Prevalence of Cryptosporidium and Giardia in vegetables in Iran: a nineteen-years meta-analysis review


Cryptosporidium and Giardia are two major protozoa reported from vegetables and environment. The prevalence of these parasites supposes to be different regarding the climate zones. This review aimed to evaluate the prevalence of Cryptosporidium and Giardia in vegetables according to the major climate zones in Iran. The results showed pooled prevalence 7% (95% CI: 2%, 14%) and 4% (95% CI: 3%, 6%) for Cryptosporidium spp., and Giardia spp., respectively. The prevalence of Giardia spp. in mountain, desert and semi-desert, and Mediterranean regions was 4% (95% CI: 2%, 6%), 5% (95% CI: 3%, 8%) and 7% (95% CI: 1%, 18%), respectively. Cryptosporidium spp. was reported 8% (95% CI: 0%, 65%), 6% (95% CI: 0%, 18%) and 4% (95% CI: 0%, 77%) from mountain, desert and semi-desert, and Mediterranean climate zones, respectively. This review suggests the higher prevalence of Giardia and Cryptosporidium in Mediterranean and mountain regions, respectively.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Fuhrimann S, Nauta M, Pham-Duc P, Tram NT, Nguyen-Viet H, Utzinger J, et al. Disease burden due to gastrointestinal infections among people living along the major wastewater system in Hanoi, Vietnam. Adv Water Res. 2017.

    Article  Google Scholar 

  2. 2.

    Fuhrimann S, Winkler MS, Kabatereine NB, Tukahebwa EM, Halage AA, Rutebemberwa E, et al. Risk of intestinal parasitic infections in people with different exposures to wastewater and fecal sludge in Kampala, Uganda: A cross-sectional study. PLoS Neg Trop Dis. 2016;10(3):e0004469.

    CAS  Article  Google Scholar 

  3. 3.

    Javanmard E, Rahimi HM, Niyyati M, Aghdaei HA, Sharifdini M, Mirjalali H, et al. Molecular analysis of Blastocystis sp. and its subtypes from treated wastewater routinely used for irrigation of vegetable farmlands in Iran. J Water Health. 2019;17:837–44.

    Article  Google Scholar 

  4. 4.

    Garcia BCB, Dimasupil MAZ, Vital PG, Widmer KW, Rivera WL. Fecal contamination in irrigation water and microbial quality of vegetable primary production in urban farms of Metro Manila, Philippines. J Environ Sci Health B. 2015;50:734–43.

    CAS  Article  Google Scholar 

  5. 5.

    Caradonna T, Marangi M, Del Chierico F, Ferrari N, Reddel S, Bracaglia G, et al. Detection and prevalence of protozoan parasites in ready-to-eat packaged salads on sale in Italy. Food Microbiol. 2017;67:67–75.

    Article  Google Scholar 

  6. 6.

    Becerra-Castro C, Lopes AR, Vaz-Moreira I, Silva EF, Manaia CM, Nunes OC. Wastewater reuse in irrigation: a microbiological perspective on implications in soil fertility and human and environmental health. Environ Int. 2015;75:117–35.

    CAS  Article  Google Scholar 

  7. 7.

    Hobbs SH. Attitudes, practices, and beliefs of individuals consuming a raw foods diet. Explore (New York, NY). 2005;1:272-7.

  8. 8.

    Jernberg C, Hjertqvist M, Sundborger C, Castro E, Lofdahl M, Paajarvi A, et al. Outbreak of Salmonella enteritidis phage type 13a infection in Sweden linked to imported dried-vegetable spice mixes, December 2014 to July 2015. Euro Surveill. 2015;20.

  9. 9.

    Sotir MJ, Ewald G, Kimura AC, Higa JI, Sheth A, Troppy S, et al. Outbreak of Salmonella Wandsworth and Typhimurium infections in infants and toddlers traced to a commercial vegetable-coated snack food. Pediatr Infect Dis J. 2009;28:1041–6.

  10. 10.

    Tsai HC, Lee SS, Huang CK, Yen CM, Chen ER, Liu YC. Outbreak of eosinophilic meningitis associated with drinking raw vegetable juice in southern Taiwan. Am J Trop Med Hyg. 2004;71:222–6.

