Study of the Frequency of Superficial Candidiasis at the Fann National Hospital: Search for Candida auris

Background: Superficial candidiasis is a very frequent opportunistic disease caused by yeasts of the genus Candida. Among Candida types, some, such as Candida auris, have developed resistance to several antifungal agents. The objective of this study was to determine the hospital frequency of superficial candidiasis diagnosed at the CHU Fann and to investigate the presence of C. auris among the identified Candida strains. Methods: A cross-sectional study was conducted from February to June 2019. It involved all patients received at the Parasitology-Mycology laboratory of the CHU of Fann for suspected superficial candidiasis. Nails, skin, and vaginal specimens were subjected to direct examination and culture to identify yeasts of the genus Candida. The Candida strains were then tested by molecular biology targeting the specific C. auris ITS2 region. Results: A total of 1196 patients were examined. One thousand two hundred and five specimens (1205) were collected, including 1042 vaginal specimens, 92 nail specimens, and 71 skin specimens. Superficial candidiasis was diagnosed in 408 patients (37%). Women (34.52%) and patients under 30 years of age (39.60%) were the most affected. Yeasts of the genus Candida were found in 411 specimens (349 vaginal swabs, 36 nail fragments, and 26 skin flakes) by routine mycological techniques. The Candida albicans complex (C. albicans, C. dubliniensis, and C. africana) represented 75.91% of the Candida strains isolated. Molecular biology did not identify C. auris. Conclusion: Superficial candidiasis remains very common in hospitals in Senegal. Candida auris was not found in our study. Due to its rapid spread, surveillance is necessary to prevent epidemics in our hospitals.

Diagnosis of Toxoplasma gondii infection in pregnant women using automated chemiluminescence and quantitative real time PCR

Objective: To identify serodiagnosis and quantification of Toxoplasma gondii(T. gondii) infection among pregnant women in Salmas, northwest of Iran. Methods: In this crosssectional study, 276 blood samples were collected from pregnant women referred to the health care centers in Salmas city. The demographic variables were also recorded. Titers of antiToxoplasma IgM and IgG antibodies(Ab) were determined using the chemiluminescence immunoassay. Quantitative real-time PCR targeting the T. gondii repeated element gene was also performed on the blood sample. Results: Out of all, 19.92%(55/276) and 2.17%(6/276) patients were seropositive for anti-Toxoplasma IgG and IgM Ab, respectively. Moreover, the presence of T. gondii DNA was observed in 12.31%(34/276) blood samples. A significant relationship was observed between the IgG Ab seropositivity and contact with the cat as a risk factor(P=0.022). Conclusions: The seroprevalence rate of T. gondii infection in pregnant women is relatively low. Consequently, the seronegative pregnant women are at risk, and a considerable rate of positive blood samples for the presence of parasite's DNA should not be ignored. Besides, quantitative real-time PCR could be considered as an accurate method for diagnosis of acute toxoplasmosis especially when the precise results are of the most importance in pregnancy. Limiting contact with cats is also suggested for pregnant women.

Phlebotomus papatasi and Meriones libycus as the vector and reservoir host of cutaneous leishmaniasis in Qomrood District,Qom Province,central Iran

Objective:To determine the sand flies species responsible for most transmission of Leishmania major(L major) to human,as well as to determine the main reservoir hosts of the disease. Methods:Sand flies were collected using sticky papers and mounted in Puri’s medium for species identification.Rodents were trapped by live Sherman traps.Both sand flies and rodents were subjected to molecular methods for detection of leishmanial parasite.Results:Phlebotomus papatasi(P.papatasi) was the common species in outdoor and indoor resting places.Employing PCR technique only three specimens of 150 P.papatasi(2%) were found naturally infected by parasites with a band of 350 bp which is equal to the L major parasite.Forty six rodents were captured by Sherman traps and identified.Microscopic investigation on blood smear of the animals for amastigote parasites revealed 1(3.22%) infected Meriones libycus(M.libycus). Infection of this animal to L.major was confirmed by PCR against rDNA loci of the parasite. Conclusions:This is the first molecular report of parasite infection of both vector(P.papatasi) and reservoir(M.libycus) to L major in the region.The results indicated that P.papatasi was the primary vector of the disease and circulating the parasite between human and reservoirs and M. libycus was the most important host reservoir for maintenance of the parasite source in the area.

