Toxoplasma gondii Infection in Immunocompromised Patients in Iran (2013-2022): A Systematic Review and Meta-Analysis

Abstract

Background: Toxoplasma gondii infection (toxoplasmosis) has the potential to cause a serious disease in immunocompromised patients and can be fatal in this population. We conducted a systematic review and meta-analysis to assess comprehensively the pooled seroprevalence of toxoplasmosis among immunocompromised patients including HIV/AIDS patients, cancer patients, and transplant recipients in Iran.

Methods: PubMed, Web of Science, Scopus, Embase, and Google Scholar databases (international) and Scientific Information Database (SID), Magiran, IranMedex, and IranDoc databases (national) were systematically searched for all reports that possibly contained data for T. gondii prevalence in different immunocompromised populations in Iran between 2013 and 2022.

Results: Overall, IgG seroprevalence rate of toxoplasmosis in Iranian immunocompromised patients was 45.1% (95% confidence interval (CI), 37.4-52.9). IgG seroprevalence rate of toxoplasmosis in 12 studies that included 2279 cancer patients, 19 studies that included 2565 HIV/AIDS patients and in 3 studies that included 200 transplant recipients was 43.6% (95% CI, 30.2-57.0), 45.9% (95% CI, 34.8-57.1) and 45.8% (95% CI, 32.5-59.0), respectively. Moreover, IgM seroprevalence rate in the 26 studies was 2.6% (95% CI, 1.4-3.7).

Conclusion: Our findings represent a high seroprevalence rate of Toxoplasma IgG among immunocompromised patients. Health improvement and education toward prevention of toxoplasmosis is of great importance for these susceptible populations.

Keywords: Aids; Cancer patients; HIV; Immunocompromised patients; Iran; Toxoplasma gondii; Transplant recipients.

Fig. 1

Flow diagram describing the study design process

Fig. 2:

Forest plot diagram of studies showing IgG seropositivity rates to T. gondii in cancer patients from Iran

Fig. 3:

Forest plot diagram of studies showing IgG seropositivity rates to T. gondii in HIV/AIDS patients from Iran

Fig. 4:

Forest plot diagram of studies showing IgG seropositivity rates to T. gondii in transplant recipients from Iran

Fig. 5:

Forest plot diagram of studies showing IgG seropositivity rates to T. gondii in immunocompromised (country divisions of provinces) patients from Iran (Region 1: Provinces of Tehran, Qazvin, Mazandaran, Semnan, Golestan, Alborz, Qom, Region 2: Provinces of Isfahan, Fars, Bushehr, Chaharmahal Bakhtiari, Hormozgan, Kohkiluyeh & Boyer-Ahmad, Region 3: Provinces of East Azerbaijan, West Azerbaijan, Ardabil, Zanjan, Guilan, Kurdistan, Region 4: Kermanshah, Ilam, Lorestan, Hamedan, Markazi, Khuzestan, Region 5: Provinces of Razavi Khorasan, South Khorasan, North Khorasan, Kerman, Yazd, Sistan & Baluchestan)

Fig. 6:

Forest plot diagram of studies showing IgM seropositivity rates to T. gondii in cancer patients from Iran

Fig. 7:

Forest plot diagram of studies showing IgM seropositivity rates to T. gondii in HIV/AIDS patients from Iran

Fig. 8:

Forest plot diagram of studies showing IgM seropositivity rates to T. gondii in transplant recipients from Iran

Fig. 9:

Forest plot diagram of studies showing IgM seropositivity rates to T. gondii in immunocompromised (country divisions of provinces) patients from Iran (Region 1: Provinces of Tehran, Qazvin, Mazandaran, Semnan, Golestan, Alborz, Qom, Region 2: Provinces of Isfahan, Fars, Bushehr, Chaharmahal Bakhtiari, Hormozgan, Kohkiluyeh & Boyer-Ahmad, Region 3: Provinces of East Azerbaijan, West Azerbaijan, Ardabil, Zanjan, Guilan, Kurdistan, Region 4: Kermanshah, Ilam, Lorestan, Hamedan, Markazi, Khuzestan, Region 5: Provinces of Razavi Khorasan, South Khorasan, North Khorasan, Kerman, Yazd, Sistan & Baluchestan)