Skip to main content
NCBI home page
BMC Gastroenterology logoLink to BMC Gastroenterology
. 2025 Aug 13;25:584. doi: 10.1186/s12876-025-04144-y

Global prevalence and correlation of intestinal parasitic infections in patients with colorectal cancer: a systematic review and meta-analysis

Maryam Hataminejad 1,2,#, Bahareh Basirpour 1,2,#, Melika Baharlou 1,2, Masoumeh Gholami Koohestan 3,4, Hajar Ziaei Hezarjaribi 2,4, Bahman Rahimi Esboei 2,4, Shirzad Gholami 2,4, Seyed Abdollah Hosseini 2,4,✉, Reza Saberi 3,4,✉
PMCID: PMC12351808  PMID: 40804378

Abstract

Objective

Colorectal cancer (CRC) is a leading cause of cancer-related deaths globally, and researchers continue to explore its underlying factors. This systematic review and meta-analysis study aimed to clarify the prevalence and potential association between intestinal parasitic infections (IPIs) and CRC.

Methods

A comprehensive search was conducted across databases that contain articles in English, including PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar, to identify articles published up to October 2024 that reported on the prevalence of IPIs in CRC patients. Selected studies were screened according to inclusion and exclusion criteria. A random-effects model was used to estimate the pooled prevalence and odds ratios (ORs) for association IPIs in CRC.

Results

A total of 70 studies were included, and 46 case–control and cross-sectional studies were analyzed. The pooled prevalence of IPIs among CRC patients was determined to be 19.67% (95% CI: 14.81% to 25.02%). Furthermore, individuals with parasitic infections exhibited a significantly higher likelihood of developing CRC, with an OR of 3.61 (95% CI: 2.41—5.43).

Conclusion

This study demonstrated a significantly high prevalence of parasitic infections, including both helminths and protozoa, among patients with CRC. The analysis revealed a notable association between IPIs and CRC, suggesting that these infections may contribute to the development and progression of the cancer.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-025-04144-y.

Keywords: Colorectal cancer, Intestinal parasitic infection, Systematic review, Meta-analysis

Introduction

Colorectal cancer (CRC) is a major global health issue, ranking second among malignancies in terms of mortality, with approximately 9.2% of cases resulting in death [1]. Although there have been progresses in surgical methods, the adoption of screening and updated therapy guidelines [2], evidence suggests a concerning trend, with anticipated rises of 60% and 71.5% in mortality rates for rectal and colon cancer to the year 2035, respectively [3]. These statistics emphasize the urgent need for enhanced prevention, early detection, and effective treatment strategies to address the growing burden of CRC worldwide [1].

There are numerous environmental and biological risk factors contributing to the development of CRC, among them, infectious pathogens are increasingly recognized as potential contributors to CRC [4]. Research indicates that approximately 16% of cancers worldwide are attributable to infectious agents [5]. This connection is particularly evident in CRC, where various studies have explored how bacteria and viruses may influence the disease's onset and progression [5]. Viruses are implicated in CRC development via direct infection of cells and indirect modulation of the gut microbiome [6]. For example, human papillomavirus (HPV) and cytomegalovirus are viruses associated with colon cancer risk, while Fusobacterium nucleatum, Enterococcus faecalis, Escherichia coli, and Salmonella sp. are bacteria that have been implicated in CRC [6].

Intestinal parasite infections (IPIs), especially in developing countries, are associated with various gastrointestinal disorders and may contribute to the development of CRC [7]. IPIs, comprising protozoa such as Cryptosporidium spp., Blastocystis spp., and Entamoeba histolytica, as well as helminths like Schistosoma spp., can provoke chronic inflammation and immunological dysregulation [8]. Previous researches suggested that immunopathological responses to parasitic infections may promote conditions favorable for cancer development [8]. Particularly, chronic inflammation plays a crucial role in triggering multiple cancers, including CRC [9]. Moreover, the inflammatory responses elicited by parasitic infections can promote carcinogenesis and contribute to the onset of CRC through different mechanisms including increasing oxidative stress that cause DNA damage, production of inflammatory cytokines such as IL-6, TNF-α, NF-κB which enhance cell proliferation, and modifications in the local microenvironment [7]. These connections underscore the intricate relationship between parasites and particular cancer types, accentuating the necessity of early detection, prevention, and efficacious treatments to mitigate long-term cancer risks linked to IPIs (6).

While epidemiological evidence suggests a potential relationship between IPIs and CRC, current evidence exhibits wide heterogeneity in findings. These variations are likely to reflect methodological variation among study design, population genetics, endemicity gradients, and methods of diagnosis. Additionally, the exact pathobiological pathways underlying this association are not yet elucidated. To address these knowledge gaps, we conducted a systematic review and meta-analysis to determine the prevalence of IPIs in CRC patients and to assess the association between these infections and CRC.

Methods and search strategy

Study design

This systematic review and meta-analysis was designed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure methodological rigor and transparency in reporting [10].

Search strategy

A comprehensive search was conducted using Medical Subject Headings (MeSH) combined with ("Colorectal Neoplasm"OR “Colorectal"OR"CRC"OR"colon cancer") AND ("Parasitic Diseases"OR"parasite"OR"parasitic infection") AND ("Protozoan Infections"OR"protozoa") AND ("Helminthiasis"OR"helminth") keywords. We conducted a comprehensive literature review using PubMed, ScienceDirect, Web of Science, and Scopus databases, along with Google Scholar for supplementary verification, to identify global publications examining the prevalence and association between IPIs and CRC. The search included English-language articles published up to October 2024 by three researchers independently [MH, BB, and MB]. The references from the relevant papers were checked for other associated articles not indexed through the electronic databases that may have been missed. The search results from five databases were imported into the EndNote X20 library for management.

Inclusion and exclusion criteria

Following the removal of duplicate records, three researchers (MH, BB, and MB) conducted an independent review of the remaining records, applying pre-specified inclusion and exclusion criteria to identify eligible studies. Finally, the articles were assessed based on the following criteria: (1) cross-sectional or case–control studies about the prevalence and relationship between parasite infection and CRC, (2) case reports and experimental studies providing details on the parasitic infection and CRC, (3) published articles written in English, and (4) studies conducted and published up to October 2024. Studies were excluded if (1) studies were in other languages except English, (2) letters to the editor, (3) studies had insufficient information, and (4) studies presented only the final results without providing the raw data (Fig. 1).

Fig. 1.

Fig. 1

Open in a new tab

PRISMA flowchart diagram for the selection process of eligible studies

In the next step, four independent researchers (MH, BB, MGh, and MB) carefully reviewed all titles and abstracts identified, along with the full texts considered to be relevant. Possible disagreements were resolved by discussion and consensus with another author (RS). Titles and abstracts obtained from the initial electronic search were carefully assessed for potential inclusion based on the study type (prevalence of IPIs in CRC patients). Full texts were assessed, and unrelated articles were excluded. All articles that met the eligibility criteria were selected for the meta-analysis. Next, the desired data were extracted using a standardized data extraction form including the first author’s surname, the publication year, continent, countries, the types of methods used, the type of parasite, the type of cancer, total sample sizes, and the number of positive samples.

Study quality assessment

The quality of the included studies was evaluated using the Newcastle–Ottawa Scale (NOS) for case–control and cross-sectional studies. This quality assessment evaluates studies based on three main categories: selection, comparability, and exposure. Studies were rated as low, moderate, or high quality based on their scores. The NOS quality assessment assigned scores ranging from 0 to 9, with low quality defined as less than 3, moderate quality as 4 to 6, and high quality as 7 to 9.

Data analysis

In the current study, the StatsDirect statistical software package version 2.6.1 was used for data meta-analysis. Cochrane’s Q and the inverse variance (I2) statistics were employed to estimate the effects of probable factors in the heterogeneity of studies. If I2 was > 50% or > 75% and the P-value was < 0.01, the articles were considered to be heterogeneous or highly heterogeneous, respectively. If I2 was below 25%, the articles were considered homogeneous. Random- or fixed-effect models were used in case of significant or lack of heterogeneity to estimate the pooled prevalence and odds ratios (ORs) for association IPIs in CRC. In the last step, a funnel plot based on Egger’s test was used to calculate the possibility of publication bias during the analysis.

Results

Study characteristics

Our preliminary search on five databases, including PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar, yielded 1205 articles, but 46 were excluded from the study due to duplication. After a primary screening based on the titles of the articles, 99 studies were extracted. In the next step, by screening the abstracts and based on the inclusion/exclusion criteria, 29 articles were excluded. Finally, 70 articles were included in the analysis with respect to the inclusion/exclusion criteria (Fig. 1).

In this systematic review, the included papers were published between 1980 and 2024.

The data were derived from a comprehensive analysis of 70 studies, which encompassed case–control, and cross-sectional studies (n = 46), case report (n = 15), and experimental studies (n = 9). These investigations were conducted across 26 distinct countries, including China, Egypt, Iran, Uzbekistan, Turkey, Malaysia, Poland, Iraq, Colombia, Saudi Arabia, United Arab Emirates, Spain, United States America, Tunisia, Lebanon, Brazil, United Kingdom, Laos, Philippines, Tanzania, Netherlands, Korea, Sudan, Mexico, Germany and Japan. Our Meta-analysis included 46 case–control and cross-sectional studies (68 data sets), categorized into three distinct times: 6 studies from 1980 to 2008, 24 studies from 2012 to 2020, and 16 studies from 2020 to 2024. Table 1 is a baseline table of studies included in the meta-analyses.