    Article  Google Scholar 

  11. 11.

    Javanmard E, Mirjalali H, Niyyati M, Jalilzadeh E, Seyed Tabaei SJ, Asadzadeh Aghdaei H, et al. Molecular and phylogenetic evidences of dispersion of human-infecting microsporidia to vegetable farms via irrigation with treated wastewater: One-year follow up. Int J Hyg Environ Health. 2018;221(4):642–51.

    Article  Google Scholar 

  12. 12.

    Losio MN, Pavoni E, Bilei S, Bertasi B, Bove D, Capuano F, et al. Microbiological survey of raw and ready-to-eat leafy green vegetables marketed in Italy. Int J Food Microbiol. 2015;210:88–91.

    CAS  Article  Google Scholar 

  13. 13.

    Jiménez B. Irrigation in developing countries using wastewater. Int Rev Environ Strateg. 2006;6:229–50.

    Google Scholar 

  14. 14.

    Qadir M, Wichelns D, Raschid-Sally L, McCornick PG, Drechsel P, Bahri A, et al. The challenges of wastewater irrigation in developing countries. Agric Water Manag. 2010;97 4:561–8.

    Article  Google Scholar 

  15. 15.

    Maimon A, Tal A, Friedler E, Gross A. Safe on-site reuse of greywater for irrigation - a critical review of current guidelines. Environ Sci Technol. 2010;44:3213–20.

    CAS  Article  Google Scholar 

  16. 16.

    Troldborg M, Duckett D, Allan R, Hastings E, Hough RL. A risk-based approach for developing standards for irrigation with reclaimed water. Water Res. 2017;126:372–84.

    CAS  Article  Google Scholar 

  17. 17.

    United Nations. Water for people, water for life. The United Nations world water development report. Barcelona: UNESCO; 2003.

    Google Scholar 

  18. 18.

    Hatam-Nahavandi K, Mohebali M, Mahvi AH, Keshavarz H, Mirjalali H, Rezaei S, et al. Subtype analysis of Giardia duodenalis isolates from municipal and domestic raw wastewaters in Iran. Environ Sci Pollut Res Int. 2017;24:12740–7.

    CAS  Article  Google Scholar 

  19. 19.

    Hatam-Nahavandi K, Mohebali M, Mahvi AH, Keshavarz H, Najafian HR, Mirjalali H, et al. Microscopic and molecular detection of Cryptosporidium andersoni and Cryptosporidium xiaoi in wastewater samples of Tehran province, Iran. Iran J Parasitol. 2016;11:499–506.

    Google Scholar 

  20. 20.

    Kitajima M, Haramoto E, Iker BC, Gerba CP. Occurrence of Cryptosporidium, Giardia, and Cyclospora in influent and effluent water at wastewater treatment plants in Arizona. Sci Total Environ. 2014;484:129 – 36.

  21. 21.

    Sroka J, Stojecki K, Zdybel J, Karamon J, Cencek T, Dutkiewicz J. Occurrence of Cryptosporidium oocysts and Giardia cysts in effluent from sewage treatment plant from eastern Poland. Ann Agric Environ Med. 2013;Spec no. 1:57–62.

  22. 22.

    Domenech E, Amoros I, Moreno Y, Alonso JL. Cryptosporidium and Giardia safety margin increase in leafy green vegetables irrigated with treated wastewater. Int J Hyg Environ Health. 2018;221:112–9.

    Article  Google Scholar 

  23. 23.

    Fallah AA, Makhtumi Y, Pirali-Kheirabadi K. Seasonal study of parasitic contamination in fresh salad vegetables marketed in Shahrekord, Iran. Food Control. 2016;60:538–42.

    Article  Google Scholar 

  24. 24.

    Xiao S, Hu S, Zhang Y, Zhao X, Pan W. Influence of sewage treatment plant effluent discharge into multipurpose river on its water quality: A quantitative health risk assessment of Cryptosporidium and Giardia. Environ Pollut. 2018;233:797–805.

    CAS  Article  Google Scholar 

  25. 25.

