Toxoplasmosis is a serious zoonotic disease that can lead to abortion and congenital disorders and has a widespread global distribution in humans and animals. The objective of this review was to investigate the incidence of toxoplasmosis in Iranian neonates in order to obtain a comprehensive assessment of the overall situation of the disease for use in developing future interventions. Original studies investigating the incidence of Toxoplasma gondii infections in Iranian neonates were systematically searched in a number of English-language and Persian-language electronic databases. The search process resulted in the inclusion of a total of 11 studies in the systematic review, 10 of which were entered into the meta-analysis. The reviewed articles included 2,230 Iranian neonates investigated through January 1, 2018. Based on the retrieved studies, the overall weighted incidence rates of toxoplasmosis in the Iranian neonatal population and neonates with suspected congenital toxoplasmosis were estimated to be 0.64% (95% confidence interval [CI], 0.31 to 1.09) and 4.10% (95% CI, 2.68 to 5.77), respectively, using a fixed-effects model. The findings of the reviewed studies demonstrate that the incidence of toxoplasmosis is high in Iranian neonates. Accordingly, it can be concluded that toxoplasmosis is a serious public health concern that has been ignored by the Ministry of Health. Therefore, it is essential to perform further studies, in addition to implementing screening and detection programs, using standardized methods to estimate the incidence of toxoplasmosis in Iran and to determine its associated risk factors.
Animals ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Humans ; Incidence ; Infant, Newborn ; Iran ; Mass Screening ; Public Health ; Risk Factors ; Toxoplasmosis ; Toxoplasmosis, Congenital ; Zoonoses

Toxoplasmosis is a serious zoonotic disease that can lead to abortion and congenital disorders and has a widespread global distribution in humans and animals. The objective of this review was to investigate the incidence of toxoplasmosis in Iranian neonates in order to obtain a comprehensive assessment of the overall situation of the disease for use in developing future interventions. Original studies investigating the incidence of Toxoplasma gondii infections in Iranian neonates were systematically searched in a number of English-language and Persian-language electronic databases. The search process resulted in the inclusion of a total of 11 studies in the systematic review, 10 of which were entered into the meta-analysis. The reviewed articles included 2,230 Iranian neonates investigated through January 1, 2018. Based on the retrieved studies, the overall weighted incidence rates of toxoplasmosis in the Iranian neonatal population and neonates with suspected congenital toxoplasmosis were estimated to be 0.64% (95% confidence interval [CI], 0.31 to 1.09) and 4.10% (95% CI, 2.68 to 5.77), respectively, using a fixed-effects model. The findings of the reviewed studies demonstrate that the incidence of toxoplasmosis is high in Iranian neonates. Accordingly, it can be concluded that toxoplasmosis is a serious public health concern that has been ignored by the Ministry of Health. Therefore, it is essential to perform further studies, in addition to implementing screening and detection programs, using standardized methods to estimate the incidence of toxoplasmosis in Iran and to determine its associated risk factors.
Animals ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Humans ; Incidence ; Infant, Newborn ; Iran ; Mass Screening ; Public Health ; Risk Factors ; Toxoplasmosis ; Toxoplasmosis, Congenital ; Zoonoses

Toxoplasmosis is an important cause of foodborne, inflammatory, as well as congenital abnormalities. There is an urgent need for safe and effective therapies to eliminate or treat this cosmopolitan infectious disease. A medicinal herbal plant, Meliae fructus, has been used to soothe the liver and kills worms in Chinese medicine. In this study, Meliae fructus ethanol extract was examined and screened for its anti-T. gondii activity. For anti-T. gondii activity screening, in vitro study of Meliae fructus extract using tachyzoit of T. gondii RH strain-infected HeLa cells was performed. Further, in vivo anti-T. gondii study using a mouse infection model was conducted. Safety of herbal compounds was evaluated in SD rats by treatment with Meliae fructus extract for 28 days. As a result, selectivity of Meliae fructus ethanol extract was 5.85, which was higher than sulfadiazine selectivity (2.06). We also performed an in vivo study to evaluate the anti-T. gondii activity of Meliae fructus extract in a mouse model. The inhibition rate of Meliae fructus extract was as high as that of sulfadiazine. These results demonstrate that Meliae fructus can successfully cure T. gondii infection and could be a promising native herb treatment for prevention of T. gondii infection.
Animals ; Asian Continental Ancestry Group ; Communicable Diseases ; Congenital Abnormalities ; Ethanol* ; HeLa Cells ; Humans ; Liver ; Mass Screening ; Melia* ; Mice ; Plants ; Plants, Medicinal ; Rats ; Sulfadiazine ; Toxoplasma ; Toxoplasmosis