Table 1.

The base line table of included cross-sectional and case–control studies

NO Author (Ref) Year Country Type of study Parasite Diagnostic methods NO. case NO. Positive case NO. control NO. Positive NOS QA score*
1 Seleem et al. [11] 2024 Egypt Case–control

Blastocystis spp. Cryptosporidium

E. histolytica

G. intestinalis Microsporidia

E. coli Iodamoeba butchilli

E. hartmani

 Microscopic 100

Blastocystis spp. (37)

Cryptosporidium (14)

E. histolytica (6)

G. intestinalis (6)

Microsporidia (6)

E. coli (4)

Iodamoeba butchilli (1)

E. hartmani (1)

 100

B. hominis (13)

E. coli (5)

E. histolytica (4)

G. intestinalis (3)

 8
2 Labania et al. [12] 2023 United Arab Emirates Case–control Blastocystis spp. Microscopic and PCR

52 (CRC = 15

COGT = 37)

CRC (n = 9)

COGT (n = 12)

 52 9 6
3 Abd El-Latif et al. [13] 2023 Egypt Case–control Cryptosporidium spp. Microscopic, ZIehl–Neelsen method (ZN), PCR, ELISA 40

Ziehl–Neelsen (13)

ELISA (17)

PCR (19)

 60

Ziehl–Neelsen (2)

ELISA (3)

PCR (3)

 7
4 Mona I Ali et al. [14] 2023 Egypt Case–control Cryptosporidium parvum Microscopic, Immunochromatographic and nested PCR 100

Microscopic (n = 7)

Immunochromatographic (n = 7)

nested PCR (n = 40)

 20 0 7
5 Gezici et al. [15] 2023 Turkey Case–control Blastocystis spp. Cryptosporidium spp. Giardia. intestinalis Cyclospora. Cayetanensis Microscopic 100

Blastocystis spp. (7)

Cryptosporidium spp. (4)

Giardia. intestinalis (2)

Cyclospora. Cayetanensis (1)

 100 Blastocystis spp. (2) 7
6 Ali et al. [16] 2022 Egypt Cross-sectional Blastocystis spp. Microscopic, Culture, and PCR 100 52 100 42 8
7 Chen et al. [17] 2022 China Cross-sectional Giardia intestinalis Microscopic and PCR 307 25 8
8 Ghanadi et al. [18] 2022 Iran Case–control Cryptosporidium spp. Microscopic, PCR, Histopathological tests, Immunochemical test 87 37 87 11 8
9 Haghighi et al. [19] 2022 Iran Cross-sectional Entamoeba histolytica PCR and immunohistochemical staining (IHC) 19 5 81 2 7
10 Castro et al. [20] 2022 Colombia Cross-sectional Blastocystis spp. Giardia intestinalis, and commensal amoebas Microscopic, Ziehl–Neelsen staining, PCR 28 Blastocystis spp. (24/80) Giardia intestinalis (2/80) and commensal amoebas (5/80) 6
11 Redondo et al. [21] 2022 Spain Case–control Microsporidia spp. Real-time PCR and IFA 87 36 25 0 8
12 Zhang et al. [22] 2022 China Case–control Pentatrichomonas hominis Nested PCR 25 8 9 6
13 Mahmoudvand et al. [23] 2021 Iran Case–control Blastocystis spp. Microscopic and PCR 67 16 67 6 8
14 Hawash et al. [24] 2021 Saudi Arabia Case–control Blastocystis spp. Microscopic 75 20 25 2 8
15 Sulzyc Bielicka et al. [25] 2021 Poland Case–control Blastocystis spp. Microscopic and PCR 107 13 124 3 8
16 Karabey et al. [26] 2021 Turkey Cross-sectional Cryptosporidium spp. Ziehl–Neelsen staining, real-time PCR and ELISA 94

Ziehl–Neelsen staining (n = 2)

real-time PCR (n = 5)

ELISA (n = 5)

 6
17 Asghari et al. [27] 2020 Iran Cross-sectional Blastocystis spp. Microscopic, culture, and PCR 4 2 6
18 Zhang et al. [28] 2020 China Case–control Cryptosporidium. Nested PCR 116 20 141 0 8
19 Nasir et al. [29] 2020 Iraq Case–control Cryptosporidium spp. Modified Ziehl–Neelsen and crypto-strip (Immunochromatographic Assay) 31 3 65 2 7
20 wang et al. [30] 2020 China Cross-sectional Schistosoma HE-stained formalin-fixed paraffin-embedded 351 137 6
21 Majeed et al. [31] 2019 Iraq Cross-sectional Blastocystis spp. Microscopic. Direct DNA sequencing 116 15 6
22 Esteghamati et al. [32] 2019 Iran Cross-sectional Blastocystis spp. Microscopic, nested PCR and amplification of the 18S rRNA gene 39 11 8
23 Mahmoudvand et al. [33] 2019 Iran Cross-sectional

Cystoisospora belli

Cyclospora cayetanensis

 Microscopic and Ziehl–Neelsen stain 87

C. belli (5)

C. cayetanensis (3)

 6
24 Zhang et al. [34] 2019 China Case–control Pentatrichomonas hominis Microscopic and nested PCR 116 44 142 13 8
25 Sulzyc Bielicka et al. [35] 2018 Poland Case–control Cryptosporidium spp. Immunoenzymatic test, Antigen-EIA technique 108 14 125 5 8
26 Essid et al. [36] 2018 Tunisia Cross-sectional Cryptosporidium spp. Modified Ziehl Neelsen stain and PCR 15 5 5
27 Toychiev et al. [37] 2018 Uzbekistan Case–control

Blastocystis spp. Entamoeba dispar

Entamoeba coli

Ascaris lumbricoides

Giardia intestinalis Hymenolepis nana

Enterobius vermicularis

Chilomastix mesnili

Iodamoeba butchilli

 Microscopic andZiehl–Neelsen staining 200

Blastocystis spp. (160)

Entamoeba dispar (2)

Entamoeba coli (14)

Ascaris lumbricoides (6)

Giardia intestinalis (20)

Hymenolepis nana (3)

Enterobius vermicularis (6)

Chilomastix mesnili (40)

Iodamoeba butchilli (45)

 200

Blastocystis spp. (36)

Entamoeba dispar (1)

Entamoeba coli (38)

Ascaris lumbricoides (4)

Giardia intestinalis (32)

Hymenolepis nana (4)

Enterobius vermicularis (9)

Chilomastix mesnili (6)

Iodamoeba butchilli (12)

 9
28 Dabbagh et al. [38] 2017 Iraq Case–control Blastocystis spp. Microscopic and ELISA 40 15 80 33 6
29 Mohamed et al. [39] 2017 Saudi Arabia Case–control Blastocystis spp. Microscopic, culture, and PCR 74 22 80 12 8
30 Osman et al. [40] 2017 Lebanon Case–control Cryptosporidium spp. Histological examination and PCR 93 colon cancer (n = 72) stomach cancer (n = 21) 125 9 8
31 Zhang et al. [41] 2017 China Cross-sectional

Enterocytozoon bieneusi

Blastocystis spp.

 PCR

Blastocystis (27)

Enterocytozoon bieneus (5)

 4 8
32 Yersal et al. [42] 2015 Turkey Cross-sectional Blastocystis spp. Microscopic, culture, and PCR 66 5 6
33 Feng et al. [43] 2015 China Cross-sectional Schistosoma Microscopic, Clonoscopy 60 26 6
34 Kumarasamy et al. [44] 2014 Malaysia Case–control Blastocystis spp. Microscopic, culture, and PCR 204 43 221 22 8
35 Sanad et al. [45], 2014 Saudi Arabia Case–control Cryptosporidium spp. Microscopic 20 14 42 8 7
36 Abdelkareem et al. [46] 2014 Malaysia Cross-sectional Schistosoma mansoni Microscopic, colonoscopy and histopathology 93 27 5
37 Liu et al. [47] 2013 China Cross-sectional Schistosoma Colonoscopy and Pathological Examination 179 32 5
38 Chandramathi et al. [48] 2012 Malaysia Cross-sectional Blastocystis spp. Microscopic and culture 15 7 5
39 Shebl et al. [49] 2012 United States Cross-sectional Cryptosporidium spp. Microscopic 320 7 6
40 Sulzyc Bielicka et al. [50] 2012 Poland Cross-sectional Cryptosporidium spp. Immunoenzymatic test 87 11 6
41 Machado et al. [51] 2008 Brazil Case–control Strongyloides stercoralis Baermann and Lutz, IFA, ELISA 33

parasitological methods: n = 3

Serological methods: n = 8

 44

parasitological methods: n = 1

Serological methods: n = 2

 7
42 Sulzyc Bielicka et al. [52] 2007 Poland Cross-sectional Cryptosporidium spp. Microscopic. Enzyme and immunoassay 55 23 5
43 Steer et al. [53] 2007 United Kingdom Cross-sectional Blastocystis spp. Microscopic 83 40 5
44 Qiu et al. [54] 2005 China Case–control Schistosoma japonicum Microscopic and Colonoscopy 142 42 285 41 7
45 Zhong Xu et al. [55] 1984 China Case–control Schistosoma japonicum skin test and histopathologic examination 252 21 252 11 6
46 Ming-Chai et al. [56] 1980 China Cross-sectional Schistosoma histopathologic and H&E stain 454 289 6
Open in a new tab

*High quality (7–9), moderate quality (4–6), and low quality (≤ 3) in case–control studies and high quality (6 and 7), moderate quality (3–5), and low quality (1 and 2) in cross sectional studies

Pooled prevalence of IPIs among CRC patients

The meta-analysis demonstrated high heterogeneity across the studies that were included in the analysis (Q = 2,191.58, I2 = 96.9%, P < 0.001). Since the heterogeneity was significant, the random effect was used to obtain the pooled prevalence of IPIs among CRC patients globally. Furthermore, the funnel plot and bias coefficient diagram indicated no evidence of publication bias (Harbord: bias = 3.33, Egger: bias = 6.14, P = 0.132). In general, the pooled prevalence of IPIs among the subjects studied in the world using the random effect method was 19.67% (95% CI = 14.81% to 25.02%) (Fig. 2). A total of 5,686 cases were examined in the study, among which 1,081 were identified as positive.

