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Cryptosporidiosis in Human and Animal a Systematic Review and Meta-analysis

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Cryptosporidium fauna species in Islamic republic of iran: a systematic review and meta-analysis

  • Zohreh Khorshidvand1,
  • Salman Khazaei2,
  • Faezeh Foroughi-Parvari,
  • Hossein Sarmadianthree,
  • Nastaran Barati4,
  • Fariborz Etemadifar1 &
  • Reza Ghasemikhah ORCID: orcid.org/0000-0002-9677-7484 5

Tropical Medicine and Health volume 48, Article number:97 (2020) Cite this article

  • 1899 Accesses

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Abstruse

Background

Cryptosporidiosis is an acute and short-term infection which can atomic number 82 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 Islamic republic of 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 I ii 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 full, 4795 studies were included in the initial screening. Duplicated or not-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 get-go listing for the meta-assay, xl, 16, 13, 10, ix, 7, and five were washed 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 Islamic republic of iran was estimated to exist 7.5%, xix.5%, twenty.8%, 8.4%, iv.9%, 14.4%, and 9.1%, respectively.

Determination

The unlike Cryptosporidium species take been found in different regions of Iran. Geographical region, climate, and domestic animals are considered every bit factors responsible for animal cryptosporidiosis prevalence in the area. Moreover, this parasite is zoonotic which causes illness in animals besides as humans which tin can effect in economic loss.

Introduction

Abdominal parasites are considered an of import public health problem in humans and animals in developing and low-income countries [1,ii,3]. Cryptosporidium is i of the most mutual abdominal protozoan parasites which is located in the phylum of Apicomplexa and causes cryptosporidiosis [2]. Cryptosporidium is spread easily in the surround due to its unproblematic transmission via contaminated h2o, air, and dust. Cryptosporidiosis is considered as a major economic problem in many countries including Iran, and at that place are annually numerous reports of this infection in immunocompromised and young children [two,3,iv,5]. Different methods have been used to detect the protozoan parasite including the molecular diagnostic method which is considered ane of the about useful diagnostic tools.

This method has identified up to 30 species and more 50 genotypes of Cryptosporidium [6,7,8]. Dissimilar species of Cryptosporidium accept been reported in diverse hosts including birds, horses, cattle, sheep, camels, rodents, and dogs. Cryptosporidium parvum, C. hominis, C. canis, C. felis, C. meleagridis, and C. muris were distinguished from gastrointestinal diseases likewise every bit diarrhea in humans [9]. Notwithstanding, the infection typically occurs in a brusque-term and acute form in immunocompromised and HIV-positive individuals. In these cases, it tends to remain in the lower intestine for up to half dozen weeks with astringent diarrhea and persistent cough [9]. This protozoan could develop its life cycle in one host without the requirement of other animals as intermediate or reservoir hosts [9, 10]. Despite the many studies which were conducted in Iran on investigating the prevalence of cryptosporidiosis in different animal hosts, these data accept non shown the overall prevalence of animals in Iran. Since cryptosporidiosis causes irreversible economic damages to domestic animals, critical screening programs and epidemiological aspects should be considered by authorities. This systematic review and meta-analysis was conducted to gauge the prevalence of animal Cryptosporidium species and their epidemiological aspects in Iran.

Materials and methods

Study protocol

The present systematic review focused on the estimates of the prevalence of animate being Cryptosporidium species according to the PRISMA guidelines for systematic review and meta-analysis [11] (Supplementary one).

Search strategy

In order to select the suitable articles for this study, all records since 1991 up to February 2018 were investigated using seven international databases in English including PubMed, Web of Science, Scopus, Science Direct, and Google Scholar search engine as well as national databases in Persian including Magiran (http://www.magiran.com/) and Scientific Information Database (SID) (http://world wide web.sid.ir/). Furthermore, references of each article were screened manually, and the authors were contacted for additional references.