    Utaaker KS, Skjerve E, Robertson LJ. Keeping it cool: Survival of Giardia cysts and Cryptosporidium oocysts on lettuce leaves. Int J Food Microbiol. 2017;255:51–7.

    Article  Google Scholar 

  26. 26.

    Yan C, Liang LJ, Zheng KY, Zhu XQ. Impact of environmental factors on the emergence, transmission and distribution of Toxoplasma gondii. Parasite Vect. 2016;9:137.

  27. 27.

    Ezatpour B, Chegeni AS, Abdollahpour F, Aazami M, Alirezaei M. Prevalence of parasitic contamination of raw vegetables in Khorramabad, Iran. Food Control. 2013;34:92–5.

    Article  Google Scholar 

  28. 28.

    Rostami A, Ebrahimi M, Mehravar S, Fallah Omrani V, Fallahi S, Behniafar H. Contamination of commonly consumed raw vegetables with soil transmitted helminth eggs in Mazandaran province, northern Iran. Int J Food Microbiol. 2016;225:54–8.

    Article  Google Scholar 

  29. 29.

    Shahnazi M, Jafari-Sabet M. Prevalence of parasitic contamination of raw vegetables in villages of Qazvin province, Iran. Foodborne Pathog Dis. 2010;7:1025–30.

    Article  Google Scholar 

  30. 30.

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annal Intern Med. 2009;151:264–9, w64.

  31. 31.

    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.

    Article  Google Scholar 

  32. 32.

    Masoudian A, Kaviani M. Climatology of Iran. Isfahan: University of Isfahan; 2007.

    Google Scholar 

  33. 33.

    Daryani A, Ettehad G, Sharif M, Ghorbani L, Ziaei H. Prevalence of intestinal parasites in vegetables consumed in Ardabil, Iran. Food Control. 2008;19:790–4.

    Article  Google Scholar 

  34. 34.

    Siyadatpanah A, Tabatabaei F, Zeydi AE, Spotin A, Fallah-Omrani V, Assadi M, et al. Parasitic contamination of raw vegetables in Amol, North of Iran. Arch Clin Infect Dis. 2013;8.

  35. 35.

    Ebrahimzadeh A, Jamshidi A, Mohammadi S. The parasitic contamination of raw vegetables consumed in Zahedan, Iran. Health Scope. 2013;1:205–9.

    Article  Google Scholar 

  36. 36.

    Razavi Piranshahi A, Kazemi F, Tavalla M. Prevalence of parasitic contamination in fast food salads in Ahvaz, southwest of Iran. Asian Pac J Trop Dis. 2017;7:724–6.

    Article  Google Scholar 

  37. 37.

    Fallah AA, Pirali-Kheirabadi K, Shirvani F, Saei-Dehkordi SS. Prevalence of parasitic contamination in vegetables used for raw consumption in Shahrekord, Iran: influence of season and washing procedure. Food Control. 2012;25:617–20.

    Article  Google Scholar 

  38. 38.

    Esboei BR, Sharif M, Daryani A, Hosseini F, sattar Pagheh A, Rahimid M, et al. Parasitic contamination in commonly-consumed vegetables in Mazandaran province, Northern Iran. J Hum. 2017;2 2:89–95.

    Google Scholar 

  39. 39.

    Balarak D, Mahdavi Y, Modrek MJ, Sadeghi S, Joghataei AA. Prevalence of parasitic contamination of raw vegetables in Ahar, Iran. Int J Anal Pharm Biomed Sci. 2016;5(1):28–32.

    Google Scholar 

  40. 40.

    Joghatayi BD. Modrek. A, Ansari MJ. H. The study of consumed vegetables parasitic infections in Qom city in 2014: A short report. J Rafsanjan Univ Med Sci. 2016;14:895–902.

  41. 41.

    Izadi. Sh AS, Mahmoudi AS. M. Study of parasitic contamination of vegetables in vegetable farms of Isfahan City. J Kurd Univ Med Sci. 2006;11: 51–58.

  42. 42.

    Shahnazi M, Sharifi M, Kalantari Z, Heidari MA, Agamirkarimi N. The study of consumed vegetable parasitic infections in Qazvin. J Qazvin U Med Sci. 2009;12:83.

