Forest plots of the therapeutic effects of different anti-Toxoplasma gondii medicines (P-S, TMP-SMX, and P-C).

<p>Scale: NCR of drugs.</p

Forest plots of the therapeutic effects for vertical transmission rate and AIDS patients with <i>Toxoplasma</i> encephalitis (AIDS).

<p>Scale: NCR of drugs.</p

A Systematic Review and Meta-Analysis of the Efficacy of Anti-<i>Toxoplasma gondii</i> Medicines in Humans

<div><p>No effective drug and definitive “gold standard” treatment for <i>Toxoplasma gondii</i> (<i>T</i>. <i>gondii</i>) infection has been available so far, though some medicines have been commonly used in the treatment of <i>T</i>. <i>gondii</i> infection, such as spiramycin, azithromycin, traditional Chinese medicine (TCM), pyrimethamine- sulfadiazine (P-S), trimethoprim-sulfamethoxazole (TMP-SMX), and pyrimethamine-clindamycin (P-C). A systematic review and meta-analysis were performed to compare the efficacies of these conventional medicines in the treatment. Cohort studies for the treatment of acute <i>T</i>. <i>gondii</i> infection were searched from PubMed, Google Scholar, ect. All the cases number for different group extracted from each included literature were input to meta-analysis 3.13 software to calculate the pooled negative conversion rate (NCR), cure rate (CR) or vertical transmission rate based on their sample size and weight. The pooled NCR with 95% confidence intervals (CI) was used to evaluate the overall rate of a diagnosis positive result conversion to a negative result after treatment, which of spiramycin, azithromycin and TCM were 83.4% (95%CI, 72.1%-90.8%), 82.5% (95%CI, 75.9%-87.6%), and 85.5% (95%CI, 71.3%-93.3%) respectively, with no statistical difference between them. The pooled CR with 95% CI was used to evaluate the overall rate of complete disappearance of clinical symptoms for toxoplasmic encephalitis after therapy, which of P-S, TMP-SMX, and P-C were 49.8% (95%CI, 38. 8% -60.8%), 59.9% (95%CI, 48.9%-70.0%), and 47.6% (95%CI, 24.8%-71.4%) respectively, with no statistical difference between them. Primary <i>T</i>. <i>gondii</i> infection in pregnancy was treated mainly with spiramycin alone or combined with other drugs, and the pooled rate of vertical transmission was about 9.9% (95%CI, 5.9%-16.2%) after therapy. Toxoplasmic encephalitis in AIDS patients was usually treated with sulfonamides combined with other drugs and the pooled CR was 49.4% (95%CI, 37.9%-60.9%).</p></div

Forest plots of the therapeutic effects of different anti-<i>Toxoplasma gondii</i> medicines (spiramycin, azithromycin, TCM).

<p>Scale:NCR of drugs.</p

Proportion of congenital toxoplasmosis happening when infected mother received prenatal treatment.

<p>a, The total rate of vertical transmission when mother received treatment; b-d, The rate of vertical transmission when mother received different treatment regimes. Scale: incidence of congenital toxoplasmosis.</p

Studies about abnormal pregnancy outcomes in <i>T.gondii</i> infected groups and control groups.

<p><b>Notes</b>:^#Cases, <i>Toxoplasma</i>-infected pregnant women, Controls, Non-infected pregnant women;* the data before and after the slash represent the rate of adverse pregnancy outcome in <i>T.gondii</i> infection groups and uninfected groups; - no statistics; “FGR”, fetal grown restriction.</p

Odds ratio of <i>Toxoplasma</i> infection rate between abnormal pregnancy and normal pregnancy.

<p>Scale: for value of odds ratio.</p

Studies about the rate of vertical transmission when infected mother got treatment in pregnancy.

<p><b>Notes</b>: Spir-only, spiramycin only; PS/Spir, PS in combination with spiramycin; PSF/Spir, PSF in combination with spiramycin; Others, other untypical treatment, ¹ only 75% of infected women were administered to antibiotic treatment, the rest were conducted with other medicine; ² 80% of infected women were administered to pyrimethamine-sulfadoxine, 20% were taken with spiramycin; ³ PS alternated every 3 weeks with spiramycin before 1996, and then PS was taken continually.</p

Analysis results of the rate of vertical transmission when mother got infected in different trimester.

<p>Analysis results of the rate of vertical transmission when mother got infected in different trimester.</p

Proportion of congenital toxoplasmosis happening by mother infection.

<p>a, The rate of vertical transmission when mother got infected in pregnancy; b-d, The rate of vertical transmission in different pregnancy trimester. Scale: incidence of congenital toxoplasmosis.</p