The databases screening was performed using the post-obit keywords: prevalence, Cryptosporidium, cryptosporidiosis, animate being Cryptosporidium, Cryptosporidium species, C. parvum, C.hominis, animal, cattle, dogie, sheep, caprine animal, camel, horse, rodent, bird, craven, epidemiology, Iran, serology, PCR, and molecular (Box 1).

Box one Search strategy for MEDLINE (Mesh, Medical Bailiwick Headings)

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Eligibility criteria

All original descriptive studies which investigated the prevalence of Cryptosporidium in animals in Iran, both in English language and Persian, were included in this study. Duplicates, qualitative studies, review manufactures, case reports, case series, and studies out of Iran or those performed on humans were excluded. Finally, manufactures with epidemiological parameters of interest were selected, and a total of 100 nerveless articles fulfilled the considered criteria.

Quality assessment

The scoring organisation based on the 8-detail modified Newcastle Ottawa Scale (NOS) for non-randomized studies was used for assessing the quality of the studies. In this system, each question has a score betwixt 0 and i, and the maximum signal summation is 9. Studies with signal summation 5 or less, half dozen–7, and 8–9 were considered depression, moderate, and loftier quality, respectively [12].

Screening and information extraction

All records were evaluated based on their title and abstract and according to the inclusion and exclusion criteria by ii researchers (MM and NB) independently. The kappa index showed an agreement of 91% between the findings of ii researchers. The total-text version of the papers was obtained through library resource and online databases. Finally, the departure between records amidst the researchers was corrected past re-examining the manufactures. The understanding was reached by group discussion with a 3rd researcher (SK).

Data extraction was conducted independently by 2 researchers (MM and NB) and imported to the pre-prepared class. Data including authors, year of study, publication year, kind of creature, geographical surface area of the study, number of examined, number of positive, prevalence charge per unit, and type of host were extracted from articles.

Quality assessment studies

The methodological quality of the studies was examined based on the guidelines of the Newcastle and Ottawa Statements [12]. This guideline sets the criteria for selecting people to study, comparison and accepting them, likewise every bit exposure and consequences where a maximum of nine stars tin be allocated to each study. Studies with 7 stars or more are classified as high-quality studies, and studies with 6 stars and less are considered equally depression-quality studies. Investigating the probability of an error in the results of the studies is performed separately by two researchers. The disagreement betwixt the parties is resolved through negotiations.

Data analysis

The meta-assay method was adopted to a 95% confidence interval (CI) in order to assess the pooled prevalence of Cryptosporidium infection in animals using the random effect model. Various subgroup analyses were separately conducted based on animal type and the associated species. Finally, meta-analysis results were displayed in forest plot (reported as consequence estimates (ES) with a 95% CI). We besides performed a sensitivity assay to verify the stability of the data. In lodge to assess the sensitivity analysis, the outcome judge was estimated irrespective of one study at a time, and the robustness of the pooled estimate was assessed. Heterogeneity was calculated among the studies by the Q and I two tests [6, viii]. Cochran'due south Q test (Q statistic, p < 0.10) showed statistically pregnant heterogeneity, and I 2 statistic (I two > fifty%) indicates a large heterogeneity. Statistical analysis and information analysis were performed using the 2d version of the Comprehensive Meta-assay software. The significance level was considered to be less than 0.05.

Results

Description of studies

In total, 4795 studies were collected in the initial screenings from the published articles and their references in the screened databases up to February 2018. Specifically, 62, 124, 174, 62, 543, 10, and 3820 studies nerveless from PubMed, Web of Science, Scopus, Scientific Data Database, Magiran, Science Direct, and Google Scholar, respectively. A full of 1933 duplicated records and v studies which were not original articles (i.eastward., letter, commentary, review) were screened out. Regarding the relevance of the title and abstruse to the purpose of the written report, 2857 irrelevant studies were excluded. Accordingly, 2757 studies were retrieved for further assessment. Altogether, 100 articles were selected for the meta-analysis study. The display procedure and literature search results were presented respectively in Fig. 1 and Tabular array 1.

