Global prevalence and risk factors of Enterocytozoon bieneusiinfection in humans: a systematic review and meta-analysis

Enterocytozoon bieneusiis one of the most important zoonotic pathogens. In this study, we present a systematic review and meta-analysis of the prevalence of human E. bieneusiinfection in endemic regions and analyze the various potential risk factors. A total of 75 studies were included. Among 31,644 individuals tested, 2,291 (6.59%) were E. bieneusi-positive. The highest prevalence of E. bieneusiin the male population was 5.50%. The prevalence of E. bieneusiin different age groups was varied, with 10.97% in teenagers. The prevalence of E. bieneusiin asymptomatic patients (6.49%) is significantly lower than that in HIV-infected patients (11.49%), and in patients with diarrheal symptoms (16.45%). Rural areas had a higher rate (7.58%) than urban ones. The prevalence of E. bieneusiin humans was the highest (6.42%) at altitudes <10 m. Moreover, the temperate zone marine climate (13.55%) had the highest prevalence. A total of 69 genotypes of E. bieneusihave been found in humans. This is the first global study regarding E. bieneusiprevalence in humans. Not only people with low immunity (such as the elderly, children, people with HIV, etc.), but also people in Europe in temperate marine climates should exercise caution to prevent infection with E. bieneusiduring contact process with animals.