    Google Scholar 

  43. 43.

    Avazpoor M, Yousefipoor MT, Dusty M, Mehdipour M, Seifipour F, Gholami Z. Determination of the level of parasitic infection (Cryptosporidium and Giardia) of the vegetables marketed in Ilam city. 2015. Environ Eng Manag J 2015;4:37–41.

  44. 44.

    Mehrnejat N, Kadkhodaie S, Farrokhzadeh H, Yousefi HA, Pourgheysari H, Seyf S. Evaluation of parasitic contamination in consuming vegetables in a city of Iran in 2011. Int J Environ Health Engin. 2015;4 1:25.

    Google Scholar 

  45. 45.

    Nazemi S, Raei M, Amiri M, Chaman R. Parasitic contamination of raw vegetables in Shahroud, Semnan. Zahedan Uni Med Res. 2012;84:14.

    Google Scholar 

  46. 46.

    Ranjbar-Bahadori S, Mostoophi A, Shemshadi B. Study on Cryptosporidium contamination in vegetable farms around Tehran. Trop Biomed. 2013;30 2:193–8.

    Google Scholar 

  47. 47.

    Valipour Nouroozi R. Detection of parasitic contamination in ready to eat fresh packaged herbs sold in Tehran, Iran. J Commun Health Res. 2015;4 2:99–104.

    Google Scholar 

  48. 48.

    Soleimanpoor H, Zohor A, Ebrahimzade A, Beiranvand L, Dabirzade M. Parasitic contamination of vegetables in Zabul. QI Rostamineh. 2011;8:39–47.

    Google Scholar 

  49. 49.

    Rahimi-Esboei B, Pagheh A, Fakhar M, Pagheh S, Dadimoghadam Y. Parasitic contamination of consumed vegetables in Golestan province, 2012. Med Lab J. 2014;8:3:82–9.

    Google Scholar 

  50. 50.

    Malakotiyan M, Hosseini M, Bahrami H. Study of parasitic contamination in Kerman City. Hormozgan J Med. 2008;1:55–62.

    Google Scholar 

  51. 51.

    Homayouni M, Khalagi N. Parasitic infestation of consumed vegetables in Tehran in 1383. J Arm Univ Med Sci. 2007;4:1053–6.

    Google Scholar 

  52. 52.

    Asadpour M, Malekpour H, Jafari A, Bahrami S. Diversity of parasitic contamination in raw vegetables commonly consumed in Shiraz, Southwest of Iran. Asia Pacific J Trop Dis. 2016;6(2):160–2.

    Article  Google Scholar 

  53. 53.

    Matini M, Shamsi-Ehsan T, Maghsood AH. The parasitic contamination of farm vegetables in Asadabad city, West of Iran, in 2014. Avicenna J Clin Microbiol Infect. 2017;4:1.

    Google Scholar 

  54. 54.

    Zamini G, Hamidi P, Khadem Erfan MB, Faridi A, Ghahramani E, Babaei E. Prevalence of parasitic contamination of raw vegetables in Sanandaj, Iran, in 2013. J Health Res Commun. 2017;2 4:54–8.

    Google Scholar 

  55. 55.

    Zohour A, Molazadeh P. Prevalence of parasitic contamination of commonly used vegetables in Jiroft In 2001. J Birjand Uni Med Sci. 2001.

  56. 56.

    Balarak D, Ebrahimi M, Modrek MJ, Bazrafshan E, Mahvi AH, Mahdavi Y. Investigation of parasitic contaminations of vegetables sold in markets in the city of Tabriz in 2014. Glob J Health Sci. 2016;8 10:178.

    Article  Google Scholar 

  57. 57.

    Saki J, Asadpoori R, Khademvatan S. Prevalence of intestinal parasites in vegetables consumed in Ahvaz, South West of Iran. J Med Sci. 2013;13 6:488.

    Google Scholar 

  58. 58.

    Olyaei A, Hajivandi L. Parasitological contamination of markets and farms in vegetables consumed in southern Iran. Glob Vet. 2013;10:3:327–31.

    Google Scholar 

  59. 59.