Fig. ane
figure 1

Flowchart describing the study design process

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Table 1 Baseline characteristics of included studies

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Within these 100 articles, xl, xvi, 13, x, 9, vii, and five studies were performed on cattle, birds, dogs, sheep, rodents, camels, and horses, respectively. The most frequent studies were performed on cattle and the least ones on horses. Because the various projects in searching cryptosporidiosis on cattle in Iran, the distribution of positive cases relating to cattle is presented in Fig. 9. The quality assessment of studies using the guideline of the Newcastle Ottawa Scale showed that 27%, 65%, and 8% of the studies have low, medium, and high quality, respectively.

Main analysis

The prevalence charge per unit of cryptosporidiosis within a 27-year menses for birds, horses, rodents, camels, dogs, cattle, and sheep in Iran using the random issue model was estimated to be 7.5% (95%, CI = 4.7%, 11.9%), 19.five% (95%, CI = fourteen.6%, 25.half-dozen%), twenty.8% (95%, CI = 9.1–40.vii%), eight.4% (95%, CI = 3.8%, 17.8%), 4.ix% (95%, CI = two.6%, 8.8%), xiv.4% (95%, CI = eleven%, 18.6%), and 9.one% (95%, CI = viii.4%, 9.ix%), respectively. The forest plot diagrams of the current study are shown in Figs. 2, 3, four, 5, 6, 7, and 8.

Fig. 2
figure 2

Forest plot diagram showing the prevalence charge per unit of Cryptosporidium infection in birds of Iran

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Fig. 3
figure 3

Forest plot diagram showing the prevalence rate of Cryptosporidium infection in horses of Islamic republic of iran

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Fig. 4
figure 4

Forest plot diagram showing the prevalence rate of Cryptosporidium infection in rodents of Iran

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Fig. 5
figure 5

Forest plot diagram showing the prevalence rate of Cryptosporidium infection in camels of Iran

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Fig. six
figure 6

Wood plot diagram showing the prevalence rate of Cryptosporidium infection in dogs of Iran

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Fig. 7
figure 7

Forest plot diagram showing the prevalence charge per unit of Cryptosporidium infection in cattle of Iran

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Fig. 8
figure 8

Forest plot diagram showing the prevalence rate of Cryptosporidium infection in sheep of Iran

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A wide variation was observed in the prevalence estimations among the various studies. The Q statistic, df, and I 2 were as follows: 26.63, 15, and 43.74% for birds; xv.15, viii, and 47.18% for rodents; 11.15, half-dozen, and 46.17% for camels; 58.85, 43, and 26.93% for cattle; and xvi.64, 10, and 39.93% for sheep, respectively. Depression heterogeneity was reported in studies which were conducted on horses as well equally the ones on dogs. The statistic factors (Q statistic, df, and I two) were 3.86, 4, 0.00% for horses and 6.07, 12, and 0.00% for dogs.

The prevalence rate of Cryptosporidium infection in cattle is shown in Fig. nine. The most positive cases of cryptosporidiosis were reported in cattle of Due west Azerbaijan, Tehran, Khuzestan, Chaharmahal and Bakhtiari, Kohgiluyeh and Boyer-Ahmad, and Kerman provinces. Considerable positivity rates of cryptosporidiosis in cattle were identified in Razavi Khorasan, S Khorasan, Semnan, Hamadan, Alborz, and Eastward Azerbaijan provinces. There were no positive reports of cryptosporidiosis in cattle in other provinces.

Fig. 9
figure 9

Incidence of Cryptosporidium infection in the Iranian cattle in different provinces [2]

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Discussion

Cryptosporidiosis is one of the most important zoonotic diseases which is reported in humans and animals with a worldwide distribution in more than 106 countries and especially in developing countries [91, 92]. To the best of our cognition, this is the starting time systematic review and meta-analyses on the prevalence of beast cryptosporidiosis in Iran.

