
==== Front
Food Waterborne Parasitol
Food Waterborne Parasitol
Food and Waterborne Parasitology
2405-6766
Elsevier

S2405-6766(24)00024-6
10.1016/j.fawpar.2024.e00242
e00242
Review Article
Foodborne concerns of Blastocystis spp. in marine animals (fish, bivalves, and sponges): A systematic review and meta-analysis of global prevalence and subtypes distribution
Ghafari-Cherati Mohammad a
Karampour Amin a
Nazem-Sadati Seyedeh-Sara b
Asghari Ali asghari3@yahoo.com
c⁎
a Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
b Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
c Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
⁎ Corresponding author. asghari3@yahoo.com
25 8 2024
9 2024
25 8 2024
36 e0024218 6 2024
14 8 2024
21 8 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Blastocystis spp. is a common intestinal parasite found in humans and various animals, including marine species like fish, bivalves, and sponges. While traditionally considered non-pathogenic, emerging evidence suggests potential foodborne concerns, especially for vulnerable populations. The present systematic review and meta-analysis reviewed four electronic databases (PubMed, Scopus, Google Scholar, and Web of Science) until June 13, 2024, for studies reporting the prevalence and subtypes (STs) distribution of Blastocystis spp. in marine animals, including fish, bivalves, and sponges, to assess foodborne concern and zoonotic importance. In the analysis of 11 studies involving 1329 marine animals from nine countries, five studies/datasets (742 samples) focused on fish, five studies/datasets (567 samples) on bivalves, and one (20 samples) on sponges. This review found that 12.4 % (95 % CI: 4.3–31 %) of marine animals globally were infected by Blastocystis spp., with bivalves showing the highest infection rate at 32 % (95 % CI: 13–59.7 %), exceeding sponges with a single study at 10 % (95 % CI: 2.5–32.4 %), and fish at 4.4 % (95 % CI: 2–9.3 %). Sensitivity analysis assessed changes in weighted prevalence after excluding certain studies. A subgroup analysis of Blastocystis spp. prevalence was conducted based on publication years, countries, continents, WHO regions, and sample sizes. The data collected indicated that marine animals serve as suitable reservoirs for various Blastocystis spp. STs (ST1-ST4, ST7, ST8, ST10, ST14, ST23, ST26, and ST44), with most (except for ST26 and ST44) having the potential for zoonotic transmission. Overall, the findings emphasize the potential for foodborne risk posed by Blastocystis spp. in marine animals and highlight the need for improved monitoring and control measures to ensure food safety.

Highlights

• This review found that 12.4 % (95 % CI: 4.3–31 %) of marine animals globally were infected by Blastocystis spp.

• Bivalves had the highest infection rate at 32 % (95 % CI: 13–59.7 %).

• The findings emphasize the potential for foodborne risk posed by Blastocystis spp. in marine animals.

Keywords

Blastocystis spp.
Prevalence
Subtypes
Marine animals
Systematic review
==== Body
pmc1 Introduction

Blastocystis spp. is a prevalent protozoan parasite found in the digestive tracts of animals and humans globally (Asghari et al., 2024c; Guilavogui et al., 2022). The frequency of Blastocystis spp. differs between developed and developing countries, with higher rates usually observed in regions with inadequate sanitation and restricted access to safe water (Asghari et al., 2024b; Mohammad et al., 2018). Risk factors for contracting Blastocystis spp. include poor hygiene practices, close contact with infected individuals, and consuming contaminated food or water (Asghari et al., 2024a; Mohammad et al., 2017). Clinical symptoms of infection can vary from mild gastrointestinal discomfort to more severe symptoms like diarrhea, nausea, and abdominal pain (Salvador et al., 2016). The pathogenesis of Blastocystis spp. infection is not fully understood, but Blastocystis spp. has the ability to regulate the gut microbiome and immune responses to maintain the homoeostasis as well (Roberts et al., 2014; Shams et al., 2024; Vassalos et al., 2008).