Fig. 2.

Fig. 2

Open in a new tab

A meta-analysis of the pooled prevalence of IPI among cancer patients using random effects analysis

Results of the subgroup analyses

Using a random-effects model, the pooled prevalence of helminthic and protozoan infections in the studied populations worldwide was calculated to be 20.79% (95% CI: 8.35% to 36.96%) and 19.4% (95% CI: 14.39% to 24.96%), respectively.

Based on Table 2, Schistosoma spp. had the highest pooled prevalence in CRC patients, which pooled prevalence is 31.87% (95% CI: 16.33%−49.84%) with a pooled OR of 3.04 (95% CI: 1.62% to 5.71%). Furthermore, among protozoan infections, Blastocystis spp. and Cryptosporidium spp. had the highest pooled prevalence in CRC patients. The subgroup analysis based on different diagnostic methods revealed that the highest pooled prevalence of IPIs in CRC patients was identified using molecular methods, specifically PCR, with a prevalence of 28.34% (95% CI: 20.43%—36.99%). Furthermore, the parasitological method, microscopy, revealed pooled prevalence rates of 15.04% (95% CI: 9.30%—21.88%). Moreover, the highest pooled prevalence of IPIs among CRC patients was observed in years < 2010, which is 34.95% (95% CI: 14.28%—59.16%).

Table 2.

The Pooled prevalence of protozoan and helminthic infection among CRC patients and pooled prevalence of IPI in CRC patients in different subgroups

 Variables No. study (datasets) Positivity percent Heterogeneity Publication bias
Pooled prevalence CI 95% Q I2 P-value Egger P value
Infection
 Protozoan 39 (58) 19.4% 14.39%−24–96% 1,431.44 96.1% P < 0.0001 6.22 P < 0.0001
 Helminthic 9 (10) 20.79% 8.35%- 36.96% 702.16 98.6% P < 0.0001 10.32 P = 0.05
Parasite
 Cryptosporidium 15 (15) 26.75% 15.21%−40.19% 384.74 96.4% P < 0.0001 6.30 P = 0.001
 Blastocystis spp. 19 (19) 30.62% 20.24%−42.10% 388.69 95.4% P < 0.0001 1.95 P = 0.537
 Schistosoma 7 (7) 31.87% 16.33%−49.84% 301.90 98% P < 0.0001 3.95 P = 0.67
 Pantatrichomonas 2 (2) 37.05% 29.32%−45.14% 0.26 0% P = 0.6081
 Microspora 2 (2) 19.36% 0.00%−64.57% 44.44 97.8% P = 0.6081
 Iodamoeba 2 (2) 9.29% 0.00%−39.31% 37.74 97.4% P < 0.0001
 Giardia intestinalis 5 (5) 6.15% 3.54%−9.41% 11.03 63.8% P = 0.02 0.93 P = 0.87
 Entamoeba histolytica 2 (2) 14.20% 0.00%−38.93% 5.69 82.4% P = 0.017
 Entamoeba coli 3 (3) 4.8% 1.66%−9.68% 6.59 69.7% P = 0.037
 Cyclospora 2 (2) 2.47% 0.00%−5.47% 1.19 16.2% P = 0.2747
Year
< 2010 6 (6) 34.95% 14.28–59.16% 268.86 98.1% P < 0.0001 3.61 P = 0.666
 2011–2020 24 (34) 20.12% 13.34–27.89% 1,15 97.1% P < 0.0001 6.54 P < 0.0001
 2020–2024 16 (28) 16.11% 10.53–22.60% 478.48 94.4% P < 0.0001 6.57 P < 0.0001
Diagnostic method
 ELISA 4 (4) 20.49% 11.21–31.70% 12.54 76.1% P = 0.0057 4.07 P = 0.0767
 Parasitological (Microscopy) 36 (40) 15.04% 9.30–21.88% 1,73 97.8% P < 0.0001 7.83 P < 0.0001
 Molecular (PCR) 24 (25) 28.34% 20.43–36.99% 370.73 93.8% P < 0.0001 5.29 P = 0.001
Country
 China 11 (13) 23.79% 12.53–37.32% 490.01 97.8% P < 0.0001 4.13 P = 0.445
 Colombia 1 (3) 11.15% 0.96–30.27% 29.48 93.2% P < 0.0001
 Egypt 4 (11) 14.93% 5.6–27.71% 269.07 96.3% P < 0.0001 8.64 P < 0.0001
 Iran 6 (7) 21.93% 9.47–37.77% 65.32 90.8% P < 0.0001 4.27 P = 0.0413
 Iraq 3 (3) 19.29% 6.87–36.08% 11.37 82.4% P = 0.0034
 Malaysia 3 (3) 27.92% 18.28–38.73% 5.78 65.4% P = 0.0555
 Poland 4 (4) 18.63% 9.11–30.57% 21.30 85.9% P < 0.0001 8.25 P = 0.0175
 Saudi Arabia 3 (3) 39.45% 20.99–59.63% 12.79 84.4% P = 0.0017
 Turkey 3 (6) 5.8% 2.7–10.18% 18.54 73% P = 0.0023 4.21 P = 0.004
 Uzbekistan 1 (9) 12.61% 2.54–28.76% 619.25 98.7% P < 0.0001 15.91 P = 0.0282
Open in a new tab

The analysis of the distribution of studies indicated a significant concentration in particular countries. Specifically, there are 11 studies originating from China, which collectively encompass 12 datasets. In Saudi Arabia, Malaysia, China, Iran, and Iraq, the pooled prevalence of IPIs was notably higher than in other countries. The highest pooled prevalence rates were observed at 39.45% (95% CI: 20.99%—59.63%) in Saudi Arabia, 27.92% (95% CI: 18.28%—38.73%) in Malaysia, 22.49% (95% CI: 11.90%—35.27%) in China, 23.79% (95% CI: 12.53%—37.72%) in Iran, and 19.29% (95% CI: 6.87%—36.08%) in Iraq.

Results of assessing the association between IPIs and CRC

Compared to the healthy control group, individuals with parasitic infections exhibited a significantly higher likelihood of developing CRC, with an odds ratio of 3.61 (95% CI: 2.41—5.43). As illustrated in Fig. 3, there was also a notable elevation in the prevalence of IPIs among CRC patients. The assessment of statistical heterogeneity indicated substantial variability across the studies, with a Q = 248.39 and I2 = 83.5% (P < 0.001). Furthermore, a significant publication bias was detected, as evidenced by the Egger bias statistic of 0.744 (P = 0.341) (Fig. 4).

Fig. 3.

Fig. 3

Open in a new tab

Forest plot for assessment of odds-ratio of influence of CRC and IPI, according to selected articles used in the meta-analysis using random effects analysis with pooled odds ratio of 3.61 (95% CI: 2.41—5.43)

Fig. 4.

Fig. 4

Open in a new tab

Funnel plot showing the absence of publication bias among the included studies (P = 0.341)

The pooled ORs for protozoan and helminthic infections were found to be 4.24 (95% CI: 2.65 to 6.79) and 1.96 (95% CI: 1.37 to 2.83), respectively. Additionally, the pooled ORs for specific infections, including Cryptosporidium spp., Blastocystis spp., and Giardia intestinalis, were reported as 12.48 (95% CI: 5.82 to 26.79), 3.24 (95% CI: 21.64 to 6.39), and 0.77 (95% CI: 0.44 to 1.36), respectively (Table 3).

Table 3.

The pooled OR of parasitic infection in CRC patients in different subgroups

Subgroups Datasets Heterogeneity Pooled odd ratio
Q I2 P-value OR CI 95% P-value
Type of Infection Protozoan 57 230.92 84.8% P < 0.0001 4.24 2.65 to 6.79 P < 0.0001
Helminthic 11 9.03 44.6% P = 0.1077 1.96 1.37 to 2.83 P = 0.0001
Type of Protozoan Cryptosporidium.spp. 15 24.39 63.1% P < 0.0001 12.48 5.82 to 26.79 P < 0.0001
Blastocystis spp. 19 66.59 86.5% P < 0.0001 3.24 1.64 to 6.39 P = 0.0007
Giardia intestinalis 3 4.18 52.2% P = 0.12 0.77 0.44 to 1.36 P = 0.35
Open in a new tab

Results of reviewed case report studies

As shown in Fig. 1, this review identified 15 case reports published between 2001 and 2023. Among these cases, seven patients (46.66%) were male, and eight patients (53.33%) were female. The cases were reported from various countries, including the USA (three studies), Korea (two studies), Colombia, Laos, the Philippines, Tanzania, the Netherlands, Sudan, Japan, China, and Saudi Arabia. The mean age of the patients was 55.62 years. In the studies mentioned, IPIs were detected using microscopic identification, histopathological methods, and molecular diagnostic techniques such as PCR. Furthermore, cancer diagnoses were made through colonoscopy and imaging methods such as computed tomography scans (CT scans). Most of the studies reported helminth contamination, while only two studies documented protozoan contamination. Further details of case report studies included in this review can be found in Table 4.