The nowadays study showed that the average prevalence rate of cryptosporidiosis in birds was 7.v% in Iran. Additionally, the prevalence rate of cryptosporidiosis in animals in Ahvaz, southwestern of Islamic republic of iran was reported as 50% [86] while it was shown that in Gilan, n of Iran, this charge per unit was 17% [84]. In a report by Jasim and Marhoon, it has shown that in Iraq, which is a neighboring region of Iran, the cryptosporidiosis prevalence rate in wild and domestic birds was 58.1% [93]. Fifty-fifty though this region is about the southwest of Iran, the prevalence was higher than in Iran. Moreover, a prevalence of 49% was shown in Mexico [94], and in Brazil, 76% of birds were infected past Cryptosporidium [95]. Changes in the prevalence seen in various reports indicate that the probability of transmitting the parasite is higher among animals living together on farms and next to each other compared to other studies that have examined private specimens.

Preventive efforts by Iranian government related to awareness of zoonotic diseases, control of stray dogs, and a depression population of pet dogs have increased the possibility of transmission of the disease from livestock [96]. On the one mitt, the stray dogs are the largest group of dogs in both rural and urban areas in Iran which normally become infected by roaming in homo neighborhoods and feeding on contaminated residues. On the other paw, domestic dogs are not restricted to the express expanse of houses or farms. Stray dogs are allowed to wander around, so it increases the adventure of zoonotic infections in rural habitats. In this study, the overall prevalence of cryptosporidiosis between dogs was found to be 4.9% in Iran. There are various reports of cryptosporidiosis prevalence in the different geographical regions of Iran. Mohaghegh et al. reported a prevalence of 21.7% and 25.four% of cryptosporidiosis respectively in domestic and stray dogs of Kermanshah [61]. Furthermore, the 12.3% prevalence rate of cryptosporidiosis in dogs was observed in Ahvaz [threescore]. These results are higher than the information which were obtained in other regions of Islamic republic of iran, specifically v% in Chenaran, northeast of Islamic republic of iran [56]; seven% in Ilam [97]; 2% in Kerman, southeast of Iran [98]; 2.ix% in Urmia, northwest of Islamic republic of iran [99]; two.14% in Isfahan, centre of Iran [62]; and three.8% in Hamadan, west of Iran [17]. The high prevalence of cryptosporidiosis in some areas, for instance, Kermanshah Province, indicated that humans are at serious risk of Cryptosporidium infection. Furthermore, the infection tin spread vastly and cause severe bug in the customs.

Epidemiological studies on cryptosporidiosis infection indicated that the prevalence of Cryptosporidium species in dogs is very different in various countries changing from 0 to 52.seven%. These differences might be attributed to several factors, such as geographical area, sample size, keeping a domestic dog, correlation with other hosts (such equally goat, sheep, horse, cattle, and pig), dissimilar species of Cryptosporidium, and sampling procedures also as diagnostic methods [100, 101]. The current results imply that the prevalence rate of cryptosporidiosis in Iran is higher than in countries such as the Czech republic with 1.4% [102], Thailand with two.i% [103], Brazil with 2.four% [104], Japan with three.9% [105], and Spain with 4.1% [106], just lower than in Nigeria with xviii.five% [107] and Romania with 52.vii% [108].

Rodents could exist potential reservoir hosts for zoonotic cryptosporidiosis. During extensive epidemiological studies that accept been performed throughout the world, infection in rodents was highly varied from 7.half-dozen% in Maryland [109] to 63% in Britain [110]. Other studies showed unlike statistic in different countries. Specifically, 8.2% in northern Australia [111], eleven/five% in People's republic of china [112], 24.3% in Italy [113], 25.8% in Philippines [114], and 32.8% in the Usa of America [115] were reported. The average prevalence rate of cryptosporidiosis in rodents in Iran was estimated every bit twenty.8% in this study. Similar studies in different geographical regions of Iran showed diverse range of prevalence. The frequency of rodent's cryptosporidiosis in Meshgin shahr, Tehran, Shooshtar, and Ahvaz was 0.5% [75], 27.3 % [71], vii.1% [74], and 3% [1], respectively. In the parasite investigation of rodents of Mashhad, none resulted to be were contaminated (0%) [72].