Knowledge,attitude,and practices related to cutaneous leishmaniasis in an endemic focus of cutaneous leishmaniasis,Southern Iran

Objective:To assess knowledge,attitudes,and practices(KAP)of inhabitants of an endemic area it)Fars province toward cutaneous leishmaniasis(CI).Methods:the study was carried out in Lapui district in Fars province,south of Iran,one of the most important foci of CL in this province.Sample size(237 residents)was calculated based on population.House-to-house survey was done to collect the data regarding knowledge,attitudes,and practices of the inhabitants.The head of each household was interviewed by a trained staff to assess his/her KAP related to CL.A semi-structured KAP questionnaire was used for data collection.Results:Mean age of participants was 39 and more titan half of the respondents were in the age group of 31-40.Males constituted 172(72.5%)of subjects.Most of the respondents(84.3%)were literate.The majority of the study poulation(83%)had heard about SalaJc(local name for CL)and most of these respondents(91%)were aware that CL is presented with a cutaneous lesion.Nearly two-third of the participants(63.5%)stated the bite of mosquito(not specifically sandflies)for CL transmission.The respondents'attitude regarding the treatment of CL was not satisfactory since Only 48%believed that CL can be treated by medicine.A noticeable proportion of respondents(21%)believed in indigenous medicine for the treatment of CL.A small proportion of respondents(14%)stated that traditional healers are good at treating this disease.More than two-third(69%)of respondents believed that the disease is preventable although most of interviewees did not know about preventive measures.Conclusions:In this study,insufficient knowledge of community about infection nature,vector,transmission mode and preventive measures of CL,highlights the needs for a health education initiative to enhance the awareness of people about CL.This would improve inhabitants'contribution in control program of CL in this area.

Incidence of Enterobius vermicularis in acute appendicitis: A systematic review and meta-analysis

Objective: To evaluate the incidence of Enterobius vermicularis (E. vermicularis) in appendectomies in Iran from 1993 to 2018 . Methods: Data were systematically collected on the electronic databases including PubMed, GoogleScholar, ScienceDirect, Scopus, Web of Science, Magiran, Irandoc (Bareket), IranMedex, and Scientific Information Database in English or Persian. Six articles including 29694 cases of appendicitis with 258 positive cases of infection withE. vermicularis were eligible to enter into this systematic review and meta-analysis. Results: The overall prevalence of E. vermicularis in appendicitis in Iran was 1% (95%CI=0.00-0.02) with the highest rate of 3% (95%CI=0.02-0.03) and lowest rate of 0% (95%CI=0.00-0.01). Conclusions: Prevalence of E. vermicularis infectionin appendicitis in Iran is low and has no statistically significant correlation with age and gender.

Comparative study of chloroquine and quinine on malaria rodents and their effects on the mouse testis

Objective:To evaluate the effects of quinine and chloroquine against mole mice infected with Plasmodium berghei and their adverse effects on the mice testes.Methods:In this study,48 adult male mice,(20-23 g).aged 8 to 12 weeks were divided into four groups.This study was carried out from December 2009 until May 2010 in the School of Public Health,Tehran University of Medical Sciences.Results:The results showed that 58.33%of mice treated with chloroquine were completely recovered.Parasitemia was 4%on day 8 when compared to that on day 0,whereas it was 9%on day 9.There was no orchitis found in this group.The mortality of mice after exposing to quinine on day 5 was 8.3%,whereas from day 10 to day 14 it was 91.7%.We found 73%orchitis occurred in quinine treated group.There was a significant difference between quinine and chloroquine effects on the parasite and also mice testes(P<0.05).Conclusions:In this study,It can be concluded that male mice have full resistance to the quinine.Quinine does not only make male mice recover completely,but also cause inflammation on mice testicles tissue.