The SSU-rRNA gene polymorphism identified 40–44 genetically different variants, or subtypes (STs). 17 have been identified in humans and animals (ST1-ST10, ST12-ST14, ST16, ST23, ST35, and ST41), with ST1–ST4 comprising >90 % of human isolates. ST1–ST4 infections are usually transmitted between humans, while other STs are prevalent among specific host groups such as mammals or birds, spreading through human–animal interactions (Bastaminejad et al., 2024; Santin et al., 2024).

Given the zoonotic significance and genetic variety of this parasitic protozoan, numerous original and/or review studies have been carried out on humans and various animal categories, particularly zoo animals, domestic animals, and pets (Abedi et al., 2022; Asghari et al., 2021b; Asghari et al., 2021a; Badparva et al., 2017; Barati et al., 2022; Fusaro et al., 2024; Kumarasamy et al., 2023; Rostami et al., 2017; Shams et al., 2021, Shams et al., 2022b; Shams et al., 2022a; dos Zanetti et al., 2020). However, there are few studies on the frequency and STs distribution of Blastocystis spp. in aquatic animals, possibly because of the challenge in sampling these animals. As many individuals worldwide are beginning to consume aquatic foods like fish and bivalves, the examination for parasitic infections such as Blastocystis spp. in these animals is crucial. Thus, this study was conducted to determine the prevalence and STs distribution of Blastocystis spp. in marine animals (fish, bivalves, and sponges) using existing information in this area.

2 Methods

2.1 Ethics approval and study type

The study received approval from the Ethics Committee of Qazvin University of Medical Sciences, Qazvin, Iran (approval no. IR.QUMS.REC.1403.176). It was a global systematic review and meta-analysis for the prevalence and subtype distribution of Blastocystis spp. in marine animals (fish, bivalves, and sponges). The research adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines (Moher et al., 2015).

2.2 Database search

The study analysed four global databases: Medline/PubMed, ProQuest, Scopus, and the Web of Knowledge, for articles published until June 13, 2024. Google Scholar was consulted for grey literature. The search was performed using Medical Subject Heading (MeSH) terms alone or in combination: (“Intestinal Parasites” OR “Parasitic Infections” OR “Blastocystis spp.”) AND (“Prevalence” OR “Epidemiology” OR “Frequency” OR “Occurrence”) AND (“Subtype” OR “Subtyping”) AND (“Aquatic animals” OR “Marine animals” OR “Fish” OR “Molluscs” OR “Bivalves” OR “Sponges”). To include more pertinent papers, extra keywords were utilized, and the references of relevant papers were examined. The data collected was input into EndNote X9 software, and duplicate articles were automatically removed. Two researchers independently reviewed the articles.

2.3 Inclusion/exclusion criteria

Cross-sectional studies from all languages, regions, and time periods that reported Blastocystis spp. prevalence in marine animals using microscopy, molecular, and serological methods were evaluated in this review. Studies on non-marine animals, humans and plants, case reports, commentaries, reviews, and studies that lacked total sample size or Blastocystis spp. prevalence rate were excluded from this review.

2.4 Data selection criteria

Papers were evaluated for inclusion or exclusion based on the Joanna Briggs Critical Appraisal Checklist for Studies Reporting Prevalence Data (Munn et al., 2014). Studies scoring 4–6 points were considered as moderate-quality, while those scoring 7 points or more were classified as high-quality. Articles with scores ≤3 were excluded. Two researchers extracted key data from the chosen papers, which were then validated by other researchers. The extracted information included the primary author's last name, animal type, quality assessment score, publication year, implementation year, continent, country, World Health Organization (WHO) classification, total sample size, and number of infected samples.

2.5 Statistical analysis

Statistical analyses utilized the Comprehensive Meta-Analysis (CMA) v3 software. P-values below 0.05 were deemed statistically significant. The random-effects model was employed to evaluate Blastocystis spp. prevalence by estimating pooled prevalence and 95 % CIs. Subgroup analysis was conducted to assess the weighted prevalence of infection by animal types, WHO regions, countries, publication years, continents, sample size, and diagnostic methods. A forest plot diagram was created to display the pooled prevalence with 95 % CIs. The funnel plot was used to assess publication bias in the analysis. Heterogeneity across studies was evaluated using the I2 index. Values below 25 %, 25–50 %, and over 50 % were categorized as low, moderate, and high heterogeneity. Furthermore, a sensitivity analysis was conducted to examine changes in the final weighted prevalence of Blastocystis spp. by excluding specific studies.

