Worldwide prevalence of emerging parasite Blastocystis in immunocompromised patients: A systematic review and meta-analysis.

BACKGROUND: Blastocystis is one of the most common pathogens of the human intestine, caused by an emerging parasite, which can lead to severe symptoms and even death in immunocompromised patients. We aimed to determine the global prevalence of Blastocystosis infection in people with immunodeficiency. A systematic literature search was conducted on Web of Science, Scopus, Google scholar, Science Direct and MEDLINE databases to select all observational studies reporting the prevalence of Blastocystosis infection in Worldwide, based on different diagnostic methods in immunocompromised patients of any age and published from inception to February 2019. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using random effects models and in addition, the I2 statistic was calculated. The geographic distribution of studies was evaluated and the diagnosis of Blastocystis was compared by various techniques. Electronic databases were reviewed for Blastocystosis infection in HIV/AIDS, cancer and other immunocompromised patients, and meta-analyses were conducted to calculate the overall estimated prevalence. Total68 eligible studies were included. The estimated pooled prevalence rate of Blastocystosis infection in immunocompromised patients was overall 10% (95% CI, 7-13%; I2 96.04%) (P < 0.001), of whom 21% [18-25] were in Australia, 12% [4-24] in America, 11% [6-17] in Europe and 10% [5-15], 7% [3-13] in Asia and Africa, respectively. It was calculated that the estimated pooled prevalence rate of Blastocystosis infection in immunocompromised patients was overall 10% and the prevalence estimates ranged from 0.44 to 72.39. Also, overall the prevalence of parasites co-infection in immunocompromised patients was detected as 0.024%. Our finding showed that immunocompromised people show a high prevalence of Blastocystosis infection compared to the control population. Adequate information on the prevalence rate is still missing from many countries. However, current information underscore that Blastocystis should not be neglected.

Immunomodulatory chitosan nanoparticles for Toxoplasma gondii infection: Novel application of chitosan in complex propranolol-hydrochloride as an adjuvant in vaccine delivery.

The study aimed to investigate the immunomodulatory effects of propranolol hydrochloride (PRO) in combination with chitosan nanoparticles (CS NPs) as an adjuvant to develop an effective vaccine against T. gondii. A total of 105 BALB/c mice were randomly divided into seven equal groups including PBS alone, CS NPs, SAG1 (Surface antigen 1), CS-SAG1 NPs, CS-PRO NPs, SAG1-PRO, and CS-SAG1-PRO NPs. The immunostimulatory effect of each adjuvant used for vaccine delivery was evaluated in a mice immunization model. The results showed that the mice immunized with CS-SAG1-PRO NPs exhibited the highest lymphocyte proliferation rate, along with increased secretion of IFN-γ, TNF-α, IL-6, IL-12, IL-17, and IL-23, as well as elevated levels of protective cytokines such as TGF-ß, IL-27, and IL-10. Although, the CS-SAG1-PRO NPs immunized mice showed the highest level of T. gondii specific IgG compared to the other groups, a significant production of IgG2a and IgG1 was observed in the sera of mice immunized with the CS-SAG1-PRO NPs compared to the other group (p <0.001). The higher IgG2a/IgG1 ratio observed in the CS-SAG1-PRO NPs group indicates a bias towards Th1 cell polarization, suggesting the promotion of Th1 cell-mediated immune responses. Considering the combination of the highest lymphocyte proliferation and survival rates, IgG2a/IgG1 ratio, and cytokine levels in the mice immunized with CS-SAG1-PRO NPs, this approach holds promise for immunostimulation and vaccine delivery against T. gondii infection.

Fatal Disseminated Strongyloidiasis in an Immunosuppressed Patient During COVID-19 Pandemic.