Seroprevalence of IgG and IgM anti-Toxoplasma antibodies in HIV/AIDS patients,northern Iran

ObjectiveTo determine the seroprevalence of anti-Toxoplasma gondii (T. gondii) IgG and IgM antibodies in HIV/AIDS patients and uninfected subjects.MethodsThis cross sectional survey was carried out on 78 healthy and 62 HIV+/AIDS individuals in northern Iran between September 2007 and October 2008. Five mL of blood samples were collected from each person in case and control groups. Determination of CD4+ counts was performed by flow cytometry. The serum separated from blood samples was evaluated by conventional ELISA technique to determine the presence of antibodies to T. gondii.ResultsForty eight out of 62 (77.4%) HIV/AIDS serum samples were found positive for anti-T. gondii IgG antibody, compared with 59 among 78 (75.6%) HIV negative samples from the same area (P > 0.05). Six out of 62 (9.7%) HIV+/AIDS patients showed anti-T. gondii IgM antibody in their serum samples, compared with 7 among 78 (9%) HIV negative samples (P > 0.05). The mean of CD4+ counts in HIV+/AIDS was (430.8±182.3) cells/μL and in control group was (871.0±243.3)% cells/μL (P<0.01). CD4+ estimation in 5 (11.1%) of HIV+/AIDS patients was <200 cells/μL (P < 0.0001).ConclusionsSeroprevalence of latent toxoplasmosis in HIV patients is high, therefore the prevention of toxoplasmic encephalitis, administration of primary prophylaxis with co-trimoxazole to all HIV+/AIDS patients are necessary.

Immunodiagnosis of human hydatid disease: Where do we stand?

Cystic echinococcosis(CE) is a zoonotic parasitic infection caused by the larval stage of Echinococcus granulosus. Diagnosis of CE mainly relies on a combination of serological testing along with imaging approaches. A variety of serological methods, mainly based on hydatid cyst fluid, antigen B(Ag B) and antigen 5, have been developed and used for immunodiagnosis of CE, yet their performances are not satisfactory. Although utilizing of recombinant or synthetic antigens, improved the performance of serological tests, it has not applicably overcome the problem of low sensitivity and cross reactivity, seen in the diagnosis of CE. Performances of immunodiagnostic tests based on Ag B subunits are promising. The 8 k Da subunit of Ag B is the most studied antigen in native, synthetic or recombinant form for diagnosis of CE. From the 5 subunits of Ag B, antigen B8/1 and B8/2 provided the highest diagnostic sensitivity and specificity. Moreover, detecting of specific antibodies of Ig G subclasses has improved the efficacy of immunodiagnostic tests. Among the Ig G subclasses, both Ig G2 and Ig G4 are considered as good markers for diagnosis and Ig G4 as a suitable marker for follow up of the patients. In this review an overview of immunodiagnostic methods, related antigens and their performances in the diagnosis of CE are given. The paper highlights pitfall and challenges in the serological diagnosis of CE. Moreover, limitation of currently available immunodiagnostic tests and the most recent development in the designing and application of serological assays for diagnosis of CE in human are addressed.

Phylogeography,genetic variability and structure of Acanthamoeba metapopulations in Iran inferred by 18S ribosomal RNA sequences:A systematic review and meta-analysis