3 Results

3.1 Article selection

Rigorous searches of four international databases found a total of 5792 initial records. After removing duplicates and reviewing the remaining 3547 records, a total of 13 articles were ultimately selected. Additionally, a quality assessment based on JBI criteria led to the exclusion of two more studies. Finally, a total of 11 relevant papers (11 datasets) met the inclusion criteria for this study (Fig. 1).Fig. 1 Flowchart of the included eligible studies in the present study.

Fig. 1

3.2 Qualitative and quantitative characteristics of the papers included

The analysis included 11 articles/datasets (five related to fish, five to bivalves, and one to sponges) published between 1997 and 2024. Out of the 1329 marine hosts, 742 were fish, 567 were bivalves, and 20 were sponges. France and Mexico published the most studies with two papers each, followed by single papers from each of Chile, China, Germany, Iran, Malaysia, Poland, and Qatar. Sample sizes ranged from 18 to 374 marine animals in the 11 studies. Seven papers detailed the subtype distribution of Blastocystis spp. in marine animals. Molecular method was the prevalent diagnostic technique in eight studies, with microscopy and culture techniques utilized in one and two studies, respectively (Table 1). The evaluation with the JBI checklist indicated that 6 papers were classified as high quality (>6 points), while the other 5 articles were deemed to be of moderate quality (4–6 points) (Supplementary Table 1).Table 1 The main data from 11 studies in this review about the prevalence and subtype distribution of Blastocystis spp. in marine animals.

Table 1Author, year	Examined animals	Most infected animals	Time tested	Country	Total no.	Infected no.	Prevalence (%)	Method	STs e	
Konig and Müller, 1997	Fish	UCa	UC	Germany	18	2	11.1	Cl b	–	
Słodkowicz-Kowalska et al., 2015	Mussels	UC	2012	Poland	114	4	3.5	Mic c	–	
Martínez-Barbabosa et al., 2018	Oysters	UC	UC	Mexico	30	15	50	Mic and Mol d	–	
Compean et al., 2018	Oysters	UC	2016–2017	Mexico	250	166	66.4	Mic and Mol	ST1 and UNf	
Gantois et al., 2020	Fish	Herring	2019	France	374	16	4.3	Mol	ST8, ST10g, ST7, ST2, ST4, ST3	
Rauff-Adedotun et al., 2022	Fish	UC	UC	Malaysia	123	0	0	Cl	–	
Wang et al., 2024	Fish	Chinese sturgeon	2020–2022	China	27	3	11.1	Mol	ST1 and UN	
Ryckman et al., 2024	Mussels	UC	2023	France	100	62	62	Mol	ST3, ST44, ST14, ST26, ST7, ST23, Mixed/UN	
Suarez et al., 2024	Mussels	UC	2022	Chile	73	9	12.3	Mol	ST3 and UN	
Boughattas et al., 2024	Sponges	UC	UC	Qatar	20	2	10	Mol	ST3	
Asghari et al., 2024a	Fish	Narrow-barred mackerel	2022–2023	Iran	200	4	2	Mol	ST2, ST1, ST7	
a Unclear.

b Culture method.

c Microscopic detection.

d Molecular detection.

e Subtypes.

f Unidentified subtypes.

g This subtype, identified as ST10, exhibits a sequence similarity of 92 % with sequences found in GenBank, suggesting that it may be a new subtype.

3.3 Overall prevalence of Blastocystis spp. in marine animals

The global occurrence of Blastocystis spp. in marine animals across different countries is illustrated in Fig. 2. This study revealed that 12.4 % (95 % CI: 4.3–31 %) of global marine animals were infected by Blastocystis spp. (Fig. 3). Statistical analysis revealed a considerable degree of heterogeneity among the included studies in the current systematic review and meta-analysis (Q = 328.1, I2 = 96.9 %, P = 0.000).Fig. 2 The global occurrence of Blastocystis spp. in marine animals across different countries (the numbers following the country names and the cases in parentheses indicate the prevalence rate of Blastocystis spp.)

