Toxoplasmosis and Schizophrenia: A Systematic Review and Meta-Analysis of Prevalence and Associations and Future Directions.

Psychiatric research and clinical practice Pub Date : 2022-04-22 eCollection Date: 2022-01-01 DOI:10.1176/appi.prcp.20210041

Despina G Contopoulos-Ioannidis, Maria Gianniki, Angeline Ai-Nhi Truong, Jose G Montoya

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引用次数: 7

Abstract

Background: A potential link between toxoplasmosis with schizophrenia (SCZ) has been extensively studied over the past 2 decades. Our study was aimed to determine whether, beyond an association, the field is primed for randomized clinical trials of anti-Toxoplasma prophylaxis in Toxoplasma seropositive patients with SCZ.

Methods: We performed a methodological appraisal of toxoplasmosis-SCZ association studies, a meta-analysis, and a compilation of claims and pathophysiologic hypotheses.

Results: We analyzed 66 studies with 11,540 patients with SCZ and 69,491 controls. For patients with SCZ, 54 studies targeted Toxoplasma-IgG seropositivity, 18 targeted Toxoplasma-IgG serointensity, and 17 targeted Toxoplasma-IgM seropositivity. For SCZ-phenotypes, 26 targeted Toxoplasma-IgG seropositivity, six targeted Toxoplasma-IgG serointensity, and three targeted Toxoplasma-IgM seropositivity. Two-thirds of these studies reported a positive association. Statistically significant associations with SCZ were reported in 31/54 studies, 11/18 studies, and 3/17 studies. Significant associations with SCZ-phenotypes were reported in 20/26 studies, 2/6 studies, and 0/3 studies, respectively. Toxoplasma-IgG seropositivity increased the odds of SCZ (OR = 1.91; 95% CI: 1.61-2.27). Heterogeneity across studies was large (I ² = 80.03%). Adjusted analyses for at least age and socioeconomic status/place of residence were done in 17 studies; temporality was addressed only in 4.

Conclusion: A large number of observational studies revealed a modest to large association between toxoplasmosis and SCZ. Although important methodological biases were identified, further association studies are unlikely to change this association and are not justified. It is time to test this association in randomized double-blind placebo-controlled clinical trials of first line anti-Toxoplasma prophylaxis in Toxoplasma seropositive patients with SCZ.

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弓形虫病和精神分裂症:患病率、相关性和未来方向的系统回顾和荟萃分析。

背景:在过去的20年里，弓形虫病与精神分裂症(SCZ)之间的潜在联系已经被广泛研究。我们的研究旨在确定，除了关联之外，该领域是否为弓形虫血清阳性SCZ患者抗弓形虫预防的随机临床试验做好了准备。方法:我们对弓形虫与scz相关性研究进行了方法学评估，进行了荟萃分析，并汇编了索赔和病理生理学假设。结果:我们分析了66项研究，11,540例SCZ患者和69,491例对照。针对SCZ患者，54项研究针对弓形虫- igg血清阳性，18项研究针对弓形虫- igg血清强度，17项研究针对弓形虫- igm血清阳性。在scz表型中，26例弓形虫igg血清阳性，6例弓形虫igg血清强度阳性，3例弓形虫igm血清阳性。三分之二的研究报告了正相关。31/54项研究、11/18项研究和3/17项研究报告了与SCZ有统计学意义的关联。分别有20/26项研究、2/6项研究和0/3项研究报告了与scz表型的显著关联。弓形虫igg血清阳性增加SCZ的几率(OR = 1.91;95% ci: 1.61-2.27)。研究间异质性较大(i2 = 80.03%)。在17项研究中进行了至少年龄和社会经济地位/居住地的调整分析;只有第4章提到了时间性。结论:大量的观察性研究显示弓形虫病与SCZ之间存在中等到较大的关联。虽然确定了重要的方法学偏差，但进一步的关联研究不太可能改变这种关联，也不合理。现在是时候在随机双盲安慰剂对照临床试验中对血清弓形虫阳性的SCZ患者进行一线抗弓形虫预防了。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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