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Abstract：
BACKGROUND: Plasmodium cynomolgi is a simian malaria parasite that has been reported as a naturally acquired human infection. The present study aims to systematically review reports on naturally acquired P. cynomolgi in humans, mosquitoes, and macaques to provide relevant data for pre-emptive surveillance and preparation in the event of an outbreak of zoonotic malaria in Southeast Asia.
METHODS: The protocol of the systematic review was registered at PROSPERO with approval ID CRD42020203046. Three databases (Web of Science, Scopus, and MEDLINE) were searched for studies reporting the prevalence of P. cynomolgi infections in Southeast Asian countries between 1946 and 2020. The pooled prevalence or pooled proportion of P. cynomolgi parasitemia in humans, mosquitoes, and macaques was estimated using a random-effects model. Differences in the clinical characteristics of P. cynomolgi infections were also estimated using a random-effects model and presented as pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).
RESULTS: Thirteen studies reporting on the prevalence of naturally acquired P. cynomolgi in humans (3 studies, 21 cases), mosquitoes (3 studies, 28 cases), and macaques (7 studies, 334 cases) were included. The results demonstrated that the pooled proportion of naturally acquired P. cynomolgi in humans was 1% (95% CI, 0.1%, I2, 0%), while the pooled proportion of P. cynomolgi infecting mosquitoes was 18% (95% CI, 10-26%, I2, 32.7%). The pooled prevalence of naturally acquired P. cynomolgi in macaques was 47% (95% CI, 27-67%, I2, 98.3%). Most of the cases of naturally acquired P. cynomolgi in humans were reported in Cambodia (62%) and Malaysia (38%), while cases of P. cynomolgi in macaques were reported in Malaysia (35.4%), Singapore (23.2%), Indonesia (17.3%), Philippines (8.5%), Laos (7.93%), and Cambodia (7.65%). Cases of P. cynomolgi in mosquitoes were reported in Vietnam (76.9%) and Malaysia (23.1%).
CONCLUSIONS: This study demonstrated the occurrence of naturally acquired P. cynomolgi infection in humans, mosquitoes, and macaques. Further studies of P. cynomolgi in asymptomatic human cases in areas where vectors and natural hosts are endemic are extensively needed if human infections with P. cynomolgi do become public health problems.
METHODS: The protocol of the systematic review was registered at PROSPERO with approval ID CRD42020203046. Three databases (Web of Science, Scopus, and MEDLINE) were searched for studies reporting the prevalence of P. cynomolgi infections in Southeast Asian countries between 1946 and 2020. The pooled prevalence or pooled proportion of P. cynomolgi parasitemia in humans, mosquitoes, and macaques was estimated using a random-effects model. Differences in the clinical characteristics of P. cynomolgi infections were also estimated using a random-effects model and presented as pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).
RESULTS: Thirteen studies reporting on the prevalence of naturally acquired P. cynomolgi in humans (3 studies, 21 cases), mosquitoes (3 studies, 28 cases), and macaques (7 studies, 334 cases) were included. The results demonstrated that the pooled proportion of naturally acquired P. cynomolgi in humans was 1% (95% CI, 0.1%, I2, 0%), while the pooled proportion of P. cynomolgi infecting mosquitoes was 18% (95% CI, 10-26%, I2, 32.7%). The pooled prevalence of naturally acquired P. cynomolgi in macaques was 47% (95% CI, 27-67%, I2, 98.3%). Most of the cases of naturally acquired P. cynomolgi in humans were reported in Cambodia (62%) and Malaysia (38%), while cases of P. cynomolgi in macaques were reported in Malaysia (35.4%), Singapore (23.2%), Indonesia (17.3%), Philippines (8.5%), Laos (7.93%), and Cambodia (7.65%). Cases of P. cynomolgi in mosquitoes were reported in Vietnam (76.9%) and Malaysia (23.1%).
