Animal and Human Dirofilariasis in India and Sri Lanka: A Systematic Review and Meta-Analysis

Abstract

Dirofilariasis is an emerging vector-borne tropical disease of public health importance that mainly affects humans and dogs. Dirofilaria immitis and D. repens are the two well-documented dirofilariasis-causing filarioid helminths of both medical and veterinary concerns in India and Sri Lanka. This systematic review and meta-analysis aimed to describe and summarize the current evidence of dirofilariasis prevalence and distribution in India and Sri Lanka. Interestingly, D. repens is reported to circulate in both dogs (prevalence of 35.8% (95% CI: 11.23-60.69)) and humans (97% of published case reports) in India and Sri Lanka, but D. immitis is reported to be present in the dog populations in India (prevalence of 9.7% (95% CI: 8.5-11.0%)), and so far, it has not been reported in Sri Lanka. This peculiar distribution of D. immitis and D. repens in the two neighbouring countries could be due to the interaction between the two parasite species, which could affect the pattern of infection of the two worm species in dogs and thus influence the geographical distribution of these two filarial worms. In medical and veterinary practice, histopathology was the most commonly used diagnostic technique (31.3%; 95% CI 2.5-60.2%). The low specificity of histopathology to speciate the various Dirofilaria spp. may lead to misdiagnosis. It was identified in this study that several regions of India and Sri Lanka have not yet been surveyed for dirofilariasis. This limits our understanding of the geographical distribution and interspecies interactions of the two parasites within these countries. Parasite distribution, disease prevalence, and interspecies interactions between the vectors and the host should be targeted for future research.

Keywords: D. immitis; D. repens; One Health; heartworm; mosquito-borne; parasites; vector-borne infectious disease.

Figure 1

Life cycles of D. immitis and D. repens.

Figure 2

PRISMA flow diagram of the study selection process.

Figure 3

Forest plot of the pooled estimated prevalence of D. repens and D. immitis. The central square represents point estimates, whereas the square size represents the weight of each study in the meta-analysis. Diamonds represent the overall or summary effect for the respective category. Immitis = D. immitis; Repens = D. repens [45,51,52,53,54,55,56,57,58,59,60,61,62].

Figure 4

Forest plot of the pooled estimated prevalence of D. repens and D. immitis in India and Sri Lanka. The central square represents point estimates, whereas the square size represents the weight of each study in the meta-analysis. Diamonds represent the overall or summary effect for the respective category [45,51,52,53,54,55,56,57,58,59,60,61,62].

Figure 5

Forest plot of the pooled estimated prevalence of D. repens and D. immitis identified using different diagnostic techniques. The central square represents point estimates, whereas the square size represents the weight of each study in the meta-analysis. Diamonds represent the overall or summary effect for the respective category [45,51,52,53,54,55,56,57,58,59,60,61,62].

Figure 6

Forest plot of the pooled estimated prevalence of D. repens and D. immitis identified in different dog types. The central square represents point estimates, whereas the square size represents the weight of each study in the meta-analysis. Diamonds represent the overall or summary effect for the respective category [45,51,52,53,54,55,56,57,58,59,60,61,62].