Fig. 2

Fig. 3 The worldwide prevalence of Blastocystis spp. in marine animals using a random-effects model and 95 % CIs.

Fig. 3

3.4 Pooled prevalence of Blastocystis spp. based on marine animal types

Among marine animals, bivalves exhibited the highest Blastocystis spp. infection rate at 32 % (95 % CI: 13–59.7 %), followed by sponges with a single study at 10 % (95 % CI: 2.5–32.4 %), and fish at 4.4 % (95 % CI: 2–9.3 %) (Table 2 and Supplementary Fig. 1).Table 2 Subgroup analysis of Blastocystis spp. in marine animals by publication year, continent, WHO region, country, sample size, and diagnostic method.

Table 2Subgroup variable	Prevalence % (95 % CI)	Heterogeneity (Q)	df (Q)	I2 (%)	P-value	
Publication year						
 <2020	24.8 (5.5–65.3)	69.2	3	95.7	P < 0.05	
 2020–2024	7.8 (1.8–28.8)	166.4	6	96.4	P < 0.05	
Continent						
 Asia	4.1 (1.2–13.4)	9.6	3	68.7	P < 0.05	
 Europe	12.1 (1.4–57.6)	141.6	3	97.9	P < 0.05	
 North America	60.5 (44.5–74.5)	3.1	1	67.4	P > 0.05	
 South America	12.3 (6.5–22)	0	0	0	P > 0.05	
WHO region						
 AMR	40 (12.2–76.2)	49.1	2	95.8	P < 0.05	
 EMR	4.2 (0.8–18.5)	3.5	1	71.8	P > 0.05	
 EUR	12.1 (1.4–57.6)	141.6	3	97.9	P < 0.05	
 WPR	2.8 (0.1–44.3)	4.9	1	79.7	P > 0.05	
Country						
 Chile	12.3 (6.5–22)	0	0	0	P > 0.05	
 China	11.1 (3.6–29.3)	0	0	0	P > 0.05	
 France	21.3 (0.8–90.2)	120.1	1	99.2	P < 0.05	
 Germany	11.1 (2.8–35.2)	0	0	0	P > 0.05	
 Iran	2 (0.8–5.2)	0	0	0	P > 0.05	
 Malaysia	0 (0–6.1)	0	0	0	P > 0.05	
 Mexico	60.5 (44.5–74.5)	3.1	1	67.4	P > 0.05	
 Poland	3.5 (1.3–9)	0	0	0	P > 0.05	
 Qatar	10 (2.5–32.4)	0	0	0	P > 0.05	
Sample size						
 <100	17 (6.8–36.3)	20.3	4	80.3	P < 0.05	
 100–400	9.5 (1.8–37.5)	288.2	5	98.3	P < 0.05	
Diagnostic method						
 Cl	2.7 (0.1–43.8)	4.6	1	78.1	P < 0.05	
 Mic	3.5 (1.3–9)	0	0	0	P > 0.05	
 Mol	18.7 (6–45.2)	277.1	7	97.5	P < 0.05	

3.5 Subtype distribution of Blastocystis spp. in marine animals

The findings revealed that marine animals can harbor different Blastocystis spp. STs (ST1-ST4, ST7, ST8, ST10, ST14, ST23, ST26, and ST44), with all types, except the last two, capable of spreading to humans. In particular, fish were identified as carriers of ST1-ST4, ST7, ST8, ST10, whereas bivalves carried ST1, ST3, ST44, ST14, ST26, ST7, and ST23 (Table 1).

3.6 Weighted prevalence of Blastocystis spp. in marine animals based on examined subgroups

The subgroup-based prevalence of Blastocystis spp. in marine animals is displayed in Table 2 and Supplementary Figs. 2–7.

3.7 Sensitivity analysis

Based on the sensitivity analysis, excluding particular datasets on Blastocystis spp. in marine animals did not notably alter the overall frequency (Supplementary Fig. 8).

3.8 Publication bias

A significant publication bias was detected in the current systematic review and meta-analysis (Egger's regression: intercept = − 6.805, 95 % lower limit = − 12.12, 95 % upper limit = − 1.48, t-value = 2.89, P = 0.017) (Fig. 4).Fig. 4 The funnel plot shows the publication bias in the present study.