Objective: To verify phylogeography and genetic structure of Acanthamoeba populations among the Iranian clinical isolates and natural/artificial environments distributed in various regions of the country.Methods: We searched electronic databases including Medline, Pub Med, Science Direct, Scopus and Google Scholar from 2005 to 2016. To explore the genetic variability of Acanthamoeba sp, 205 sequences were retrieved from keratitis patients, immunosuppressed cases and environmental sources as of various geographies of Iran.Results: T4 genotype was the predominant strain in Iran, and the rare genotypes belonged to T2, T3, T5(Acanthamoeba lenticulata), T6, T9, T11, T13 and T15(Acanthamoeba jacobsi).A total of 47 unique haplotypes of T4 were identified. A parsimonious network of the sequence haplotypes demonstrated star-like feature containing haplogroups IR6(34.1%) and IR7(31.2%) as the most common haplotypes. In accordance with the analysis of molecular variance, the high value of haplotype diversity(0.612–0.848) of Acanthamoeba T4 represented genetic variability within populations. Neutrality indices of the 18 S ribosomal RNA demonstrated negative values in all populations which represented a considerable divergence from neutrality. The majority of genetic diversity belonged to the infected contact lens and dust samples in immunodeficiency and ophthalmology wards, which indicated potential routes for exposure to a pathogenic Acanthamoeba sp. in at-risk individuals. A pairwise fixation index(FST) was from low to high values(0.024 33–0.418 92). The statistically FST points out that T4 is genetically differentiated between north-west, north-south and centralsouth metapopulations, but not differentiated between west-central, west-south, centralsouth, and north-central isolates.Conclusions: An occurrence of IR6 and IR7 displays that possibly a gene flow of Acanthamoeba T4 occurred after the founder effect or bottleneck experience through ecological changes or host mobility. This is the first systematic review and meta-analysis providing new approaches into gene migration and transmission patterns of Acanthamoeba sp, and targeting at the high-risk individuals/sources among the various regions of Iran.

In vitro and in vivo susceptibility of Leishmania major to some medicinal plants

Objective: To evaluate the efficacy of some medicinal plants and systemic glucantime in a comparative manner against the causative agent of cutaneous leishmaniasis both in vitro and in BALB/c mice.Methods: For in vivo testing, inbred mice were challenged with Leishmania major parasites and the resultant ulcers were treated with extract based-ointments applied topically two times per day for a period of 20 days. A group of 56 mice were randomly divided into 7 subgroups. The control group received the ointment void of extracts,whereas the reference group received glucantime only. The efficacy of treatments was evaluated by measuring ulcer diameter, parasite burden and NO production.Results: Our results indicated that plant extract based-ointments were effective in reducing ulcer size and parasite burden in spleens, but their effects did not differ significantly from that of glucantime. The plant extracts tested in this study were able to increase NO production that helped parasite suppression.Conclusions: Our findings indicate that the tested plant extracts are effective against Leishmania major both during in vitro and in vivo experiments, but further researches are required to recommend a potential plant extract as an alternative drug.

Prevalence and genotype distribution of Enterobius vermicularis among kindergarteners in Shiraz and Khorramabad cities, Iran

Objective: To study the prevalence and genotype of Enterobius(E.)vermicularis from adhesive tape samples in the cities of Shiraz and Khorramabad, Iran. Methods: A total of 1 000 adhesive tape samples from kindergartens in Shiraz(500 samples) and Khorramabad(500 samples) were collected and tested using a microscope to find E. vermicularis egg/s. A questionnaire was filled out for each sample. In order to characterize the genotype of E. vermicularis, the PCR-sequencing method of the mitochondrial cytochrome C oxidase subunit 1(cox1) gene was used. Genomic DNA was extracted from the positive scotch tape samples of E. vermicularis. The cox1 gene was amplified by the polymerase chain reaction and sequenced. The sequence data were aligned using the BioEdit software and compared with the published sequences in GenBank. Phylogenetic analysis was performed using the maximum likelihood method. Results: The parasitological method showed that 15 out of the 500 samples from Shiraz(3.00%) and 12 out of the 500 samples from Khorramabad(2.40%) were infected with E. vermicularis eggs. BLAST analysis indicated that the sequenced isolates belonged to E. vermicularis genotype B while three different haplotypes were also identified. Conclusions: This is the first study on genotyping E. vermicularis in the cities of Shiraz and Khorramabad. Considering the public health importance of the disease, further studies are necessary to characterize the genotype of E. vermicularis in human populations from other regions of Iran.

