Toxoplasma gondii and schizophrenia: a review of published RCTs

Over the last 60 years, accumulating evidence has suggested that acute, chronic, and maternal Toxoplasma gondii infections predispose to schizophrenia. More recent evidence suggests that chronically infected patients with schizophrenia present with more severe disease. After acute infection, parasit...

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Bibliographic Details
Published in:Parasitology research (1987) 2017-07, Vol.116 (7), p.1793-1799
Main Author: Chorlton, Sam D.
Format: Article
Language:English
Subjects:
Antiparasitic Agents - pharmacology
Antipsychotics
Artemether
Artemisinin
Artemisinins - pharmacology
Azithromycin
Biomedical and Life Sciences
Biomedicine
Brain - parasitology
Chronic infection
Clinical trials
Cysts
Drug development
Drug resistance
Genotype
Health aspects
Humans
Immunology
Infections
Medical Microbiology
Mental disorders
Microbiology
Parasites
Physiological aspects
Psychopathology
Randomized Controlled Trials as Topic
Review
Schizophrenia
Schizophrenia - drug therapy
Schizophrenia - etiology
Toxoplasma
Toxoplasma - drug effects
Toxoplasmosis - complications
Toxoplasmosis - drug therapy
Trimethoprim
Trimethoprim - pharmacology
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Summary:Over the last 60 years, accumulating evidence has suggested that acute, chronic, and maternal Toxoplasma gondii infections predispose to schizophrenia. More recent evidence suggests that chronically infected patients with schizophrenia present with more severe disease. After acute infection, parasites form walled cysts in the brain, leading to lifelong chronic infection and drug resistance to commonly used antiparasitics. Chronic infection is the most studied and closely linked with development and severity of schizophrenia. There are currently four published randomized controlled trials evaluating antiparasitic drugs, specifically azithromycin, trimethoprim, artemisinin, and artemether, in patients with schizophrenia. No trials have demonstrated a change in psychopathology with adjunctive treatment. Published trials have either selected drugs without evidence against chronic infection or used them at doses too low to reduce brain cyst burden. Furthermore, trials have failed to achieve sufficient power or account for confounders such as previous antipsychotic treatment, sex, age, or rhesus status on antiparasitic effect. There are currently no ongoing trials of anti- Toxoplasma therapy in schizophrenia despite ample evidence to justify further testing.
ISSN:0932-0113
1432-1955
DOI:10.1007/s00436-017-5478-y