Fig. 4

4 Discussion

The present review with 12.4 % (95 % CI: 4.3–31 %) found a moderate occurrence of Blastocystis spp. in marine animals, with bivalves showing a higher occurrence (32 %; 95 % CI: 13–59.7 %) compared to sponges (10 %; 95 % CI: 2.5–32.4 %) and fish (4.4 %; 95 % CI: 2–9.3 %). Of note, due to limited research, the true prevalence of Blastocystis spp. in these hosts remains unclear. Therefore, caution is advised when interpreting the prevalence rates from this study's analysis. Of note, in areas with high marine animal consumption, the risk of parasitic infections such as Blastocystis spp. should be taken seriously. After conducting the sensitivity analysis, the exclusion of specific datasets on Blastocystis spp. in marine animals did not significantly change the overall frequency. Furthermore, following the elimination of these datasets, the estimated prevalence of Blastocystis spp. in marine animals was around 9.6–15.3 %.

Subgroup analysis by year of publication revealed that more recent studies indicate a lower prevalence [7.8 % (95 % CI 1.8–28.8)] of Blastocystis spp. in marine animals. This shift could be attributed to the adoption of advanced molecular techniques and more accurate reporting of infection rates. Furthermore, research conducted across WHO regions, continents, and countries revealed a significantly high prevalence of Blastocystis spp. infection in marine animals in the AMR region [40 % (95 % CI: 12.2–76.2)] and on the continent of North America including Mexico [60.5 % (95 % CI: 44.5–74.5)]. Adherence to health protocols and raising public awareness regarding the consumption of raw or undercooked food in these regions is strongly advised. Increasing the sample size from <100 to 100–400 resulted in nearly halving the reported prevalence of Blastocystis spp. in marine animals, underscoring the significance of a large sample size in epidemiological research to ascertain the accurate prevalence of the targeted infection. Molecular methods (18.7 %; 95 % CI: 6–45.2) showed notably better diagnostic accuracy for identifying Blastocystis spp. in samples from marine animals compared to microscopic (3.5 %; 95 % CI: 1.3–9) and culture (2.7 %; 95 % CI: 0.1–43.8) methods. However, the number of studies varied significantly across diagnostic methods, and with an equal number of studies, the results could change entirely. Overall, the analyses in this study are mainly derived from a small pool of research and necessitate thorough interpretation.

Animals play a crucial role in the One-Health policy related to human health (Murtaugh et al., 2017). Out of the 40–44 reported STs of Blastocystis spp., 17 are zoonotic (ST1-ST10, ST12-ST14, ST16, ST23, ST35, and ST41) (Santin et al., 2024). This review found that marine animals can carry various Blastocystis spp. STs (ST1-ST4, ST7, ST8, ST10, ST14, ST23, ST26, and ST44), many of which (ST1-ST4, ST7, ST8, ST10, ST14, and ST23) can be transmitted to humans. Fish and bivalves were found to carry four STs (ST1-ST4, ST7, ST8, and ST10) and (ST1, ST3, ST44, ST14, ST26, ST7, and ST23), respectively. Overall, the research suggests that consuming raw or undercooked marine animals can lead to the spread of zoonotic Blastocystis spp. STs, potentially causing digestive issues. Furthermore, these animals can be consumed by larger predators, expanding the transmission cycle of Blastocystis spp., necessitating control and preventive actions in this area.

Parasitic infections like Blastocystis spp. can be transmitted from marine animals to humans through various means, including consumption of contaminated seafood, contact with infected water, environmental contamination, and food preparation practices. Preventive measures to reduce transmission include thoroughly cooking seafood, practising good hygiene, avoiding contaminated water, ensuring safe food preparation, and undergoing regular health check-ups. Following these practices can significantly lower the risk of transmission. To enhance the sampling of marine animals for studying parasitic infections like Blastocystis spp., future research can benefit from strategies such as collaborating with fisheries, employing non-invasive techniques like collecting water or fecal samples, and utilizing technologies like drones or underwater robots for preliminary surveys to locate and identify target species without disturbance.