The average prevalence of cryptosporidiosis in sheep was establish as nine.1%. Prevalence of cryptosporidiosis was reported every bit ane.69%, 5.viii%. six.ane% and viii.6% in Tehran [xx], Lorestan [18], Sanandaj [19] and Hamadan [xv], respectively. Majewska et al constitute like results in the west-central region of Poland (10.1%) [116] but lower rates were detected in Australia (24.5%) [117], and China (4.8%) [118].

The prevalence rate of cryptosporidiosis in cattle was 1.5% in Japan [119], 35.7% in Vietnam [120], 20.6% in Turkey [121], 40.6% in Canada [122], and 40.half-dozen% in the USA [123].

Still, according to this systematic review and meta-analysis, the prevalence of cryptosporidiosis in cattle and calves was 14.4% in Iran, and the prevalence rate in various geographical regions was equally follows: two.1% in Ahvaz [73], ix.07% in Lorestan [18], 16.45% in Qazvin [26], 22.iii% in the city of Urmia [48], and 28.iii% in the city of Mashhad [47]. Furthermore, our written report showed that the prevalence rate of cryptosporidiosis in camels and horses was 8.4% and 19.5%, respectively.

It was suggested in this study that the distribution of Cryptosporidium differs among geographical regions. Therefore, the study location might be one of the nearly determinant factors in cryptosporidiosis distribution. The highest prevalence rate (50%) of cryptosporidiosis was observed in Khuzestan Province [86]. This high prevalence might be attributed to the high temperature and humidity of the southwestern regions of Islamic republic of iran as well every bit the people's lifestyle, who have a high level of seafood consumption compared to other regions. Additionally, the immigration of birds to the south of Khuzestan Province may transmit parasite protozoan infection.

Conclusion

The relatively high prevalence of cryptosporidiosis infection among animals in Islamic republic of iran, more often than not among sheep, cattle, and calves, shows the enzootic status of cryptosporidiosis in the investigated areas and may be a threat to the inhabitants. Our data offer important information about the epidemiology of cryptosporidiosis among animals in Iran, which could be useful for managing and decision-making programs for the illness. Further investigation and monitoring will be required to expand the surveillance and control policies in order to reduce the prevalence of Cryptosporidiosis among livestock and consequently decrease the economical damages and public health hazards in Iran.

Availability of information and materials

Input data for the analyses are available from the respective author on asking.

Abbreviations

HIV:

Human being immunodeficiency viruses

CI:

Confidence interval

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Affiliations

  1. Section of Medical Parasitology and Mycology, Schoolhouse of Medicine, Hamadan University of Medical Sciences, Hamadan, Islamic republic of iran

    Mousa Motavalli Haghi, Zohreh Khorshidvand, Faezeh Foroughi-Parvar & Fariborz Etemadifar

  2. Enquiry Heart for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran

    Salman Khazaei

  3. Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak, Iran

    Hossein Sarmadian

  4. Research and Technology, Hamadan University of Medical Sciences, Hamadan, Iran

    Nastaran Barati

  5. Department of Parasitology and Mycology, School of Medicine, Arak University of Medical Sciences, Arak, Iran

    Reza Ghasemikhah

Contributions

This study was done by RG, ZK, SK, FFP, HS, NB, FE, and MMH. RG and MMH participated in the pattern of the study. Data collection was washed by RG, FFP, and NB. Interpretation and manuscript preparation were conducted by MMH and RG. HS, RG, and MMH participated in the data editing. SK performed the statistical analysis. Fe and ZK performed the coordination and helped with the drafting of the manuscript. The authors read and canonical the final version of the manuscript.

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Correspondence to Reza Ghasemikhah.

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Haghi, M.M., Khorshidvand, Z., Khazaei, S. et al. Cryptosporidium animal species in Iran: a systematic review and meta-assay. Trop Med Health 48, 97 (2020). https://doi.org/ten.1186/s41182-020-00278-ix

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  • DOI : https://doi.org/10.1186/s41182-020-00278-9

Keywords

  • Cryptosporidium
  • Abdominal parasites
  • Animal
  • Systematic review
  • Iran

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