Table 4.

Base line table of included case report studies

Author (Ref) Year Country parasite Age Gender parasitological diagnosis methods cancer diagnosis methods other signs and symptoms
Castro et al. [57] 2023 Clombia Blastocystis spp. 69 Male Microscopy, culture, PCR Colonoscopy Fever, previous history of intestinal polyps, iron- deficiency anemia
Burky et al. [58] 2022 Laos Schistosoma mekongi 40 Female Microscopic and Histopathology Colonoscopy Rectal bleeding and proctoscopy, Calcification along the portal venous system
Almoghrabi et al. [59] 2021 USA Schistosoma japonicum 67 Female Microscopic Colonoscopy, Biopsy and CT Chronic lower abdominal discomfort associated with constipation alternating with diarrhea, decreased appetite and weight loss
Sava et al. [60] 2020 USA Strongyloides stercoralis 70 Female Microscopic CT Abdominal pain and nonblood diarrhea with associated weight loss
Medina et al. [61] 2019 Philippines Schistosoma 44 Female Histopathology Colonoscopy and histopathology Constipation and decrease in caliber of stool and weight
Kiyani et al. [62] 2018 USA Schistosoma japonicum 54 Female Histopathology Colonoscopy During the colonoscopy, 2 small 4-mm flat polyps were removed from the rectum
Herman et al. [63] 2017 Tanzania Schistosoma manson 52 Male Microscopic and Histopathology Sonography and colonoscopy Abdominal pain, distension, and constipation
Furnee et al. [64] 2015 Netherlands Enterobius vermicularis 68 Male Microscopic and Histopathology Colonoscopy, CT and MRI Rectal bleeding and change in bowel habits
Catalano et al. [65] 2015 USA Strongyloides stercoralis 47 Male Microscopic Colonoscopy and CT Fatigue, weight loss and iron deficiency anemia
Won et al. [66] 2015 Korea Strongyloides stercoralis 72 Female Microscopic CT Lower back pain and intermittent abdominal discomfort with nausea
Salim et al. [67] 2010 Sudan Schistosoma mansoni 35 Male Biopsy CT, Endoscopic and biopsy Abdominal pain, constipation, and occasional bleeding per rectum
Yoo et al. [68] 2008 Korea Anisakis 50 Female Microscopic Colonoscopy, CT Abdominal pain, a segmental fold thickening in the ascending colon, a concentric narrowing in the sigmoid colon
Mineta et al. [69] 2006 Japan Anisakis 69 Male Microscopic and histopathology CT, colonoscopy Abdominal pain, diarrhea, and urticaria, obstruction of the ascending colon and a palpable tumor of the right lower abdomen
Li et al. [70] 2005 China Schistosoma japonicum 57 Female Microscopic and histopathology Colonoscopy 10-month history of left lower quadrant abdominal pain and a 2-month history of bloody stools, an exophytic fragile neoplasm with an ulcerating surface in the sigmoid colon
Al-Mashat [71] 2001 Saudi Arabia Schistosoma 46 Male Microscopic Biopsy, CT, Colonoscopy Calcification of the entire wall of the urinary bladder, the entire rectum and part of the sigmoid colon were narrowed, irregular and ulcerated
Open in a new tab

Results of reviewed experimental studies

This review included nine experimental studies (Supplementary files 1 and 2). The experimental studies were reported from various countries, including Malaysia (four studies), Mexico (three studies), Germany, and Egypt. There were three in vitro studies related to Blastocystis spp. and human colorectal cancer cells, and HCT116 was implemented. These studies used real-time reverse transcription PCR and MTT assay to determine the interaction between this parasite and the HCT116 cell line. Based on the results of these studies, Blastocystis subtypes increased the proliferation of HCT116, and its antigens are able to downregulate IFN-γ and TNF-α gene expression and upregulate the expression of the IL-6 and NF-κB genes in the HCT116 cell line [72–74]. Moreover, in this review there were 6 in vivo studies on different parasites including Taenia crassiceps [75–77], S. mansoni [78], Heligmosomoides polygyrus [79], and Blastocystis spp. [80], which are summarized in Supplementary file 2. In these studies, BALB/C mice and Wistar rats were implemented. The mentioned studies were conducted on chemically induced colon carcinogenesis and/or colitis-associated colorectal cancer. Their findings indicated that excreted/secreted products derived from T. crassiceps may enhance the effectiveness of 5-fluorouracil on established colon tumors. Additionally, treating mice with these excreted/secreted products resulted in a reduction of inflammatory cytokines such as IL-1β, TNF-α, IL-33, and IL-17, significantly decreasing colon tumorigenesis.

Discussion

IPIs represent a significant global health challenge, affecting an estimated hundreds of millions of individuals worldwide, particularly in tropical and subtropical areas [81]. The pathophysiological outcome of parasitic infections can result in a spectrum of clinical manifestations ranging from mild morbidity to severe, life-threatening conditions [82]. Moreover, IPIs have been increasingly recognized as a significant risk factor for the development of various types of cancer [83]. Chronic infections with parasites, such as Schistosoma spp. and Plasmodium spp., can lead to chronic inflammation, tissue damage, and genetic alterations in the host, thereby creating a microenvironment conducive to cancer development [84]. The pathways by which parasites promote carcinogenesis are complex and involve mechanisms such as the induction of chronic inflammation, DNA damage, and epigenetic alterations [85, 86]. Moreover, some parasites, such as Toxoplasma gondii, have been shown to manipulate the host's immune system, suppressing anti-tumor responses and promoting tumor growth [86]. Furthermore, research has revealed similarities between parasites and cancer cells in their survival strategies within a host, including immune evasion [87]. Therefore, understanding the complex relationship between parasitic infections and cancer is crucial for the development of effective prevention and treatment strategies. In this context, the present study aimed to conduct a systematic review and meta-analysis to estimate the pooled prevalence of IPIs in CRC patients and ORs for association between IPIs and an increased risk of CRC.

Our analysis included 46 case–control and cross-sectional studies in three distinct timeframes. The limited number of articles from the earlier period (1980 to 2008) reflects the emerging stage of research regarding the relationship between IPIs and CRC. The significant increase in publications between 2012 and 2020 indicates a growing interest in the association between parasitology and oncology. This trend may correlate with advancements in diagnostic techniques, which have enabled more accurate detection of parasites [88]. The most recent cohort of studies (2020 to 2024) indicates a growing interest among researchers in exploring the associations of IPIs in CRC [12, 22, 76].

The data, derived from studies conducted across different countries, highlight significant geographical trends and potential correlations between IPIs and the incidence of CRC. A systematic review of global data indicates widespread reports of Blastocystis spp. and Cryptosporidium spp. infections in CRC patients, with a notable prevalence in developing countries including Iran, China, Saudi Arabia, Turkey, Uzbekistan, and Malaysia. The concentration of studies from countries like China, where Schistosoma species are prevalent, reinforces the established link between chronic IPIs and CRC. This association is often attributed to mechanisms such as chronic inflammation, tissue damage, and the promotion of a microenvironment conducive to cancer development [31–42].

Among the included studies, microscopic examination emerged as the predominant diagnostic technique, employed in 36studies (40 datasets). This traditional method has long been recognized as a fast, reliable, and gold standard test for the identification of gastrointestinal parasitic infections. However, it has limitations such as lower sensitivity and specificity compared to molecular method [89, 90]. The notable investigation of PCR methods in 24 studies (25 datasets) signifies a shift towards more advanced and reliable diagnostic techniques in recent years. PCR-based approaches offer critical advantages, such as the detection of low quantities of parasite DNA and the ability to differentiate between species. The uncommon use of ELISA as a primary diagnostic tool in only a small fraction of studies (4 datasets) raises questions about its applicability in this context. While ELISA is effective for detecting parasite-specific antibodies, its suitability for identifying acute infections or directly detecting parasites, a crucial aspect in CRC research, may be limited. Future studies could investigate the utility of combining ELISA with other diagnostic methods to achieve a more comprehensive evaluation of IPIs in CRC patients [91, 92].

