Toxoplasma gondii has been suggested as an important opportunistic pathogen in immunocompromised patients. We conducted a global meta-analysis to assess the prevalence and odds ratios (ORs) of T. gondii infection in immunocompromised individuals. Electronic databases were reviewed for T. gondii infection in HIV/AIDS patients, cancer patients, and transplant recipients, and meta-analyses were conducted to calculate overall estimated prevalence and ORs using random-effects models. Totally, 72 eligible studies were included. The estimated pooled prevalence of T. gondii infection in immunocompromised patients and the control was 35.9% and 24.7% (p0.05), whose estimated pooled ORs were 2.03, 2.89, and 1.51 (95% CI, 1.16–1.95), respectively. This study is the first to demonstrate that the immunocompromised patients are associated with higher odds of T. gondii infection, and appropriate prevention and control measures are highly recommended for these susceptible populations.

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Toxoplasma gondii Infection in Immunocompromised Patients: A Systematic Review and Meta-Analysis.

Chikungunya and dengue autochthonous cases in Europe, 2007-2012

Prevalence and burden of Toxoplasma gondii infection in HIV-infected people: a systematic review and meta-analysis

Over 70% of the worlds’ population is infected by Toxoplasma gondii; a pathogen capable of causing cerebral toxoplasmosis in HIV patients and neonatal complications like miscarriage, chorioretinitis, hydrocephalus, cerebral calcification and foetal death in the third trimester of pregnancy. In spite of this, the burden of this zoonotic pathogen is poorly understood in Nigeria. The aim of the present study therefore, is to determine the burden of T. gondii among normal individuals, HIV patients and pregnant women as well as the distribution of the infection across Nigeria. Using the PRISMA guidelines, we conducted a systematic review and meta-analysis of data retrieved from six electronic databases (AJOL, Google Scholar, PubMed, Scopus, Science Direct and Web of Science). Pooled prevalence (PP) and heterogeneity were determined by the random-effects model and the Cochran’s Q-test respectively. The quality of each study and publication bias were assessed by the 9 point Joanna Briggs Institute Critical Appraisal Instrument and the Egger’s regression asymmetry test respectively, while the robustness of a pooled estimate was tested by the single study omission analysis. Exactly 5834 of the 16,230 individuals examined for T. gondii infection by 50 studies across 17 Nigerian States were positive for the infection. Overall PP was 32.92% (95% CI: 27.89, 38.37), with a range of 14.41% (95% CI: 5.32, 33.54) to 86.82% (95% CI: 66.13, 95.69) across sub-groups. Pooled prevalence was significantly higher (p < 0.001) among pregnant women (40.25%; 95% CI: 33.19, 47.73) and HIV patients (31.68, 95% CI: 20.53, 45.41) than normal individuals (23.32, 95% CI: 17.25, 30.75). T. gondii prevalence declined by over 58% during the 59 years reviewed. Toxoplasma gondii infection is moderately prevalent in Nigeria. Highest prevalence estimates were observed among pregnant women and in the south-south region. For effective control of the disease in Nigeria, a holistic approach involving on-farm, environmental, public health and animal components are suggested.

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Human Toxoplasma gondii infection in Nigeria: a systematic review and meta-analysis of data published between 1960 and 2019

Toxoplasmosis is a globally distributed parasitic zoonosis. Cats and other Felidae are the definitive host of the Toxoplasma gondii parasite, in whose intestines the sexual cycle takes place, and they are the primary source of infection to all animals including humans, by way of contaminating the environment with oocysts excreted in the feces (Dubey, 2010). Herbivores are infected by ingestion of food and water contaminated by oocysts, and carnivores by eating tissue cysts present in the flesh of infected animals. Omnivores including humans are infected by both routes – by oocysts via improperly washed vegetables or fruits, contaminated water or hands, and by tissue cysts via improperly processed or raw meat. Vertical transmission, from mother to offspring, may occur, and is the cause of congenital toxoplasmosis (CT). CT is actually the major T. gondii-induced clinical entity, which, along with opportunistic infection in immunocompromised patients, defines the clinical significance of toxoplasmosis. The gravity of the potential consequences of CT on the one hand, and the preventability of the disease on the other, call for implementation of prevention programs. A prerequisite for an adequate choice of prevention strategy is continuous monitoring of the local epidemiological situation.

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Toxoplasma gondii Infection in South-East Europe: Epidemiology and Epizootiology

Prevalence of antibodies against Toxoplasma gondii in patients infected with human immunodeficiency virus in Croatia