Evaluation of protective effect of IL-22 and IL-12 on cutaneous leishmaniasis in BALB/c mice

Objective:To investigate the protective effect of IL-22 and IL-12 on cutaneous leishmaniasisin BALB/c mice.Methods:The protective effect of IL-22 and IL-I2 on cutaneous leishmanias in BALB/c mice was evaluated by measurement of IL-4.INF-γ.total IgG,IgG1 and IgG2 a after challenge with Leishamania major.Clinical evaluations were performed by measurement of lesion diameter,and survival rate of the mice.Results:In week 27 post infection,the mortality rates for control groups were 100%.While the survival rates for the IL-12.IL-12 + IL-22.and IL-22(5 ng/g) groups were 100%.The size of lesions decreased in the presence IL-22(5 ng/g) of mice weight,which was statistically significant in comparison with other groups(P<0.05).Mean of total IgG,IgG1 and IgG2 a for IL-22(5 ng/g) group was more than other groups.In IL-22 group(5 ng/g).INF—γ production was significantly higher than other groups and IL-4 was significantly lower than other groups.Conclusions:The results obtained indicate the effectiveness of IL-22 and its effect on IL-12 in protection of cutaneous leishmaniasis.

Co-detection and isolation of Leishmania and Crithidia among naturally infected Tatera indica(Rodentia: Muridae) in Fars province, southern Iran

Objective:To explore the co-detection of natural infection of Trypanosomatidae parasites such as Leishmania and Crithidia in reservoir hosts of leishmaniasis.Methods:Rodent populations were monitored in two endemic foci of cutaneous leishmaniasis of Fars province,southern Iran from March to October 2016.Rodents were trapped alive in several parts of Shiraz and Kharameh cities.Afterwards,their organs were prepared for detection of Leishmania and Crithidia species by molecular,microscopic,and culture methods.Results:Totally,115rodents of five species;Tatera indica(T.indica)(85),Rattus rattus(12),Meriones libycus(9).Mus musculus(7),and Rattus norvegicus(2),were trapped alive and their tissue samples were examined using microscopic,cultivation,and molecular assays.Overall,59(51.3%)rodents were positive for Leishmania or Crithidia parasites.The highest rate(61.2%;52/85)of Leishmania infection was related to the T.indica population.The cultivatioin,and molecular observations showed that two(2.4%;2/85)of T.indica(foot-pad,and spleen samples)were positive to Crithidia.Conclusions:This is the first report of Crithidia infection in T.indica in Iran.Consequently,more epidemiological and ecological studies are needed to understand the role of Crithidia and Leishmania in T.indica.

Promising antileishmanial effectiveness of doxorubicin and Doxil against Leishmania major:An in vitro assay

Objective: To evaluate the effect of doxorubicin and its pegylated liposomal formulation(Doxil, Caelyx) on in vitro susceptibility of promastigote and amastigote stages of Leishmania major. Methods: Throughout in vitro assays the IC50 was calculated in the promastigotes and amastigotes forms in J774 macrophage cell line. Also as cytotoxicity in J774 cell line macrophages. Results: Doxorubicin and Doxil showed the same activity against promastigote form with IC50 values of 10.49 μg/m L and 9.63 μg/m L, respectively. Similarly, the amastigote stage was susceptible at concentration of at least 1 μg/m L when compared to positive control(P<0.000 1). Also, cytotoxicity assay against macrophage revealed no toxicity on the host cells at IC50 concentrations. Conclusions: Our findings demonstrated the efficacy of both doxorubicin and its pegylated liposomal formulation on Leishmania major at low concentrations. Further researches are needed for evaluating the safety of drugs in animal model particularly as topical formulation.