Toxoplasma gondii is one of the major agents of infectious abortions and due to its worldwide distribution can threat healthy pregnant women who had no previous exposure to this parasite. The present study was designed to investigate the contribution of T. gondii to spontaneous abortions in Zanjan, Northwest of Iran, using ELISA method. Blood Samples were collected from 264 mothers referred to the provincial hospitals of Zanjan due to spontaneous abortion. The sera were isolated and subjected to evaluate the anti-Toxoplasma IgG, IgM and IgA antibodies. The results showed IgG positive (IgG+) in 99 cases (37.5%). A total of 68 women (25.8%) showed seroconversion with IgM or IgA or both IgM and IgA. They included: IgM+ in 21 (8.0%), IgA+ in 23 (8.7%) and both IgM+ and IgA+ in 24 (9.1%) subjects. In 23 cases, positive titers of IgM and IgG were accompanied. In general, the analysis of anti-Toxoplasma antibody patterns, showed that about 17% of the spontaneous abortions were associated with serological patterns of acute infection. According to these findings, a considerable proportion of spontaneous abortions can be attributed to T. gondii in the study area.
Abortion, Spontaneous/immunology/*parasitology ; Antibodies, Protozoan/*blood ; Cross-Sectional Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin A/blood ; Immunoglobulin G/blood ; Immunoglobulin M/blood ; Iran/epidemiology ; Mothers ; Pregnancy ; Pregnancy Complications, Parasitic/*immunology/parasitology ; Toxoplasma/*immunology ; Toxoplasmosis, Congenital/*immunology/parasitology

OBJECTIVETo reveal the relationship among congenital Toxoplasma gondii (T. gondii) infection, T lymphocyte cell subsets in umbilical cord blood and pregnancy outcome.

METHODS784 umbilical cord blood samples were collected and information of pregnancy outcomes was collected in a hospital of Hefei city, Anhui province during March 2009 to May 2010. T. gondii IgM antibodies in the sera were detected by ELISA. For all neonates infected with T. gondii and 10 healthy neonates, T lymphocyte cell subsets were detected by flow cytometry.

RESULTSAccording to the detection results of T. gondii IgM antibodies, 784 neonates were divided into infection group (21 neonates) and control group (763 neonates). The body weight and 1 min Apgar score of infection group were (3116.4 ± 352.6) g and (8.21 ± 1.26) points, respectively, which were statistically lower than control group ((3220.1 ± 242.3) g and (8.77 ± 1.61) points, respectively) (P < 0.01). The proportion of adverse pregnancy outcome of infection group was 19.0% (4/21), which was statistically greater than control group (4.8%, 37/763) (P < 0.01). The percentage of CD(3)(+) T lymphocyte cells in umbilical cord blood in infection group with and without adverse pregnancy outcomes were (64.51 ± 5.27)% and (64.32 ± 4.56)%, respectively, which were statistically lower than control group ((69.32 ± 4.32)%) (P < 0.01). The ratio value of CD(4)(+)/CD(8)(+) in infection group with, without adverse pregnancy outcomes and control group are 1.39 ± 0.24, 1.64 ± 0.28 and 2.34 ± 0.46, respectively, which showed statistical difference between any 2 groups (P < 0.01).

CONCLUSIONT. gondii infection leads to adverse pregnancy outcomes and disorder of cellular immunity while T lymphocyte cell subsets are closely associated with adverse pregnancy outcome.