    Derakhshan L, Jafarpanahi M, Mohammadzadeh M, Barihi E. Study of parasitic contamination of vegetables consumed in Dezful. Histo Bio Vet. 2014;2 1:28–35.

  60. 60.

    Ashrafi Hafez A, Asadolahi E, Havasian M, Panahi J, Davoudian A, Lotfikar M, et al. Study on the parasitic and microbial contamination of vegetables, and the effect of washing procedures on their elimination in Ilam city. J Paramed Sci (JPS). 2008.

  61. 61.

    Gharavi M, Jahani M, Rokni M. Parasitic contamination of vegetables from farms and markets in Tehran. Iran J Pub Health. 2002;31:3–4:83 – 6.

  62. 62.

    Rahmati K, Fallah M, Maghsood AH, Shamsi-Ehsan T, Matini M. The prevalence of parasitic contamination of vegetables consumed in Malayer city, west of Iran, in 2014. Avicenna J Clin Microbiol Infect. 2017;4:2.

    Article  Google Scholar 

  63. 63.

    Garedaghi Y, Farhang HH, Pooryagoobi S. Parasitic contamination of fresh vegetables consumed in Tabriz, Iran. Res J Biol Sci. 2011;6:10:518–22.

    Article  Google Scholar 

  64. 64.

    Avazpour M, Rostami Nejad M, Seifipour F, Abdi J. Assessment of the microbiological safety of salad vegetables from different restaurants in Ilam. Arch Adv Biosci. 2013;4:111.

    Google Scholar 

  65. 65.

    Razavi S, Nasirinasab-Rafsanjani M, Bahrami S. A study on Cryptosporidium contamination in lettuce collected from different areas in Shiraz. J Shahrekord Uni Med Sci. 2010;12:44.

    Google Scholar 

  66. 66.

    Taherimoghaddam M, Foroughi Parvar F, Kashinahanji M, Matini M. Parasitic contamination of raw vegetables consumed in Hamadan, west of Iran during 2017–2018. Avicenna J Clin Microbiol Infect. 2018;5:82–5.

    Google Scholar 

  67. 67.

    Taghipour A, Javanmard E, Haghighi A, Mirjalali H, Zali MR. The occurrence of Cryptosporidium sp., and eggs of soil-transmitted helminths in market vegetables in the north of Iran. Gastroenterol Hepatol Bed Bench. 2019;12:364–9.

    Google Scholar 

  68. 68.

    Tiyo R, de Souza CZ, Arruda Piovesani AF, Tiyo BT, Colli CM, Marchioro AA, et al. Predominance of Giardia duodenalis assemblage aii in fresh leafy vegetables from a market in southern Brazil. J Food Protect. 2016;79:1036–9.

    CAS  Article  Google Scholar 

  69. 69.

    Sim S, Won J, Kim JW, Kim K, Park WY, Yu JR. Simultaneous molecular detection of Cryptosporidium and Cyclospora from raw vegetables in Korea. Korean J Parasitol. 2017;55:137–42.

    CAS  Article  Google Scholar 

  70. 70.

    Ahmed SA, Karanis P. An overview of methods/techniques for the detection of Cryptosporidium in food samples. Parasitol Res. 2018;117:629–53.

    Article  Google Scholar 

  71. 71.

    Aberg R, Sjoman M, Hemminki K, Pirnes A, Rasanen S, Kalanti A, et al. Cryptosporidium parvum caused a large outbreak linked to frisee salad in Finland, 2012. Zoonos Pub health. 2015;62:618–24.

    CAS  Article  Google Scholar 

  72. 72.

    Decraene V, Lebbad M, Botero-Kleiven S, Gustavsson AM, Lofdahl M. First reported foodborne outbreak associated with microsporidia, Sweden, October 2009. Epidemiol Infect. 2012;140:519–27.

    CAS  Article  Google Scholar 

  73. 73.

    Ponka A, Kotilainen H, Rimhanen-Finne R, Hokkanen P, Hanninen ML, Kaarna A, et al. A foodborne outbreak due to Cryptosporidium parvum in Helsinki, November 2008. Euro Surveill. 2009;14.

  74. 74.