CONCLUSIONS: This study demonstrated the occurrence of naturally acquired P. cynomolgi infection in humans, mosquitoes, and macaques. Further studies of P. cynomolgi in asymptomatic human cases in areas where vectors and natural hosts are endemic are extensively needed if human infections with P. cynomolgi do become public health problems.
摘要：
背景：食蟹性疟原虫是一种猿猴疟疾寄生虫，已被报道为自然获得性人类感染。本研究旨在系统回顾人类自然获得的食蟹猴的报道，蚊子,和猕猴提供相关数据，以便在东南亚爆发人畜共患疟疾时进行先发制人的监测和准备。
方法：系统评价方案在PROSPERO注册，批准号为CRD42020203046。三个数据库(WebofScience，Scopus,和MEDLINE）搜索了报告1946年至2020年东南亚国家食蟹猴感染流行率的研究。人类食蟹猴寄生虫血症的合并患病率或合并比例，蚊子,猕猴是用随机效应模型估计的。还使用随机效应模型估计了食蟹猴感染的临床特征的差异，并表示为具有95％置信区间（CI）的合并比值比（OR）或平均差异（MD）。
结果：13项研究报告了人类自然获得性食蟹猴的患病率（3项研究，21例)，蚊子（3项研究，28例)，和猕猴(7项研究，334例）包括在内。结果表明，人类自然获得的食蟹猴的合并比例为1％（95％CI，0.1％，I2，0%），而感染食蟹猴的蚊子的合并比例为18%(95%CI，10-26%，I2，32.7%）。在猕猴中自然获得的食蟹猴的合并患病率为47％（95％CI，27-67％，I2，98.3%）。大多数人类自然获得的食蟹猴的病例报告在柬埔寨（62％）和马来西亚（38％），虽然马来西亚报告了猕猴中的食蟹猴的病例（35.4％），新加坡（23.2%），印度尼西亚（17.3%），菲律宾（8.5%），老挝（7.93%），和柬埔寨（7.65%）。据报道，越南（76.9％）和马来西亚（23.1％）的蚊子中的食蟹猴病例。
结论：这项研究证明了人类自然获得性食蟹猴感染的发生，蚊子,还有猕猴.如果人类感染食蟹猴的病确实成为公共卫生问题，则广泛需要在病媒和天然宿主流行的地区对无症状人类病例中的食蟹猴进行进一步研究。
方法：系统评价方案在PROSPERO注册，批准号为CRD42020203046。三个数据库(WebofScience，Scopus,和MEDLINE）搜索了报告1946年至2020年东南亚国家食蟹猴感染流行率的研究。人类食蟹猴寄生虫血症的合并患病率或合并比例，蚊子,猕猴是用随机效应模型估计的。还使用随机效应模型估计了食蟹猴感染的临床特征的差异，并表示为具有95％置信区间（CI）的合并比值比（OR）或平均差异（MD）。
结果：13项研究报告了人类自然获得性食蟹猴的患病率（3项研究，21例)，蚊子（3项研究，28例)，和猕猴(7项研究，334例）包括在内。结果表明，人类自然获得的食蟹猴的合并比例为1％（95％CI，0.1％，I2，0%），而感染食蟹猴的蚊子的合并比例为18%(95%CI，10-26%，I2，32.7%）。在猕猴中自然获得的食蟹猴的合并患病率为47％（95％CI，27-67％，I2，98.3%）。大多数人类自然获得的食蟹猴的病例报告在柬埔寨（62％）和马来西亚（38％），虽然马来西亚报告了猕猴中的食蟹猴的病例（35.4％），新加坡（23.2%），印度尼西亚（17.3%），菲律宾（8.5%），老挝（7.93%），和柬埔寨（7.65%）。据报道，越南（76.9％）和马来西亚（23.1％）的蚊子中的食蟹猴病例。
结论：这项研究证明了人类自然获得性食蟹猴感染的发生，蚊子,还有猕猴.如果人类感染食蟹猴的病确实成为公共卫生问题，则广泛需要在病媒和天然宿主流行的地区对无症状人类病例中的食蟹猴进行进一步研究。