Cattle toxoplasmosis in Iran:a systematic review and meta-analysis

Objective:To analyze and review the overall seroprevalence rate of Toxoplasma gondii(T.gondii) infection in cattle from Iran.Methods:In the current study,data collection(published and unpublished papers,abstracts of national scientific congresses and dissertations) using particular terms was carried out systematically on the following electronic databases like PubMed,Google Scholar,Ebsco,Science Direct,Scopus,Magiran,Irandoc,IranMedex and SID(Scientific Information Database).Results:A total of 22 studies since 1983 to 2012 reporting the seroprevalence of toxoplasmosis in cattle from different regions of Iran met our eligibility criteria.The pooled proportion of toxoplasmosis,using random effect model,among cattle in Iran from over the 30-year period was estimated 18.1%(95%CI:9.9%to 28.2%).Conclusions:This study firstly establishes a crude seroprevalence rate of Toxoplasma infection in cattle which can lead us to understand the condition of eattle toxoplasmosis,which have to take into accounted fur an appropriate and effective prevention and controls.Secondly,it compares and discusses elaborately the role of risk factors including sex,age and breed in the epidemiology of the disease.Thus,it determines gaps and drawbacks in the prior studies which are greatly useful to design more accurate investigations in the future.

Microsporidiosis in Iran:A systematic review and meta-analysis

Objective:To examine all evidences about Microspondia infection in vertebrate/invertebrate hosts and Iranian populations distributed in different regions of the country.Methods:All published articles up to December 2015,including descriptive and cross-sectional studies related to the prevalence and genotyping of Microspondia infection in Iran,was considered in this systematic review.The meta-analysis was done using the random-effects model and Stats Direct statistical software.MEGA 5.05 software and maximum likelihood algorithm with Kimura 2-parameter model were used for phylogenetic analysis.Results:Of the 1 152 investigated studies,33 eligible studies reported a prevalence of Microspondia infection in vertebrate and invertebrate hosts.According to this systematic review,the overall prevalence rate of Microsporidia infection in immunocompromised patients in Iran was 8.18%.Furthermore,the overall prevalence rate of Microsporidia infection in immunocompromised patients with chronic diarrhoea,patients with non-diarrhoea,gastroenteritis,and patients with CD4(< 200 cells/μL) was 15.4%,4.1%,0.5%,and 12.9%respectively.The highest prevalence rate of human and animal Microsporidia was estimated in Kerman(29%) and Khuzestan(26.5%).The overall prevalence rate of Microsporidia infection in honeybees using the random-effects model was 40%.Furthermore,the highest prevalence rate of nosemosis was described in East Azerbaijan(48.2%).The maximum number of Microsporidia isolates from immunocompromised patients and pigeons in Iran belonged to genotypes D(n=16;50%) and E(n=6;20.6%) of Enterocytozoon bieneusi.Conclusions:This study may be the first systematic review and meta-analysis that provides a broad outlook on the prevalence of microsporidiosis in Iran.It is necessary to investigate Microsporidia infection in vertebrate and invertebrate hosts and environmental resources in Iran.

First molecular identification of Leishmania species in a new endemic area of cutaneous leishmaniasis in Lorestan,Iran

Objective:To identify Leishman{u using PCR.Methods:This studs was conducted from April2009 to March 2011 in order to identify Leishmania species in a new endemic area of CL in Lorestan.Iran.Samples were taken from 62 patients that referred to the health centers in different cities of Lorestan province,the presence of Leishmcania was confirmed using direct smear and then grown in NNN media and mass cultured in RPM!1640 medium supplemented with 10%heat-inactivated fetal bovine serum.DNA was extracted from cultured promastigotes and used in P15-PCR.Results:45(72.6%)samples out of 62 showed a hand in the range of 485 hp and 17(27.4%)with a hand in the range of 626 hp which were similar to standard strains of Leichmania tropica(L.tropical and Leishnrania major(L.major),respectively.50(65.80%)of samples were collected from people with no history of travel in at least a year prior to the onset which shows that indigenous source of infection.Conclusions:Since the vector and reservoir of the two species are different.so precise and extensive control and prevention methods should be designed and earned out.