    Ethelberg S, Lisby M, Vestergaard LS, Enemark HL, Olsen KE, Stensvold CR, et al. A foodborne outbreak of Cryptosporidium hominis infection. Epidemiol Infect. 2009;137:348–56.

    CAS  Article  Google Scholar 

  75. 75.

    Ryan U, Hijjawi N, Feng Y, Xiao L. Giardia: an under-reported foodborne parasite. Int J Parasitol. 2019;49:1–11.

    Article  Google Scholar 

  76. 76.

    Ryan U, Hijjawi N, Xiao L. Foodborne cryptosporidiosis. Int J Parasitol. 2018;48:1–12.

    Article  Google Scholar 

  77. 77.

    Karshima SN. Parasites of importance for human health on edible fruits and vegetables in Nigeria: a systematic review and meta-analysis of published data. Pathog Glob Health. 2018;112:47–55.

    Article  Google Scholar 

  78. 78.

    Utaaker KS, Kumar A, Joshi H, Chaudhary S, Robertson LJ. Checking the detail in retail: Occurrence of Cryptosporidium and Giardia on vegetables sold across different counters in Chandigarh, India. Int J Food Microbiol. 2017;263:1–8.

    CAS  Article  Google Scholar 

  79. 79.

    Alemu G, Mama M, Misker D, Haftu D. Parasitic contamination of vegetables marketed in Arba Minch town, southern Ethiopia. BMC Infect Dis. 2019;19:410.

    Article  Google Scholar 

  80. 80.

    Eraky MA, Rashed SM, Nasr Mel S, El-Hamshary AM, Salah El-Ghannam A. Parasitic contamination of commonly consumed fresh leafy vegetables in benha, egypt. J Parasitol Res. 2014;2014:613960.

    Article  Google Scholar 

  81. 81.

    Swaffer B, Abbott H, King B, van der Linden L, Monis P. Understanding human infectious Cryptosporidium risk in drinking water supply catchments. Water Res. 2018;138:282–92.

    CAS  Article  Google Scholar 

  82. 82.

    Benedict KM, Reses H, Vigar M, Roth DM, Roberts VA, Mattioli M, et al. Surveillance for waterborne disease outbreaks associated with drinking water - United States, 2013–2014. MMWR Morb Mortal Wkly Rep. 2017;66 44:1216–21.

  83. 83.

    Alderisio KA, Villegas LF, Ware MW, McDonald LA, Xiao L, Villegas EN. Differences in staining intensities affect reported occurrences and concentrations of Giardia spp. in surface drinking water sources. J Appl Microbiol. 2017;123 6:1607–13.

  84. 84.

    dos Santos Toledo R, Martins FDC, Freire RL. Waterborne Giardia and Cryptosporidium: contamination of human drinking water by sewage and cattle feces. Semina: Ciências Agrárias. 2017;38 5:3395–415.

  85. 85.

    Efstratiou A, Ongerth J, Karanis P. Evolution of monitoring for Giardia and Cryptosporidium in water. Water Res. 2017;123:96–112.

    CAS  Article  Google Scholar 

  86. 86.

    Gallas-Lindemann C, Sotiriadou I, Plutzer J, Karanis P. Prevalence and distribution of Cryptosporidium and Giardia in wastewater and the surface, drinking and ground waters in the Lower Rhine, Germany. Epidemiol Infect. 2013;141:9–21.

    CAS  Article  Google Scholar 

  87. 87.

    Karanis P, Kourenti C, Smith H. Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt. J Water Health. 2007;5:1–38.

    Article  Google Scholar 

  88. 88.

    Mahmoudi MR, Ongerth JE, Karanis P. Cryptosporidium and cryptosporidiosis: The Asian perspective. Int J Hyg Environ Health. 2017;220:1098–109.

    Article  Google Scholar 

  89. 89.

    Spanakos G, Biba A, Mavridou A, Karanis P. Occurrence of Cryptosporidium and Giardia in recycled waters used for irrigation and first description of Cryptosporidium parvum and C. muris in Greece. Parasitol Res. 2015;114:1803–10.

    Article  Google Scholar 

  90. 90.

    Ajonina C, Buzie C, Ajonina IU, Basner A, Reinhardt H, Gulyas H, et al. Occurrence of Cryptosporidium in a wastewater treatment plant in North Germany. J Toxicol Environ Health A. 2012;75 22–23:1351–8;

  91. 91.