This review encountered certain constraints, including a scarcity of prevalence data in many global regions, imprecise diagnostics such as molecular tests with good sensitivity and specificity, the inclusion of only one study in certain marine animal categories (e.g. sponges), and reliance on studies with limited sample sizes. These limitations hindered arriving at a definitive conclusion, yet our findings provided an assessment of the present status of Blastocystis spp. in marine animals.

5 Conclusion

This systematic review and meta-analysis study presented a 12.4 % moderate prevalence of Blastocystis spp. in marine animals, indicating that various species like fish, bivalves, and sponges can be infected with this protozoan parasite. Our findings highlighted that marine animals serve as proper hosts for different Blastocystis spp. STs, including zoonotic ones. Therefore, the significance of Blastocystis spp. infection, particularly its zoonotic STs, in the transmission from marine animals to humans and marine predatory species, should not be underestimated. Overall, investigating the prevalence and STs distribution of Blastocystis spp. in marine animals is an emerging field that warrants further exploration.

CRediT authorship contribution statement

Mohammad Ghafari-Cherati: Methodology, Investigation. Amin Karampour: Methodology, Investigation. Seyedeh-Sara Nazem-Sadati: Methodology, Investigation. Ali Asghari: Writing – review & editing, Writing – original draft, Methodology, Investigation, Conceptualization.

Declaration of competing interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Appendix A Supplementary data

Supplementary material 1

Image 1

Supplementary material 2

Image 2

Supplementary material 3

Image 3

Supplementary material 4

Image 4

Supplementary material 5

Image 5

Supplementary material 6

Image 6

Supplementary material 7

Image 7

Supplementary material 8

Image 8

Supplementary material 9

Image 9

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.fawpar.2024.e00242.
==== Refs
References