Case-Control Studies ; Female ; Fetal Blood ; cytology ; immunology ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; T-Lymphocyte Subsets ; immunology ; Toxoplasmosis, Congenital ; immunology

Some parasitic diseases are more prevalent in children than in adults. Such agespecific diseases usually result from the mode of infection. Enterobiasis and head lice infestations are contact-borne. Congenital toxoplasmosis is a transplacental infection. Hepatic capillariasis results from contact with an environment contaminated with cat stools. Enterobiasis is the most common helminthic disease in children. The diagnosis and treatment is difficult because of its characteristic life cycle: eggs are present at the end of the life of the female adult worm. Vigorous screening and repeated chemotherapy for the entire family and contact group are required. Recently, there have been reports of congenital toxoplasmosis. There may be an increase in the number of cases of toxoplasmosis owing to the increase in the number of stray cats. Cryptosporidiosis does not evoke serious illness in immunocompetent children, while severe diarrhea can occur in immunocompromised children. One case of hepatic capillariasis has been reported in Korea. Owing to its high morbidity and mortality, prompt diagnosis and treatment are required. Head lice infestation is easy to diagnose and is still an indication of public health status. Mass screening and prevention are required. In local clinics, parasitic diseases are rarely suspected, since their incidence is very low and the symptoms are usually non-specific, except in a few parasitic diseases. Therefore, a thorough evaluation of the symptoms and past history and appropriate laboratory tests are necessary.
Adult ; Animals ; Cats ; Child* ; Cryptosporidiosis ; Diagnosis ; Diarrhea ; Drug Therapy ; Eggs ; Enterobiasis ; Female ; Helminths ; Humans ; Incidence ; Korea ; Lice Infestations ; Life Cycle Stages ; Mass Screening ; Mortality ; Ovum ; Parasitic Diseases* ; Pediculus ; Public Health ; Toxoplasmosis ; Toxoplasmosis, Congenital

OBJECTIVETo study the therapeutic effects of azithromycin in treatment of congenital toxoplasmosis in children.

METHODSDefinite diagnosis of congenital toxoplasmosis was made on the basis of clinical manifestation combined with one or more positive results of the following laboratory tests and excluded other congenital infectious diseases: toxoplasma DNA (TOX-DNA), circulating toxoplasma antigen (TOX-CAG), and toxoplasma IgM antibody (TOX-IgM). All the patients were given oral azithromycin 10 mg/(kg.d) for 6 days followed by 8 days without medication (one course of treatment), and the regimen was persisted for 2 months and then another 2-month treatment was given at a 1-month interval. The authors continued to provide further treatment according to the state of the illness at one month interval. The patients received 2 to 8 (average 5) courses of treatment. The patients were followed-up for 2.5 to 5 (average 4) years.

RESULTSThe treatment was effective in all the patients and the patient's condition was improved. The authors repeated in 12 cases the four tests for toxoplasma (TOX-DNA, TOX-CAG, TOX-IgM, and TOX-IgG) 9 months to one and a half years after treatment. In 10 cases all these tests showed negative results, in 2 cases TOX-IgG was positive and in the other 4 cases symptoms disappeared.

CONCLUSIONThe results of the study showed that oral azithromycin had significant therapeutic effects with little side effect and was well tolerated. Azithromycin may become an alternative therapy in treatment of congenital Toxoplasma gondii infection in children.

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Azithromycin ; administration & dosage ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Male ; Prognosis ; Toxoplasmosis, Congenital ; diagnosis ; drug therapy ; Treatment Outcome

The diagnosis of congenital toxoplasmosis may be difficult due to diversity of symptoms. However, the diagonosis is very important for treatment and determination of the prognosis of infected infants. We recently experienced two cases of congenital toxoplasmosis. The first case was suspected as congenital infection with hydrocephalus that was detected by prenatal ultrasonography. Postnatal evaluation revealed positive latex agglutination and ELISA IgG antibodies, and negative ELISA IgM antibodies for Toxoplasma gondii. Histologic examination of the biopsied brain tissue revealed microcalcification. The second case presented with jaundice and intraventricular hemorrhage, and serological evaluation revealed positive latex agglutination and ELISA IgG antibodies, and negative ELISA IgM antibodies for T. gondii. The mother was positive for ELISA IgM antibodies as well as for latex agglutination and ELISA IgG antibodies. In the blood and CSF of both infants as well as in the blood of their mothers, Toxoplasma specific B1 gene was detected by polymerase chain reaction and Southern blot analysis. Based on these results, we have confirmed two cases of congenital toxoplasmosis whose presenting symptoms were hydrocephalus, seizure, or jaundice, and these cases represent the first series of congenital toxoplasmosis diagnosed in Korea by polymerase chain reaction.
Agglutination ; Antibodies ; Blotting, Southern ; Brain ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Humans ; Hydrocephalus ; Immunoglobulin G ; Immunoglobulin M ; Infant ; Jaundice ; Korea ; Latex ; Mothers ; Polymerase Chain Reaction* ; Prognosis ; Seizures ; Toxoplasma ; Toxoplasmosis ; Toxoplasmosis, Congenital* ; Ultrasonography, Prenatal