INTRODUCTION: This report presents a fatal case of disseminated strongyloidiasis in a patient with myasthenia gravis and diabetes mellitus who had received corticosteroid therapy. CASE REPORT: The patient was a 67-year-old woman living in a rural area endemic for Strongyloides stercoralis in northern Iran. Disseminated strongyloidiasis was diagnosed in the advanced stage of the disease, with enormous numbers of larvae demonstrated in direct smears prepared from stool samples and stomach biopsy. Despite treatment with ivermectin and antibiotics, the patient succumbed to the severity of the infection. CONCLUSION: Clinicians working in endemic areas should be mindful of the possibility of gastric involvement in strongyloidiasis, even if symptoms are nonspecific. We recommend that high-risk individuals be screened for S. stercoralis prior to immunosuppressive therapy in endemic regions to raise awareness and prevent similar cases.

Novel naltrexone hydrochloride nanovaccine based on chitosan nanoparticles promotes induction of Th1 and Th17 immune responses resulting in protection against Toxoplasma gondii tachyzoites in a mouse model.

This study was aimed to encapsulate and construct the Toxoplasma gondii surface antigen (SAG1) and naltrexone hydrochloride (NLT-HCL) as an adjuvant within chitosan nanoparticles (CS-NPs) to develop efficacious vaccine against T. gondii. Seven groups of BALB/c mice were immunized with SAG1, chitosan (CS), NLT-SAG1, CS-SAG1, CS-SAG1-NLT, CS-NLT and PBS. The efficiency of each approach was detected in vivo mouse immunization. Moreover, the immuno-induction effect of SAG1 recombinant protein and CS-NPs-based NLT-HCL as an adjuvant in a vaccine delivery was evaluated. Experimentally, Th1/Th17 biased cellular and humoral immune responses were activated in the mice immunized with CS-SAG1-NLT nanoparticles that were accompanied by considerable increased production of IFN-γ, IL-17, IL-12, IL-4, IFN-γ/IL-4 ratio, IgG, IgG2a. This group of mice also showed significantly increased survival time post-challenging. The successful encapsulated SAG1 recombinant protein and NLT-HCL, as an adjuvant, within CS-NPs can induce immune responses against toxoplasmosis. We could incorporate NLT-HCL adjuvant into the CS-NPs based delivery systems, which makes CS-NPs attractive as a colloidal carrier system for NLT-HCL as secondary adjuvant. This new approach or the simultaneous use of CS and NLT demonstrated that the co-administration of CS-NPs and NLT-HCL induce production of IL-17 cytokine. This approach can be used for vaccination purposes, in which Th17 and Th1 cellular immune are considered the key of the successful immune response.

Cryptosporidium animal species in Iran: a systematic review and meta-analysis.

BACKGROUND: Cryptosporidiosis is an acute and short-term infection which can lead to severe diarrhea (intestinal cryptosporidiosis) associated with a persistent cough in the host with immune system defect. This systematic review and meta-analysis was conducted to estimate the prevalence of animal Cryptosporidium species and the corresponding epidemiological aspects in Iran. METHODS: In this study, all original research articles relating to the animal cryptosporidiosis in Iran were collected from reliable databases using keywords. A meta-analysis was conducted separately for each subgroup, and heterogeneity among the studies was performed using the Q and I2 tests. Furthermore, it should be noticed that the significance level in the statistical analysis with the Comprehensive Meta-analysis software was considered to be less than 0.05. Finally, meta-analysis results were shown in forest plot with a 95% CI. RESULTS: In total, 4795 studies were included in the initial screening. Duplicated or non-original studies and the ones which did not meet our considered criteria were excluded from the list. Out of the 100 articles included in our first list for the meta-analysis, 40, 16, 13, 10, 9, 7, and 5 were done on cattle and calves, birds, dogs, sheep, rodents, camels, and horses, respectively. The prevalence rate of cryptosporidiosis among the birds, horses, rodents, camels, dogs, cattle, and sheep in Iran was estimated to be 7.5%, 19.5%, 20.8%, 8.4%, 4.9%, 14.4%, and 9.1%, respectively. CONCLUSION: The different Cryptosporidium species have been found in different regions of Iran. Geographical region, climate, and domestic animals are considered as factors responsible for animal cryptosporidiosis prevalence in the area. Moreover, this parasite is zoonotic which causes disease in animals as well as humans which can result in economic loss.