Survey on cattle ticks in Nur,north of Iran

Objective:To survey the prevalence of cattle ticks in Nur County and prepare a list of tick fauna in this district.Methods:This investigation was carried out on 150 head of cattle ticks of rural areas of Nur city which is located in Mazandaran province during spring and summer seasons of 2011.The collected ticks were identified using light microscope and available systematic keys.Results:A total number of 1563 ticks were isolated from examined cattle and their genus and numbers including:lxodes ricinus 51%(111 male and 691 female)and Boophilus annulatus 49%(83male and 678 female),respectively.Conclusions:Results of the current investigation indicate the presence of two species of acarine ectoparasites which have potential health risk lxodes ricinus and Boophilus annulatus.More studies are required to increase our data concerning ticks and other ectopreasites of ruminants in other areas of Mazandaran province and should be noted to their ability in transmission of infectious agents.

Birds and poultries toxoplasmosis in Iran: A systematic review and meta-analysis

Objective: To evaluate the overall prevalence of Toxoplasma gondii infection among birds and poultries in Iran. Methods: Data were systematically collected from 1983 to 2016 in Iran on the following electronic databases: Pub Med, Google Scholar, Science Direct, Scopus, Web of Science, Magiran, Irandoc, Iran Medex, and Scientific Information Database. Additionally, the abstracts of national scientific congresses and dissertations were included. Results: A total of 20 articles in the field of birds and poultries toxoplasmosis, totally examining 4 563 cases with 754 positive results reporting the overall prevalence of infection from all parts of Iran could fulfill our eligibility criteria. The overall estimated prevalence included in chicken 20%(95% CI: 3% to 38%) in chicken, pigeons 8%(95% CI:-17% to 33%) and in sparrows 15%(95% CI:-25% to 54%). Conclusion: Although there is a lack in data about poultries and birds toxoplasmosis in Iran, our meta-analysis revealed that infection rate is high among birds and poultries in Iran. More studies are needed to manage controlling programs and prevention strategies among poultries in Iran.

Global prevalence,mortality,and main risk factors for COVID-19 associated pneumocystosis:A systematic review and meta-analysis

Objective:Pneumocystis pneumonia(PcP)is a life-threatening infection caused by the opportunistic fungi Pneumocystis jirovecii.The emergence of the COVID-19 pandemic forced the focus of attention of health policymakers on these two infections due to their clinical and paraclinical similarities,which cause diagnostic dilemmas.This study was undertaken to evaluate and estimate the global prevalence and main leading risk factors of coronavirus-associated pneumocystosis(CAP).Methods:We searched related databases between December 2019 and May 2022 for studies reporting CAP.Meta-analysis was performed using StatsDirect software(version 2.7.9)according to the DerSimonian and Laird method applying the random-effects model.We evaluated heterogeneity using theχ2-based Q statistic(significant for P<0.05)and the I2 statistic(>75%indicative of“notable”heterogeneity).Moreover,an odds ratio(OR)analysis was performed for eligible data.Results:Our meta-analysis included eight studies with 923 patients hospitalized with COVID-19;among them,92 were PcP cases.The overall pooled prevalence of CAP was estimated at 11.5%.The mortality among CAP patients was lower than that of non-PcP patients(OR 1.93;95%CI 0.86-4.31).Long-term corticosteroid therapy(OR 28.22;95%CI 0.54-1480.84)was the most predisposing factor for PcP among COVID-19 patients,followed by pulmonary diseases(OR 1.46;95%CI 0.43-4.98),kidney diseases(OR 1.26;95%CI 0.21-7.49),and acute respiratory destruction syndrome(OR 1.22;95%CI 0.05-29.28).Conclusions:The prevalence of PcP among the COVID-19 population is almost similar to the pre-COVID era.However,PcP-related mortality was decreased by the emergence of the COVID-19 pandemic.Women with COVID-19 are more susceptible to PcP than men.Acute respiratory distress syndrome,kidney diseases,pulmonary diseases,and long-term corticosteroid therapy increased the risk of PcP;however,transplantation and malignancy decreased the risk for PcP among COVID-19 patients.Further retrospective,case-control,prospective,and more precisely systematic review and meta-analysis studies are needed in this field.