In subgroup analysis, the pooled prevalence of protozoan infection among CRC patients was 19.4% (95% CI: 14.39%−24.96%). Analysis revealed that Blastocystis spp. and Cryptosporidium spp. were the most prevalent protozoan parasites in CRC patients. In Taghipour et al. (2022) study, the finding showed a positive association between Cryptosporidium spp. and Blastocystis spp. infections and CRC [93]. In a similar study, Kalantari et al. (2020) found that there was an association between Cryptosporidium spp. infection and CRC [94]. In another study, Toychiev et al. (2018) reported a high prevalence (80%) of Blastocystis spp. among protozoan parasites in CRC patients [37]. Several experimental studies suggest that Blastocystis spp. may enhance the proliferative, invasive, and metastatic capabilities of CRC cells [95]. Specifically, Rajamanikam et al. (2023) found that the ST3 subtype of B. hominis significantly increased the proliferation of the human colorectal carcinoma cell line (HCT116) [96]. In the same direction, research has shown that Cryptosporidium parvum is a potential trigger for intestinal dysplasia [97]. A recent experimental study suggesting that Cryptosporidium parvum infection can alter the host cell's cytoskeleton and disrupt various cellular processes, which may contribute to the abnormal transformation of infected epithelial cells [35]. It appears that immunological and genetic alterations induced by parasites can disrupt host hemostasis, potentially promoting the development of cancerous cells. Furthermore, dysregulation of immune responses within the gut epithelium may contribute to chronic diseases, leading to detrimental consequences for the host, such as tissue damage, inflammation, and an elevated risk of carcinogenesis [98].

Conversely, the pooled prevalence of helminthic infection among CRC patients was 20.79% (95% CI: 8.35%—36.96%). Helminthic infections have a complex and potentially dual role in CRC [99]. While some helminth infections are being explored as potential therapeutics for inflammatory disorders, other helminth infections have been linked to cancer development. Cancers associated with helminth infections include cholangiocarcinoma, hepatocellular carcinoma, squamous cell carcinoma, and urinary bladder cancer [100]. Helminthic infections and tumor progression share biochemical mechanisms and immune response pathways [101]. Chronic helminthic infections modulate the host's immune responses [102]. Like tumors, helminths can subvert the immune response by modulating the environment from pro-inflammatory to anti-inflammatory. Helminths may also promote DNA mutations while also expressing similar structures to tumor cells [37, 103]. Certain helminths, such as Fasciola gigantica and Taenia solium, have been implicated as potential inducers of DNA mutations [104]. Furthermore, many helminthic parasites express mucin O-glycans, including N-acetylgalactosamine O-serine/threonine (Tn), Thomsen-Friedenreich (TF), TK, and sialyl-Tn (sTn) antigens, which are structurally analogous to those found on tumor cells [101].

For example, Echinococcus granulosus expresses Tn, sTn, and TF antigens, and the Tk antigen found on colorectal cancer cells is also present in parasites like Taenia crassiceps, Mesocestoides vogae, and Taenia hydatigena. These similarities could open new paths for cancer research and treatment [105, 106].

The tumor development process that is stimulated by the helminths is complex. Like the tumor microenvironment, helminth infections can alter the immune landscape by increasing immunosuppressive cells and factors (e.g., Tregs, IL-10) [107], decreasing cytotoxic lymphocytes, increasing vascular growth factors, and producing tumor-promoting hormones [108], leading to a pro-tumorigenic state and promoting neoplastic transformation. Schistosoma japonicum, found in a significant percentage of CRC patients, is linked to CRC through mechanisms similar to colitis-induced cancer. Schistosoma induces chronic inflammation, tissue damage, immune evasion, gut dysbiosis, and potentially direct carcinogenic effects, creating a tumor-friendly environment [30, 46, 77, 104]. The pathogenesis of S. japonicum-associated CRC is the result of chronic inflammation produced by egg deposition into the submucosa and mucosa of the colorectum, inducing granuloma formation, cellular infiltration, and ulceration [109]. Chronic inflammation leads to fibrosis, mucosal hyperplasia, and crypt elongation, forming a tumorigenic microenvironment, while reactive oxygen species (ROS) and pro-inflammatory cytokines (e.g., TNF-α, IL-6) from macrophages induce DNA damage and aberrantly regulate tumor suppressor pathways like p53 [110]. Concurrently, S. japonicum-induced immunosuppression allows for coinfection with bacterial pathogens such as Salmonella, which cooperate with the parasitic toxin to degrade mucosal barriers and trigger oncogenic signaling such as Wnt/β-catenin [109, 110]. Molecular alterations involve p53 mutations, epigenetic silencing of tumor suppressors by DNA hypermethylation, and immune evasion by polarization of M2 macrophages [105]. Schistosomal toxins enhance oxidative stress, lipid peroxidation, and DNA adduct formation and disrupt proliferative pathways (TGF-β, MAPK) and apoptosis [111]. This multifactorial interaction of inflammation, bacterial synergy, and molecular disruption is the foundation of the carcinogenic process.

According to an odds ratio analysis, Cryptosporidium spp. and Blastocystis spp. show a particularly strong association (OR = 12.48 and 3.24, respectively), while Giardia intestinalis also presents a notable risk (OR = 0.77). It should be noted that the high statistical heterogeneity observed (I2 = 83.5%, P < 0.001) implies variability in study designs and populations, which may influence the generalizability of these findings. Additionally, the presence of publication bias, as indicated by the Egger statistic (0.744, P = 0.341), raises concerns about the completeness of the evidence base.

Despite the insights gained from this systematic review, it is important to acknowledge several limitations, including i) limited sample sizes in some articles, ii) differences in study designs, iii) diverse methods for identifying IPIs, and iv) insufficient evaluation of variables such as gender, age, and the immunosuppression status of patients. Additionally, the lack of comprehensive data from certain regions may restrict the generalizability of our findings.

Conclusion

In conclusion, this review study revealed that the prevalence of IPIs is relatively high in people with CRC. Moreover, the findings suggest a significant association between IPIs and CRC in comparison to healthy group. Both helminthic and protozoan infections are common among CRC patients, potentially influencing the development and progression of CRC. The interaction between weakened immune function in cancer patients and the immune-regulating effects of parasites may foster a tumor-supportive environment, encouraging cancer development. Further investigations are necessary to clarify the relationship between IPIs and CRC. These results indicate that identifying and treating individuals with IPIs could be an important part of strategies for preventing and managing CRC.

Supplementary Information

Supplementary Material 1. (14.3KB, docx)
Supplementary Material 2. (15.2KB, docx)

Acknowledgements

We would like to thankful to all authors that their valuable publications were included in this study. This study was supported by Toxoplasmosis Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran, (Code number: 20397).

Clinical trial number

Not applicable.

Informed consent

Not applicable.

AI use statement

During the preparation of this work, the authors used AI tools just for enhancing readability, grammar checking and correcting spelling errors. After using this tool, the authors reviewed and edited the content as needed and took responsibility for the publication’s content.

Abbreviations

CRC

Colorectal cancer

IPI

Intestinal Parasite Infection

PRISMA

Preferred Reporting Items for Systematic reviews and Meta-Analyses

Authors’ contributions

M.H., B.B., and M.B. contributed to the data base search. M.H., B.B., M.B., and M.G. performed data extraction. H.Z., S.G., and B.R. were involved in the conceptualization and provided design advice. Statistical analysis was conducted by S. A. H. The original draft was written by M.H., and R.S. All authors have read and approved the final version of the manuscript.

Funding

Not applicable in this study.

Data availability

Raw data and their related analysis are available upon reasonable request from the readers of this article to the corresponding authors of this article by email to Reza.sab.68@gmail.com and Hosseini4030@gmail.com.

Declarations

Ethics approval and consent to participate

The Research Ethics Committees of Mazandaran University of Medical Sciences approved this study (IR.MAZUMS.REC.1403.067).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Maryam Hataminejad and Bahareh Basirpour co first authorship.

Contributor Information

Seyed Abdollah Hosseini, Email: Hosseini4030@gmail.com.

Reza Saberi, Email: reza.sab.68@gmail.com.

