Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jan 19;14(1):5-17.
doi: 10.1093/inthealth/ihab026.

Global epidemiology of Giardia duodenalis infection in cancer patients: a systematic review and meta-analysis

Farzad Mahdavi  1 , Alireza Sadrebazzaz  2 , Amir Modarresi Chahardehi  3 , Roya Badali  4 , Mostafa Omidian  5 , Soheil Hassanipour  6 , Ali Asghari  5
Affiliations
Meta-Analysis

Global epidemiology of Giardia duodenalis infection in cancer patients: a systematic review and meta-analysis

Farzad Mahdavi et al. Int Health. .

Abstract

Background: Application of chemotherapeutics in cancer patients may provide an immunosuppressive milieu, favourable for parasitic infections. Giardia duodenalis is an important zoonotic intestinal parasite responsible for diarrhoea in humans worldwide.

Methods: The present systematic review and meta-analysis was conducted to estimate the prevalence of G. duodenalis and respective odds ratios (ORs) in cancer patients around the globe. Four online databases-PubMed, Scopus, Web of Science and Google Scholar-were carefully explored for relevant literature without time limitation until 28 November 2020. Meta-analysis was done based on a random effects model to pool the estimations and define 95% confidence intervals (CIs).

Results: The overall weighted prevalence of G. duodenalis infection in cancer patients was calculated to be 6.9% (95% CI 0.5 to 9.3) globally, based on data from 32 studies. Although not statistically significant, eight case-control studies revealed that cancer patients were 1.24 times (95% CI 0.66 to 2.31; p=0.501) more exposed to G. duodenalis infection than healthy controls. Moreover, the prevalence of infection was not significantly associated with quantitative variables, including publication year (regression coefficient -0.0135, p=0.578), sample size (regression coefficient -0.0007, p=0.074) and human development index (regression coefficient -1.6263, p=0.419). Also, subgroup analysis of the pooled G. duodenalis infection was performed for publication year, World Health Organization regions, countries, continents, cancer types and country income.

Conclusions: Altogether, the epidemiology of G. duodenalis infection and its associated risk factors in immunocompromised individuals, especially cancer patients, is still open to question and deserves comprehensive investigations.

Keywords: Giardia duodenalis; Giardia intestinalis; Giardia lamblia; cancer patients; meta-analysis; odds ratios (ORs); prevalence; systematic review.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of the included eligible studies in the systematic review.
Figure 2.
Figure 2.
The estimated pooled prevalence of G. duodenalis infection in cancer patients.
Figure 3.
Figure 3.
A meta-analysis of the association of cancer patients and G. duodenalis infection using random effects analysis.
Figure 4.
Figure 4.
The global estimated pooled random effects prevalence of cancer patients based on each country for G. duodenalis infection.
Figure 5.
Figure 5.
The meta-regression shows an absence of a statistically significant association between the prevalence of G. duodenalis infection in cancer patients and quantitative variables such as (A) publication year, (B) sample size and (C) HDI.
Figure 6.
Figure 6.
Funnel plot showing the absence of publication bias among the included studies (p=0.221).
See this image and copyright information in PMC

References

    1. Plata JD, Castañeda X. Parasites in cancer patients. Oncol Crit Care. 2020; : 1441–50.
    1. Asghari A, Zare M, Hatam G et al. Molecular identification and subtypes distribution of Blastocystis sp. isolated from children and adolescent with cancer in Iran: evaluation of possible risk factors and clinical features. Acta Parasitol. 2020;65:462–73. - PubMed
    1. Van Tong H, Brindley PJ, Meyer CG et al. Parasite infection, carcinogenesis and human malignancy. EBioMedicine. 2017;15:12–23. - PMC - PubMed
    1. Hooshyar H, Rostamkhani P, Arbabi M et al. Giardia lamblia infection: review of current diagnostic strategies. Gastroenterol Hepatol Bed Bench. 2019;12(1):3–12. - PMC - PubMed
    1. Jian Y, Zhang X, Li X et al. Occurrence of Cryptosporidium and Giardia in wild birds from Qinghai Lake on the Qinghai-Tibetan Plateau. China Parasitol Res. 2021;120:615–28. - PubMed