Abedi S.H. Fazlzadeh A. Mollalo A. Sartip B. Mahjour S. Bahadory S. Taghipour A. Rostami A. The neglected role of Blastocystis sp. and Giardia lamblia in development of irritable bowel syndrome: a systematic review and meta-analysis Microb. Pathog. 162 2022 105215
Asghari A. Sadeghipour Z. Hassanipour S. Abbasali Z. Ebrahimzadeh-Parikhani H. Hashemzaei M. Alimardani V. Hatam G. Association between Blastocystis sp. infection and immunocompromised patients: a systematic review and meta-analysis Environ. Sci. Pollut. Res. 28 2021 60308 60328
Asghari A. Sadrebazzaz A. Shamsi L. Shams M. Global prevalence, subtypes distribution, zoonotic potential, and associated risk factors of Blastocystis sp. in domestic pigs (Sus domesticus) and wild boars (Sus scrofa): a systematic review and meta-analysis Microb. Pathog. 160 2021 105183
Asghari A. Banavand S. Akhlaghzadeh M. Shamsi L. Hatam G. First molecular identification and subtyping of Blastocystis sp. in the most consumed edible marine fish of Iran: a foodborne concern Acta Parasitol. 1–7 2024
Asghari A. Yousefi A. Badali R. Mohammadi M.R. Shamsi L. Maleki F. Bahrami A.M. First molecular subtyping and zoonotic significance of Blastocystis sp. in dromedary (C. dromedarius) and Bactrian (C. bactrianus) camels in Iran: a molecular epidemiology and review of available literature Vet. Med. Sci. 10 2024 e1442 38578271
Asghari A. Yousefi A. Mohammadi M.R. Badali R. Shamsi L. Köseoğlu A.E. Abbaszadeh A. Shams M. Mohammadi-Ghalehbin B. Comparative molecular epidemiology, subtype distribution, and zoonotic potential of Blastocystis sp. in Equus animals (horses, donkeys, and mules) in northwestern Iran Comp. Immunol. Microbiol. Infect. Dis. 2024 102124 38262257
Badparva E. Ezatpour B. Mahmoudvand H. Behzadifar Masoud Behzadifar Meysam Kheirandish F. Prevalence and genotype analysis of blastocystis hominis in Iran: a systematic review and meta-analysis Arch. Clin. Infect. Dis. 12 2017 1 9
Barati M. KarimiPour A. Rahmanian V. Bahadory S. Abdoli A. Rezanezhad H. Solhjoo K. Taghipour A. Global prevalence and subtype distribution of blastocystis sp. in rodents, birds, and water supplies: a systematic review and meta-analysis Prev. Vet. Med. 2022 105770 36181747
Bastaminejad S. Eskandari P. Mohammadi M.R. Shamsi L. Asghari A. Shahabi S. Omidian M. Pouryousef A. Shahriari B. Identification of Blastocystis spp. in urban rodents of different districts in southwestern Iran: subtype distribution and possible zoonotic potential Acta Parasitol. 2024 1 7 37987883
Boughattas S. Al-Khater A. Albatesh D. Giraldes B.W. Abu-Madi M. Althani A.A. Benslimane F.M. Molecular investigation of waterborne protozoan contamination using marine Demospongiae Ecol. Indic. 158 2024 111298
Compean J.M.C. Bustos-Martínez J. Barbabosa I. del Martínez M. Hamdan-Partida A. Detection and typing of Blastocystis spp. in oysters (Crassostrea virginica) Collected in Actopan River, Chachalacas, Veracruz 2018
dos Zanetti A.S. Malheiros A.F. De Matos T.A. Longhi F.G. Moreira L.M. Silva S.L. Castrillon S.K.I. Ferreira S.M.B. Ignotti E. Espinosa O.A. Prevalence of Blastocystis sp. infection in several hosts in Brazil: a systematic review and meta-analysis Parasit. Vectors 13 2020 1 15 31900233
Fusaro C. Bernal J.E. Baldiris-Ávila R. González-Cuello R. Cisneros-Lorduy J. Reales-Ruiz A. Castro-Orozco R. Sarria-Guzmán Y. Molecular prevalence and subtypes distribution of Blastocystis spp. in humans of Latin America: a systematic review Trop. Med. Infect. Dis. 9 2024 38 38393127
Gantois N. Lamot A. Seesao Y. Creusy C. Li L.-L. Monchy S. Benamrouz-Vanneste S. Karpouzopoulos J. Bourgain J.-L. Rault C. First report on the prevalence and subtype distribution of Blastocystis sp. in edible marine fish and marine mammals: a large scale-study conducted in Atlantic northeast and on the coasts of northern France Microorganisms 8 2020 460 32213897
Guilavogui T. Gantois N. Even G. Desramaut J. Dautel E. Denoyelle C. Cissé F.I. Touré S.C. Kourouma B.L. Sawant M. Detection, molecular identification and transmission of the intestinal protozoa Blastocystis sp. in Guinea from a large-scale epidemiological study conducted in the Conakry area Microorganisms 10 2022 446 35208899
Konig G. Müller H.E. Blastocystis hominis in animals: incidence of four serogroups Zentralblatt für Bakteriol. 286 1997 435 440
Kumarasamy V. Rajamanikam A. Anbazhagan D. Atroosh W.M. Azzani M. Subramaniyan V. Abdullah S.R. Systematic review and Meta-analysis: epidemiology of human Blastocystis spp. infection in Malaysia Trop. Med. Infect. Dis. 8 2023 415 37624353