References

  • 1.Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233–54. [DOI] [PubMed] [Google Scholar]
  • 2.Ye H, Ye Y, Wang Y, Tong T, Yao S, Xu Y, Hu Q, Liu Y, Liang C, Wang G. Automated assessment of necrosis tumor ratio in colorectal cancer using an artificial intelligence-based digital pathology analysis. Med Adv. 2023;1(1):30–43. [Google Scholar]
  • 3.AziziKia H, Teymourzadeh A, Kouchaki H, Nakhostin-Ansari A, Doudaran PJ, Ahmadinejad I, Hoveidaei A, Roshandel G. Colorectal cancer incidence in Iran based on sex, age, and geographical regions: a study of 2014–2017 and projected rates to 2025. Arch Iran Med. 2024;27(4):174. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Fernandes Q, Gupta I, Vranic S, Al Moustafa A-E. Human papillomaviruses and epstein–barr virus interactions in colorectal cancer: a brief review. Pathogens. 2020;9(4): 300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Soerjomataram I, Bray F. Planning for tomorrow: global cancer incidence and the role of prevention 2020–2070. Nat Rev Clin Oncol. 2021;18(10):663–72. [DOI] [PubMed] [Google Scholar]
  • 6.Li S, Liu J, Zheng X, Ren L, Yang Y, Li W, Fu W, Wang J, Du G. Tumorigenic bacteria in colorectal cancer: mechanisms and treatments. Cancer Biol Med. 2021;19(2):147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.de Martel C, Georges D, Bray F, Ferlay J, Clifford GM. Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob Health. 2020;8(2):e180–90. [DOI] [PubMed] [Google Scholar]
  • 8.Cao C, Yue S, Lu A, Liang C. Host-Gut Microbiota Metabolic Interactions and Their Role in Precision Diagnosis and Treatment of Gastrointestinal Cancers. Pharmacol Res. 2024;207:107321. [DOI] [PubMed]
  • 9.Singh N, Baby D, Rajguru JP, Patil PB, Thakkannavar SS, Pujari VB. Inflammation and cancer. Ann Afr Med. 2019;18(3):121–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Moher D. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021;134:103–12. [DOI] [PubMed] [Google Scholar]
  • 11.Seleem NI, El-Nadi NAE-F, Hassan EEN, Gaballah MR. Case-control study of intestinal parasites in patients with intestinal cancer in Sohag, Egypt. J Egypt Soc Parasitol. 2024;54(2):319–24. [Google Scholar]
  • 12.Labania L, Zoughbor S, Ajab S, Olanda M, Shantour SN, Al Rasbi Z. The associated risk of Blastocystis infection in cancer: a case control study. Front Oncol. 2023;13: 1115835. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Abd El-Latif NF, Kandil NS, Shamsya M, Elwany YN, Ibrahim HS. Role of cryptosporidium spp in development of colorectal cancer. Asian Pac J Cancer Prev. 2023;24(2):667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Ali MI, Wahab WMAE, Hassan A, Ryan U, Xiao L, Arafa WM, Hamdy DA. Detection of unusual Cryptosporidium parvum subtype in patients with gastrointestinal cancer in Egypt. Parasitol Res. 2023;122(2):597–606. [DOI] [PubMed] [Google Scholar]
  • 15.Gezici A, Cengiz ZT, Yilmaz H, Aydemir S. The significance of opportunistic parasitosis and blastocystosis in patients with gastric cancer: a study with control group. Turkiye Parazitol Derg. 2023;47(4):220–3. [DOI] [PubMed] [Google Scholar]
  • 16.Ali SH, Ismail MA, El-Badry AA, Abu-Sarea EY, Dewidar AM, Hamdy DA. An association between Blastocystis subtypes and colorectal cancer patients: a significant different profile from non-cancer individuals. Acta Parasitol. 2022;67(2):752–63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Chen HH, Deng Y, Li Z, Wang ZL, Run ZC, Zhang T, Cai YC, Zhang HW, Hu ZH, Chen JH, et al. Prevalence and risk factors of Giardia lamblia infections among colorectal cancer patients in Henan Province. Chin J Schistosomiasis Control. 2022;34(4):370-377and391. [DOI] [PubMed] [Google Scholar]
  • 18.Ghanadi K, Khalaf AK, Jafrasteh A, Anbari K, Mahmoudvand H. High prevalence of Cryptosporidium infection in Iranian patients suffering from colorectal cancer. Parasit Epidemiol Control. 2022;19:e00271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Haghighi L, Razmjou E, Rafiei-Sefiddashti R, Meamar AR, Akhlaghi L. Entamoeba histolytica and probable effect on production microsatellite instability in colorectal cancer. Curr Microbiol. 2022;79(4):111. [DOI] [PubMed] [Google Scholar]
  • 20.Hernández Castro C, Agudelo López SdP, Toro Londoño MÁ, Botero Garcés JH, Múnera Duque A, Correa Cote JC, Köster PC, Carmena Jiménez DA. Frequency of intestinal microeukaryotes in patients undergoing screening colonoscopy for colorectal cancer. 15th International Congress of Parasitology (ICOPA2022).
  • 21.Redondo F, Hurtado-Marcos C, Izquierdo F, Cuéllar C, Fenoy S, Sáez Y, Magnet Á, Galindo-Regal L, Uribe N, López-Bañeres M. Latent microsporidia infection prevalence as a risk factor in colon cancer patients. Cancers (Basel). 2022;14(21):5342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Zhang H, Yu Y, Li J, Gong P, Wang X, Li X, Cheng Y, Yu X, Zhang N, Zhang X. Changes of gut microbiota in colorectal cancer patients with Pentatrichomonas hominis infection. Front Cell Infect Microbiol. 2022;12:961974. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Mahmoudvand H, Sepahvand A, Badparva E, Khatami M, Niazi M, Moayyedkazemi A. Possible Association and Risk Factors of Blastocystis Infection and Colorectal Cancers in Western Iran.Arch Clin Infect Dis. 2021;16(1):e90861.
  • 24.Hawash YA, Ismail KA, Saber T, Eed EM, Khalifa AS, Alsharif KF, Alghamdi SA, Dahlawi HA, Alsanie W, Khalifa AM. Predominance of infection with Blastocystis hominis in patients with colorectal cancer and its association with high mucin content, infiltration of inflammatory cells and elevated serum tumor necrosis factor α. Infect Dis Clin Pract. 2021;29(1):e32–8. [Google Scholar]
  • 25.Sulżyc-Bielicka V, Kołodziejczyk L, Adamska M, Skotarczak B, Jaczewska S, Safranow K, Bielicki P, Kładny J, Bielicki D. Colorectal cancer and Blastocystis sp. infection. Parasit Vectors. 2021;14(1):200.10.1186/s13071-021-04681-x. [DOI] [PMC free article] [PubMed]
  • 26.Karabey M, Can H, Öner TÖ, Döşkaya M, Alak SE, Döşkaya AD, Karakavuk M, Köseoğlu AE, Ün C, Gürüz AY. Cryptosporidium spp. during chemotherapy: a cross-sectional study of 94 patients with malignant solid tumor. Ann Saudi Med. 2021;41(5):293–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Asghari A, Zare M, Hatam G, Shahabi S, Gholizadeh F, Motazedian M. 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. [DOI] [PubMed] [Google Scholar]
  • 28.Zhang N, Yu X, Zhang H, Cui L, Li X, Zhang X, Gong P, Li J, Li Z, Wang X. Prevalence and genotyping of Cryptosporidium parvum in gastrointestinal cancer patients. J Cancer. 2020;11(11):3334. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Nasir KA, Hama AA, Ali SI. Prevalence of cryptosporidiosis among cancer patients in Sulaimani province/iraq. Int J Psychosoc Rehabil. 2020;24(09):1906–15.
  • 30.Wang W, Lu K, Wang L, Jing H, Pan W, Huang S, Xu Y, Bu D, Cheng M, Liu J. Comparison of non-schistosomal colorectal cancer and schistosomal colorectal cancer. World J Surg Oncol. 2020;18:1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Majeed GH, Mohammed NS, Muhsen SS. The synergistic effect of Blastocystis hominis and H. pylori in Iraqi colorectal cancer patients. J Pharm Sci Res. 2019;11(2):523–6. [Google Scholar]
  • 32.Esteghamati A, Khanaliha K, Bokharaei-Salim F, Sayyahfar S, Ghaderipour M. Prevalence of intestinal parasitic infection in cancer, organ transplant and primary immunodeficiency patients in Tehran, Iran. Asian Pac J Cancer Prev. 2019;20(2):495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Mahmoudvand H, Sepahvand A, Khatami M, Moayyedkazemi A. Prevalence and associated risk factors of Cystoisospora belli and Cyclospora cayetanensis infection among Iranian patients with colorectal cancer. J Parasit Dis. 2019;43:402–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Zhang N, Zhang H, Yu Y, Gong P, Li J, Li Z, Li T, Cong Z, Tian C, Liu X. High prevalence of Pentatrichomonas hominis infection in gastrointestinal cancer patients. Parasit Vectors. 2019;12:1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Sulżyc-Bielicka V, Kołodziejczyk L, Jaczewska S, Bielicki D, Safranow K, Bielicki P, Kładny J, Rogowski W. Colorectal cancer and Cryptosporidium spp. infection. PLoS One. 2018;13(4): e0195834. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Essid R, Menotti J, Hanen C, Aoun K, Bouratbine A. Genetic diversity of Cryptosporidium isolates from human populations in an urban area of Northern Tunisia. Infect Genet Evol. 2018;58:237–42. [DOI] [PubMed] [Google Scholar]
  • 37.Toychiev A, Abdujapparov S, Imamov A, Navruzov B, Davis N, Badalova N, Osipova S. Intestinal helminths and protozoan infections in patients with colorectal cancer: prevalence and possible association with cancer pathogenesis. Parasitol Res. 2018;117(12):3715–23. [DOI] [PubMed] [Google Scholar]
