clinical and laboratory data suggested that herpes simplex virus was the cause of the encephalitis and acute retinal necrosis in these patients. To the authors' knowledge, this is the first report of an association of herpetic encephalitis with acute retinal necrosis in the literature.