Razvojem tehnologija laboratorijskih testova zadnjih se godina zna~ajno pove}ao broj dostupnih testova za dijagnostiku infektivnih bolesti koji se mogu izvoditi izvan laboratorija: uz bolesni~ku postelju, u ambulanti, savjetovali{tu i drugim nelaboratorijskim uvjetima. Takav oblik testiranja naziva se point-of-care (POC) testiranje – testiranje na mjestu gdje se bolesniku pru`a skrb. POC testiranje je laboratorijsko ispitivanje koje se provodi jednostavnim sustavom mjerenja na~elno izvan laboratorija u zdravstvenim ustanovama za bolni~ke i izvanbolni~ke bolesnike. POC testiranje provodi osoblje koje nema primarnu laboratorijsku osposobljenost i nema iskustvo u laboratorijskoj medicini (medicinske sestre i tehni~ari, lije~nici). Prije uvo|enja POC testiranja neophodno je evaluirati potrebu i svrhu uvo|enja ovih testova kao zamjene za rutinski laboratorijski rad. Potrebno je definirati broj testiranja, metodu i cijenu kao i tko }e i za koju namjenu koristiti POC testove te kada i kako }e se testiranje izvoditi. Uvo|enje POC testiranja ne smije biti stihijsko. POC testiranje treba planirati u dogovoru s nadle`nim laboratorijem koji }e provoditi kontrolu kvalitete rada. Osoblje koje }e raditi testiranje treba prethodno dobro educirati. Iako se radi o jednostavnim testovima, svako testiranje mora zadovoljavati pravila dobre laboratorijske prakse budu}i da se ne radi o tzv. ku}nim testovima, ve} o testovima rezultate kojih treba priop}iti bolesniku i adekvatno sa~uvati. POC testove ima smisla raditi samo ako rezultat izravno utje~e na odluku o daljnjem postupku s bolesnikom. Neispravno kori{tenje POC testova predstavlja rizik za bolesnika, a istovremeno predstavlja dodatni pove}ani tro{ak zdravstvene skrbi. Jedino primjena klini~ki evaluiranih testova odobrenih za kori{tenje mo`e zna~ajno unaprijediti kvalitetu obrade bolesnika u cilju dobivanja {to br`eg i to~nijeg nalaza koji }e usmjeriti daljnji postupak, a ujedno smanjiti tro{kove dijagnosti~ke obrade.

Point-of-care (POC) testiranje u dijagnostici infektivnih bolesti

Epstein Barrov virus (EBV) je humani herpesvirus ubikvitaran u op}oj populaciji. Poput drugih herpesvirusa ima latentnu i produktivnu fazu `ivotnog ciklusa. U EBV-infekciji razvijaju se protutijela na razli~ite antigene. Dijagnoza i definiranje statusa EBV-infekcije mogu}i su zbog karakteristi~nog odgovora specifi~nih protutijela koja se mogu odre|ivati komercijalno dostupnim testovima. U primarnoj infekciji po~inju se stvarati protutijela IgM i IgG na virusni kapsidni antigen (VCA), detektiraju se protutijela na rane antigene (EA), a izostaju protutijela IgG za EBNA. Protutijela za EBNA i VCA pokazatelj su ranije EBVinfekcije. Reaktivaciju EBV obilje`ava visoki titar protutijela za EA, porast protutijela za VCA i ranija prisutnost protutijela za EBNA. Kontrola replikacije EBV primarno je posredovana citotoksi~nim T-limfocitima i specifi~nim protutijelima za EBV-antigene.

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Imunološki odgovor u infekciji Epstein-Barrovim virusom

Dijagnoza osteomijelitisa kraljesnice jest teska i cesto zakasnjela ili cak propustena. Napredak u radioloskim metodama oslikavanja (kompjutoriziranoj tomografiji-CT i magnetskoj rezonanciji-MR), poboljsao je prognozu u bolesnika s ovom bolescu. CT predstavlja najbolju metodu za detekciju kostanih promjena, osobito za destrukciju pokrovnih ploha kraljesaka u ranoj fazi upale. MR je superiornija slikovna metoda u ovoj indikaciji jer kombinira visoku osjetljivost sa zadovoljavajucom specificnoscu. Predstavlja metodu izbora u prikazu izravnog sirenja infekcije, osobito epiduralnog apscesa i flegmone te posljedicne neuralne kompresije. MR-om je također moguce i bolje pracenje terapijske ucinkovitosti.

Imaging Techniques and Multidiciplinary Approach to the Vertebral Osteomyelitis

In 2004 the first larvae of Aedes albopictus were discovered in Croatia. During the following years the species spread and established all over the country. The first imported Dengue (DENV) infection was confirmed in Dubrovnik in August 2007 in a Spanish tourist after returning from India. So far, five imported cases have been reported. However, no autochthonous DENV cases have been reported in Croatia until 2010. The first autochthonous case in Croatia, a 33-year-old woman, with fever, headache, myalgia, leukopenia, thrombocytopenia and elevated liver transaminases, appeared in August 11th, 2010, but was undiagnosed. On October 22nd, the 54-year-old mother of the previously hospitalized patient was hospitalized with similar symptoms including papular rash. About two weeks before, ECDC informed us about a German patient with confirmed DENV infection after he returned from Croatia spending his holiday in the same village on the Peljesac peninsula where both female Croatian patients lived. A retrospective molecular analysis confirmed DENV infection in two female Croatian patients. The obtained sequences from the E-NS1 gene junction of two Croatian patients were identical and showed 98% similarity with the first imported case from India in 2007. Phylogenetic analyses revealed these sequences as Genotype V within DENV serotype 1. In addition, we screened 100 blood samples from regular blood donors from the region and 97 sera from patients with fever of unknown origin hospitalized at the General Hospital in Dubrovnik for the presence of IgG antibodies. No specific DENV IgG antibodies have been detected. Immediately upon realization of autochthonous transmission trapping of Aedes albopictus was undertaken. Trapped individuals have been pooled and tested for the presence of viral RNA, but none was detected. This is the first evidence of the autochthonous DENV infections in Croatia in a small isolated endemic niche. Strong public-health measures are necessary to monitor and prevent possible spread of DENV in other parts of Croatia.

Oktavija Đaković-Rode

Papers

Prevalence of antibodies against Toxoplasma gondii in patients infected with human immunodeficiency virus in Croatia

Point-of-care (POC) testiranje u dijagnostici infektivnih bolesti

Imunološki odgovor u infekciji Epstein-Barrovim virusom

Imaging Techniques and Multidiciplinary Approach to the Vertebral Osteomyelitis

Molecular characterization of the first autochthonous Dengue virus cases in Croatia