  • 38.Al-Dabbagh LKA, Al-Mukhtar AM. Infections with Blastocystis hominis in patients with colorectal cancer in Mosul city, Iraq. Int J Enhanced Res Sci Technol Eng. 2017;6(9):1–4. [Google Scholar]
  • 39.Mohamed AM, Ahmed MA, Ahmed SA, Al-Semany SA, Alghamdi SS, Zaglool DA. Predominance and association risk of Blastocystis hominis subtype I in colorectal cancer: a case control study. Infect Agents Cancer. 2017;12:1–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Osman M, Benamrouz S, Guyot K, Baydoun M, Frealle E, Chabe M, Gantois N, Delaire B, Goffard A, Aoun A. High association of Cryptosporidium spp. infection with colon adenocarcinoma in Lebanese patients. PLoS One. 2017;12(12):e0189422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Zhang W, Ren G, Zhao W, Yang Z, Shen Y, Sun Y, Liu A, Cao J. Genotyping of Enterocytozoon bieneusi and subtyping of Blastocystis in cancer patients: relationship to diarrhea and assessment of zoonotic transmission. Front Microbiol. 1835;2017:8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Yersal O, Malatyali E, Ertabaklar H, Oktay E, Barutca S, Ertug S. Blastocystis subtypes in cancer patients: analysis of possible risk factors and clinical characteristics. Parasitol Int. 2016;65(6):792–6. [DOI] [PubMed] [Google Scholar]
  • 43.Feng H, Lu AG, Zhao XW, Han DP, Zhao JK, Shi L, Schiergens TS, Lee SM, Zhang WP, Thasler WE. Comparison of non-schistosomal rectosigmoid cancer and schistosomal rectosigmoid cancer. World J Gastroenterol. 2015;21(23):7225–32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Kumarasamy V, Roslani AC, Rani KU, Kumar Govind S. Advantage of using colonic washouts for Blastocystis detection in colorectal cancer patients. Parasit Vectors. 2014;7:162. [DOI] [PMC free article] [PubMed]
  • 45.Sanad MM, Thagfan FA, Al-Olayan E, Almogren A, Al-Hammaad A, Al-Mawash A, Mohamed A. Opportunistic coccidian parasites among Saudi cancer patients presenting with diarrhea: prevalence and immune status. 2014. [Google Scholar]
  • 46.Abdelkareem EA, Cheong TG, Sharief AH, Huat LB, Yin KB. Identification of specific proteins in colorectal cancer patients with Schistosoma mansoni infection as a possible biomarker for the treatment of this infection. Asian Pac J Trop Dis. 2014;4:S720–4. [Google Scholar]
  • 47.Liu W, Zeng HZ, Wang QM, Yi H, Mou Y, Wu CC, Hu B, Tang CW. Schistosomiasis combined with colorectal carcinoma diagnosed based on endoscopic findings and clinicopathological characteristics: a report on 32 cases. Asian Pac J Cancer Prev. 2013;14(8):4839–42. [DOI] [PubMed] [Google Scholar]
  • 48.Chandramathi S, Suresh K, Anita ZB, Kuppusamy UR. Infections of Blastocystis hominis and microsporidia in cancer patients: are they opportunistic? Trans R Soc Trop Med Hyg. 2012;106(4):267–9. [DOI] [PubMed] [Google Scholar]
  • 49.Shebl FM, Engels EA, Goedert JJ. Opportunistic intestinal infections and risk of colorectal cancer among people with AIDS. AIDS Res Hum Retroviruses. 2012;28(9):994–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Sulżyc-Bielicka V, Kołodziejczyk L, Jaczewska S, Bielicki D, Kładny J, Safranow K. Prevalence of Cryptosporidium sp. in patients with colorectal cancer. Polish J Surg. 2012;84(7):348–51. [DOI] [PubMed] [Google Scholar]
  • 51.Machado ER, Teixeira EM, Gonçalves-Pires Mdo R, Loureiro ZM, Araújo RA, Costa-Cruz JM. Parasitological and immunological diagnosis of Strongyloides stercoralis in patients with gastrointestinal cancer. Scand J Infect Dis. 2008;40(2):154–8. [DOI] [PubMed] [Google Scholar]
  • 52.Sulżyc-Bielicka V, Kuźna-Grygiel W, Kołodziejczyk L, Bielicki D, Kładny J, Stępień-Korzonek M, Telatyńska-Śmieszek B. Cryptosporidiosis in patients with colorectal cancer. J Parasitol. 2007;93(3):722–4. [DOI] [PubMed] [Google Scholar]
  • 53.Steer H. Blastocystis hominis and colorectal cancer. Ann R Coll Surg Engl. 2007;89(5):539–539. [Google Scholar]
  • 54.Qiu D-C, Hubbard A, Zhong B, Zhang Y, Spear R. A matched, case–control study of the association between Schistosoma japonicum and liver and colon cancers, in rural China. Ann Trop Med Parasitol. 2005;99(1):47–52. [DOI] [PubMed] [Google Scholar]
  • 55.Xu Z, Su DL. Schistosoma japonicum and colorectal cancer: an epidemiological study in the People’s Republic of China. Int J Cancer. 1984;34(3):315–8. [DOI] [PubMed] [Google Scholar]
  • 56.Ming-Chai C, Chi-Yuan C, Pei-Yu C, Jen-Chun H. Evolution of colorectal cancer in schistsosomiasis: transitional mucosal changes adjacent to large intestinal carcinoma in colectomy specimens. Cancer. 1980;46(7):1661–75. [DOI] [PubMed] [Google Scholar]
  • 57.Hernández-Castro C, Maloney JG, Agudelo-López SP, Toro-Londoño MA, Botero-Garcés JH, Orozco MC, Quintero-Quinchia YC, Correa-Cote JC, Múnera-Duque A, Ricaurte-Ciro JC, et al. Identification and validation of novel Blastocystis subtype ST41 in a Colombian patient undergoing colorectal cancer screening. J Eukaryot Microbiol. 2023;70(5): e12978. [DOI] [PubMed] [Google Scholar]
  • 58.Burky M, Trembath D, Bookhout C. Rectal carcinoma arising in a patient with intestinal and hepatic schistosomiasis due to Schistosoma mekongi. IDCases. 2022;27:e01383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 59.Almoghrabi A, Mzaik O, Attar B. Schistosoma japonicum associated with colorectal cancer. ACG Case Rep J. 2021;8(5):e00572. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Sava M, Huynh T, Frugoli A, Kong L, Salehpour M, Barrows B. Colorectal cancer related to chronic Strongyloides stercoralis infection. Case Rep Gastrointest Med. 2020, 2020. [DOI] [PMC free article] [PubMed]
  • 61.Medina ML, Abola L. Colorectal cancer in a patient with intestinal schistosomiasis: A case report. In: Journal Of Gastroenterology And Hepatology: 2019: WILEY 111 RIVER ST, HOBOKEN 07030–5774, NJ USA; 2019: 291–291.
  • 62.Kiyani A, Walia A, Chuang KY. Schistosoma japonicum presenting as colon polyps. Am J Med. 2018;131(4):e149–50. [DOI] [PubMed] [Google Scholar]
  • 63.Herman AM, Kishe A, Babu H, Shilanaiman H, Tarmohamed M, Lodhia J, Amsi P, Pyuza J, Mremi A, Mwasamwaja A, et al. Colorectal cancer in a patient with intestinal schistosomiasis: a case report from Kilimanjaro Christian Medical Center Northern Zone Tanzania. World J Surg Oncol. 2017;15(1): 146. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64.Furnée EJB, Spoto C, de Graaf MJ, Smakman N. Enterobius vermicularis infection of the liver in a patient with colorectal carcinoma with suspected liver metastasis. BMJ Case Rep. 2015;2015:bcr2015212271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65.Catalano C, Aron J, Bansal R, Leytin A. Colorectal cancer associated with Strongyloides stercoralis colitis. ACG Case Rep J. 2017;4(1):e104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66.Won EJ, Jeon J, Koh YI, Ryang DW. Strongyloidiasis in a diabetic patient accompanied by gastrointestinal stromal tumor: cause of eosinophilia unresponsive to steroid therapy. Korean J Parasitol. 2015;53(2):223–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67.Hs OE. Hamid HK, Mekki SO, Suleiman SH, Ibrahim SZ: Colorectal carcinoma associated with schistosomiasis: a possible causal relationship. World J Surg Oncol. 2010;8:68. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68.Yoo HJ, Kim SH, Lee JM, Kim MA, Han JK, Choi BI. The association of anisakiasis in the ascending colon with sigmoid colon cancer: CT colonography findings. Korean J Radiol. 2008;9(Suppl):S56. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 69.Mineta S, Shimanuki K, Sugiura A, Tsuchiya Y, Kaneko M, Sugiyama Y, Akimaru K, Tajiri T. Chronic anisakiasis of the ascending colon associated with carcinoma. J Nippon Med Sch. 2006;73(3):169–74. [DOI] [PubMed] [Google Scholar]
  • 70.Li WC, Pan ZG, Sun YH. Sigmoid colonic carcinoma associated with deposited ova of Schistosoma japonicum: a case report. World J Gastroenterol. 2006;12(37):6077–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 71.Al-Mashat F, Sibiany A, Radwi A, Bahadur Y, Al-Radi A, Meir H, Ahmed GE. Rectal cancer associated with schistosomiasis: report of two cases and review of the literature. Ann Saudi Med. 2001;21(1–2):65–7. [DOI] [PubMed] [Google Scholar]
  • 72.Kumarasamy V, Kuppusamy UR, Samudi C, Kumar S. Blastocystis sp. subtype 3 triggers higher proliferation of human colorectal cancer cells, HCT116. Parasitol Res. 2013;112:3551–5. [DOI] [PubMed] [Google Scholar]
  • 73.Chandramathi S, Suresh K, Kuppusamy UR. Solubilized antigen of Blastocystis hominis facilitates the growth of human colorectal cancer cells, HCT116. Parasitol Res. 2010;106:941–5. [DOI] [PubMed] [Google Scholar]