The diagnosis of congenital toxoplasmosis may be difficult due to diversity of symptoms. However, the diagonosis is very important for treatment and determination of the prognosis of infected infants. We recently experienced two cases of congenital toxoplasmosis. The first case was suspected as congenital infection with hydrocephalus that was detected by prenatal ultrasonography. Postnatal evaluation revealed positive latex agglutination and ELISA IgG antibodies, and negative ELISA IgM antibodies for Toxoplasma gondii. Histologic examination of the biopsied brain tissue revealed microcalcification. The second case presented with jaundice and intraventricular hemorrhage, and serological evaluation revealed positive latex agglutination and ELISA IgG antibodies, and negative ELISA IgM antibodies for T. gondii. The mother was positive for ELISA IgM antibodies as well as for latex agglutination and ELISA IgG antibodies. In the blood and CSF of both infants as well as in the blood of their mothers, Toxoplasma specific B1 gene was detected by polymerase chain reaction and Southern blot analysis. Based on these results, we have confirmed two cases of congenital toxoplasmosis whose presenting symptoms were hydrocephalus, seizure, or jaundice, and these cases represent the first series of congenital toxoplasmosis diagnosed in Korea by polymerase chain reaction.
Agglutination ; Antibodies ; Blotting, Southern ; Brain ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Humans ; Hydrocephalus ; Immunoglobulin G ; Immunoglobulin M ; Infant ; Jaundice ; Korea ; Latex ; Mothers ; Polymerase Chain Reaction* ; Prognosis ; Seizures ; Toxoplasma ; Toxoplasmosis ; Toxoplasmosis, Congenital* ; Ultrasonography, Prenatal

PURPOSE: This study is to evaluate the clinical significance and possible etiologies of abnormal neurosonographic findings that revealed linear or branching linear hyperechoic vascular lesions in the thalami and basal ganglia of neonates and infants. METHODS: Analysis of 2,866 cranial sonograms (US) and doppler ultrasonography obtained from 1,150 patients identified 53 patients with linear hyperechoic vascular lesions in the thalami or basal ganglia. Patients with only punctate or coarse, nonlinear lesions of echogenicity in these lesions were excluded. Clinical records in 53 patients were reviewed for documentation of congenital cytomegalovirus (CMV) infection, rubella, syphilis, toxoplasmosis, chromosomal abnormality and other major diagnoses. Brain computed tomography (CT) had been performed in 23 of the 53 patients and these images were compared with the cranial sonograms. RESULTS: There were five CMV infection, two congenital syphilis, three Down syndrome, and one Patau syndrome patients. Other major diagnoses encountered included perinatal asphyxia, ventriculomegaly, intraventricular hemorrhage, periventricular leukomalacia, small-for-gestational age, prematurity with hyaline membrane disease, multiple congenital anomalies, neonatal seizure, meningitis, congenital choroid plexus cyst, neonatal hyperbilirubinemia, congenital heart disease, bronchopulmonary dysplasia and others. Brain CT found small calcification in basal ganglia from one patient. Resolution of lesions found in 5 cases with follow-up US studies. CONCLUSION: A broad etiologic basis for linear hyperechoic vascular lesions in the thalami and basal ganglia of neonates and infants indicates complete screening for possible various etiologies.
Asphyxia ; Basal Ganglia* ; Brain ; Bronchopulmonary Dysplasia ; Choroid Plexus ; Chromosome Aberrations ; Cytomegalovirus ; Diagnosis ; Down Syndrome ; Follow-Up Studies ; Heart Defects, Congenital ; Hemorrhage ; Humans ; Hyaline Membrane Disease ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn* ; Leukomalacia, Periventricular ; Mass Screening ; Meningitis ; Rubella ; Seizures ; Syphilis ; Syphilis, Congenital ; Toxoplasmosis ; Ultrasonography* ; Ultrasonography, Doppler