Martínez-Barbabosa I. Gutiérrez-Cárdenas E.M. Hamdan-Partida A. Bustos-Martínez J. Shea M. Presencia de Blastocystis spp. en el molusco Crassostrea virginica, en la Ciudad de México Rev. Salud Anim. 40 2018
Mohammad N.A. Al-Mekhlafi H.M. Moktar N. Anuar T.S. Prevalence and risk factors of Blastocystis infection among underprivileged communities in rural Malaysia Asian Pac J Trop Med 10 2017 491 497 28647187
Mohammad N.A. Al-Mekhlafi H.M. Anuar T.S. Subtype Distribution of Blastocystis Isolated from Humans and Associated Animals in an Indigenous Community with Poor Hygiene in Peninsular Malaysia 2018
Moher D. Shamseer L. Clarke M. Ghersi D. Liberati A. Petticrew M. Shekelle P. Stewart L.A. Group, P.-P Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement Syst. Rev. 4 2015 1 9 25554246
Munn Z. Moola S. Riitano D. Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence Int. J. Health Policy Manag. 3 2014 123 25197676
Murtaugh M.P. Steer C.J. Sreevatsan S. Patterson N. Kennedy S. Sriramarao P. The Science behind One Health: At the Interface of Humans, Animals, and the Environment 2017 Wiley Online Library
Rauff-Adedotun A.A. Syafyqah S.N. Soleha R.N. Shahida S.N. Haziqah M.T.F. Prevalence of Blastocystis sp. in freshwater fishes, poultry, and caprine from Penang, Malaysia Vet. Parasitol. Reg. Stud. Reports 33 2022 100749
Roberts T. Stark D. Harkness J. Ellis J. Update on the pathogenic potential and treatment options for Blastocystis sp Gut Pathog. 6 2014 1 9 24447766
Rostami A. Riahi S.M. Haghighi A. Saber V. Armon B. Seyyedtabaei S.J. The role of Blastocystis sp. and Dientamoeba fragilis in irritable bowel syndrome: a systematic review and meta-analysis Parasitol. Res. 116 2017 2361 2371 28668983
Ryckman M. Gantois N. Dominguez R.G. Desramaut J. Li L.-L. Even G. Audebert C. Devos D.P. Chabé M. Certad G. Molecular identification and subtype analysis of Blastocystis sp. isolates from wild mussels (Mytilus edulis) in northern France Microorganisms 12 2024 710 38674653
Salvador F. Sulleiro E. Sánchez-Montalvá A. Alonso C. Santos J. Fuentes I. Molina I. Epidemiological and clinical profile of adult patients with Blastocystis sp. infection in Barcelona, Spain Parasit. Vectors 9 2016 1 7 26728523
Santin M. Figueiredo A. Molokin A. George N.S. Köster P.C. Dashti A. González-Barrio D. Carmena D. Maloney J.G. Division of Blastocystis ST10 into three new subtypes: ST42-ST44 J. Eukaryot. Microbiol. 71 2024 e12998
Shams M. Shamsi L. Sadrebazzaz A. Asghari A. Badali R. Omidian M. Hassanipour S. A systematic review and meta-analysis on the global prevalence and subtypes distribution of Blastocystis sp. infection in cattle: a zoonotic concern Comp. Immunol. Microbiol. Infect. Dis. 76 2021 101650
Shams M. Asghari A. Baniasad M. Shamsi L. Sadrebazzaz A. Blastocystis sp. in small ruminants: a universal systematic review and meta-analysis Acta Parasitol. 67 2022 1073 1085 35834160
Shams M. Shamsi L. Yousefi A. Sadrebazzaz A. Asghari A. Mohammadi-Ghalehbin B. Shahabi S. Hatam G. Current global status, subtype distribution and zoonotic significance of Blastocystis in dogs and cats: a systematic review and meta-analysis Parasit. Vectors 15 2022 225 35733146
Shams M. Bahrami A.M. Mousivand A. Shamsi L. Asghari A. Shahabi S. Sadrebazzaz A. First molecular characterization of Blastocystis subtypes from domestic animals (sheep and cattle) and their animal-keepers in Ilam, western Iran: A zoonotic concern J. Eukaryot. Microbiol. 2024 e13019 38225853
Słodkowicz-Kowalska A. Majewska A.C. Rzymski P. Skrzypczak Ł. Werner A. Human waterborne protozoan parasites in freshwater bivalves (Anodonta anatina and Unio tumidus) as potential indicators of fecal pollution in urban reservoir Limnologica 51 2015 32 36
Suarez P. Vallejos-Almirall A. Fernández I. Gonzalez-Chavarria I. Alonso J.L. Vidal G. Identification of Cryptosporidium parvum and Blastocystis hominis subtype ST3 in Cholga mussel and treated sewage: preliminary evidence of fecal contamination in harvesting area Food Waterborne Parasitol. 34 2024 e00214
Vassalos C.M. Vakalis N. Papadopoulou C. Blastocystis and its pathogenic potential: latest aspects Rev. Res. Med. Microbiol. 19 2008 87 97
Wang Y. Zhang C. Nan H. Yin S. Cao M. An R. Ma L. Molecular Detection and Subtype Distribution of Blastocystis sp. in Cold-water Fish and Cultured Water 2024