  • 74.Chan KH, Chandramathi S, Suresh K, Chua KH, Kuppusamy UR. Effects of symptomatic and asymptomatic isolates of Blastocystis hominis on colorectal cancer cell line, HCT116. Parasitol Res. 2012;110:2475–80. [DOI] [PubMed] [Google Scholar]
  • 75.Mendoza-Rodríguez MG, Medina-Reyes D, Sánchez-Barrera CA, Fernández-Muñoz KV, García-Castillo V, Ledesma-Torres JL, González-González MI, Reyes JL, Pérez-Plascencia C, Rodríguez-Sosa M. Helminth-derived molecules improve 5-fluorouracil treatment on experimental colon tumorigenesis. Biomed Pharmacother. 2024;175:116628. [DOI] [PubMed] [Google Scholar]
  • 76.Callejas BE, Mendoza-Rodríguez MG, Villamar-Cruz O, Reyes-Martínez S, Sánchez-Barrera CA, Rodríguez-Sosa M, Delgado-Buenrostro NL, Martínez-Saucedo D, Chirino YI, León-Cabrera SA. Helminth-derived molecules inhibit colitis-associated colon cancer development through NF-κB and STAT3 regulation. Int J Cancer. 2019;145(11):3126–39. [DOI] [PubMed] [Google Scholar]
  • 77.León-Cabrera S, Callejas BE, Ledesma-Soto Y, Coronel J, Pérez-Plasencia C, Gutiérrez-Cirlos EB, Ávila-Moreno F, Rodríguez-Sosa M, Hernández-Pando R, Marquina-Castillo B. Extraintestinal helminth infection reduces the development of colitis-associated tumorigenesis. Int J Biol Sci. 2014;10(9):948. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 78.Eissa MM, Ismail CA, El-Azzouni MZ, Ghazy AA, Hadi MA. Immuno-therapeutic potential of Schistosoma mansoni and Trichinella spiralis antigens in a murine model of colon cancer. Invest New Drugs. 2019;37:47–56. [DOI] [PubMed] [Google Scholar]
  • 79.Pastille E, Frede A, McSorley HJ, Gräb J, Adamczyk A, Kollenda S, Hansen W, Epple M, Buer J, Maizels RM. Intestinal helminth infection drives carcinogenesis in colitis-associated colon cancer. PLoS Pathog. 2017;13(9):e1006649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 80.Kumarasamy V, Kuppusamy UR, Jayalakshmi P, Samudi C, Ragavan ND, Kumar S. Exacerbation of colon carcinogenesis by Blastocystis sp. PLoS One. 2017;12(8): e0183097. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 81. Cholewiński M, Derda M, Hadaś E. Parasitic diseases in humans transmitted by vectors. Ann Parasitol. 2015;61(3):137-57. [DOI] [PubMed]
  • 82.Di Genova BM, Tonelli RR. Infection Strategies of Intestinal Parasite Pathogens and Host Cell Responses. Front Microbiol. 2016;7:256. [DOI] [PMC free article] [PubMed]
  • 83.Van Tong H, Brindley PJ, Meyer CG, Velavan TP. Parasite infection, carcinogenesis and human malignancy. EBioMedicine. 2017;15:12–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 84.Arora N, Kaur R, Anjum F, Tripathi S, Mishra A, Kumar R, Prasad A. Neglected agent eminent disease: linking human helminthic infection, inflammation, and malignancy. Front Cell Infect Microbiol. 2019;9:402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 85.Villares M, Berthelet J, Weitzman JB. The clever strategies used by intracellular parasites to hijack host gene expression. Semin Immunopathol. 2020;2020:215–26. Springer. [DOI] [PubMed] [Google Scholar]
  • 86.Hakimi M-A. Epigenetic reprogramming in host-parasite coevolution: the toxoplasma paradigm. Annu Rev Microbiol. 2022;76(1):135–55. [DOI] [PubMed] [Google Scholar]
  • 87.Chulanetra M, Chaicumpa W. Revisiting the mechanisms of immune evasion employed by human parasites. Front Cell Infect Microbiol. 2021;11:702125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 88.Derbew Molla Y, Tesfahun Alemu H. New Developments in Diagnosis of Intestinal Parasites [Internet]. Infectious Diseases. IntechOpen; 2024. Available from: 10.5772/intechopen.1004876.
  • 89.Babady NE. Laboratory diagnosis of infections in cancer patients: challenges and opportunities. J Clin Microbiol. 2016;54(11):2635–46. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 90.Dąbrowska J, Groblewska M, Bendykowska M, Sikorski M, Gromadzka G. Effective laboratory diagnosis of parasitic infections of the gastrointestinal tract: where, when, how, and what should we look for? Diagnostics (Basel). 2024;14(19):2148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 91.Ahirwar R, Bhattacharya A, Kumar S. Unveiling the underpinnings of various non-conventional ELISA variants: a review article. Expert Rev Mol Diagn. 2022;22(7):761-74. [DOI] [PubMed]
  • 92.Ndao M. Diagnosis of parasitic diseases: old and new approaches. Interdiscip Perspect Infect Dis. 2009;2009(1):278246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 93.Taghipour A, Rayatdoost E, Bairami A, Bahadory S, Abdoli A. Are Blastocystis hominis and Cryptosporidium spp. playing a positive role in colorectal cancer risk? A systematic review and meta-analysis. Infect Agents Cancer. 2022;17(1): 32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 94.Kalantari N, Gorgani-Firouzjaee T, Ghaffari S, Bayani M, Ghaffari T, Chehrazi M. Association between Cryptosporidium infection and cancer: a systematic review and meta-analysis. Parasitol Int. 2020;74: 101979. [DOI] [PubMed] [Google Scholar]
  • 95.Kumarasamy V, Atroosh WM, Anbazhagan D, Abdalla MMI, Azzani M. Association of Blastocystis hominis with colorectal cancer: a systematic review of in vitro and in vivo evidences. World J Gastrointest Oncol. 2022;14(3):734. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 96.Rajamanikam A, Isa MNM, Samudi C, Devaraj S, Govind SK. Gut bacteria influence Blastocystis sp. phenotypes and may trigger pathogenicity. PLoS Neglect Trop Dis. 2023;17(3):e0011170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 97.Abdou AG, Harba NM, Afifi AF, Elnaidany NF. Assessment of Cryptosporidium parvum infection in immunocompetent and immunocompromised mice and its role in triggering intestinal dysplasia. Int J Infect Dis. 2013;17(8):e593-600. [DOI] [PubMed] [Google Scholar]
  • 98.Patankar JV, Becker C. Cell death in the gut epithelium and implications for chronic inflammation. Nat Rev Gastroenterol Hepatol. 2020;17(9):543–56. [DOI] [PubMed] [Google Scholar]
  • 99.Mayer DA, Fried B. The role of helminth infections in carcinogenesis. Adv Parasitol. 2007;65:239–96. [DOI] [PubMed] [Google Scholar]
  • 100.Brindley PJ, Loukas A. Helminth infection–induced malignancy. PLoS Pathog. 2017;13(7): e1006393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 101.Maizels RM, Smits HH, McSorley HJ. Modulation of host immunity by helminths: the expanding repertoire of parasite effector molecules. Immunity. 2018;49(5):801–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 102.Maizels RM, McSorley HJ. Regulation of the host immune system by helminth parasites. J Allergy Clin Immunol. 2016;138(3):666–75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 103. Greten FR, Grivennikov SI. Inflammation and Cancer: Triggers, Mechanisms, and Consequences. Immunity. 2019;51(1):27-41. [DOI] [PMC free article] [PubMed]
  • 104.Machicado C, Marcos LA. Carcinogenesis associated with parasites other than Schistosoma, Opisthorchis and Conorchis: a systematic review. Int J Cancer. 2016;138(12):2915–21. [DOI] [PubMed] [Google Scholar]
  • 105.Asouli A, Sadr S, Mohebalian H, Borji H. Anti-tumor effect of protoscolex hydatid cyst somatic antigen on inhibition cell growth of K562. Acta Parasitol. 2023;68(2):385–92. [DOI] [PubMed] [Google Scholar]
  • 106.Darani HY, Yousefi M. Parasites and cancers: parasite antigens as possible targets for cancer immunotherapy. Future Oncol. 2012;8(12):1529–35. [DOI] [PubMed] [Google Scholar]
  • 107.Weinstock JV, Elliott DE. Helminth infections decrease host susceptibility to immune-mediated diseases. J Immunol. 2014;193(7):3239–47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 108.Abdoli A, Ardakani HM. Helminth infections and immunosenescence: the friend of my enemy. Exp Gerontol. 2020;133: 110852. [DOI] [PubMed] [Google Scholar]
  • 109.Jain S, Rana M, Choubey P, Kumar S. Schistosoma japonicum Associated Colorectal Cancer and Its Management. Acta Parasitol. 2023;68(4):723-34. [DOI] [PubMed]
  • 110.Israel JAvD, Reyes WMA, Villaflores O, Jose JE. Exploring the link: a comprehensive literature review of Schistosoma japonicum infection and its oncogenic potential. Journal of Public Health and Emergency. 2024;8:18.
  • 111.Hamid HKS. Schistosoma japonicum-Associated Colorectal Cancer: A Review. Am J Trop Med Hyg. 2019;100(3):501-05. [DOI] [PMC free article] [PubMed]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1. (14.3KB, docx)
Supplementary Material 2. (15.2KB, docx)

Data Availability Statement

Raw data and their related analysis are available upon reasonable request from the readers of this article to the corresponding authors of this article by email to Reza.sab.68@gmail.com and Hosseini4030@gmail.com.

Articles from BMC Gastroenterology are provided here courtesy of BMC

RESOURCES