    Ramo A, Del Cacho E, Sanchez-Acedo C, Quilez J. Occurrence and genetic diversity of Cryptosporidium and Giardia in urban wastewater treatment plants in north-eastern Spain. Sci Total Environ. 2017;598:628–38;

  92. 92.

    Falloon P, Betts R. Climate impacts on European agriculture and water management in the context of adaptation and mitigation–the importance of an integrated approach. Sci Total Environ. 2010;408:5667–87.

    CAS  Article  Google Scholar 

  93. 93.

    Cheng HW, Lucy FE, Graczyk TK, Broaders MA, Tamang L, Connolly M. Fate of Cryptosporidium parvum and Cryptosporidium hominis oocysts and Giardia duodenalis cysts during secondary wastewater treatments. Parasitol Res 2009;105 3:689–96.

  94. 94.

    Gennaccaro AL, McLaughlin MR, Quintero-Betancourt W, Huffman DE, Rose JB. Infectious Cryptosporidium parvum oocysts in final reclaimed effluent. Appl Environ Microbiol. 2003;69:4983–4.

    CAS  Article  Google Scholar 

  95. 95.

    Nasser AM, Tweto E, Nitzan Y. Die-off of Cryptosporidium parvum in soil and wastewater effluents. J Appl Microbiol. 2007;102:169–76.

    CAS  Article  Google Scholar 

  96. 96.

    Aldeyarbi HM, Abu El-Ezz NM, Karanis P. Cryptosporidium and cryptosporidiosis: the African perspective. Environ Sci Pollut Res Int. 2016;23:13811–21.

    CAS  Article  Google Scholar 

  97. 97.

    Baldursson S, Karanis P. Waterborne transmission of protozoan parasites: review of worldwide outbreaks - an update 2004–2010. Wat Res. 2011;45:6603–14.

    CAS  Article  Google Scholar 

  98. 98.

    Gallas-Lindemann C, Sotiriadou I, Plutzer J, Noack MJ, Mahmoudi MR, Karanis P. Giardia and Cryptosporidium spp. dissemination during wastewater treatment and comparative detection via immunofluorescence assay (IFA), nested polymerase chain reaction (nested PCR) and loop mediated isothermal amplification (LAMP). Acta Trop. 2016;158:43–51.

  99. 99.

    Rosado-Garcia FM, Guerrero-Florez M, Karanis G, Hinojosa MDC, Karanis P. Water-borne protozoa parasites: The Latin American perspective. Int J Hyg Environ Health. 2017;220:783–98.

    Article  Google Scholar 

  100. 100.

    Martins FDC, Ladeia WA, Toledo RdS, Garcia JL, Navarro IT, Freire RL. Surveillance of Giardia and Cryptosporidium in sewage from an urban area in Brazil. Rev Brasil de Parasitol Vet. 2019.

  101. 101.

    Atnafu T, Kassa H, Keil C, Fikrie N, Leta S, Keil I, Presence. Viability and determinants of Cryptosporidium oocysts and Giardia cysts in the Addis Ababa water supply and distribution system. Water Qual Expo Health. 2012;4:55–65.

    CAS  Article  Google Scholar 

  102. 102.

    Jacxsens L, Luning P, Van der Vorst J, Devlieghere F, Leemans R, Uyttendaele M. Simulation modelling and risk assessment as tools to identify the impact of climate change on microbiological food safety–The case study of fresh produce supply chain. Food Res Int. 2010;43:1925–35.

    Article  Google Scholar 

  103. 103.

    Liu C, Hofstra N, Franz E. Impacts of climate change on the microbial safety of pre-harvest leafy green vegetables as indicated by Escherichia coli O157 and Salmonella spp. Int J Food Microbiol. 2013;163:119–28.

    Article  Google Scholar 

  104. 104.

    Miraglia M, Marvin HJ, Kleter GA, Battilani P, Brera C, Coni E, et al. Climate change and food safety: an emerging issue with special focus on Europe. Food Chem Toxicol. 2009;47:1009–21.

    CAS  Article  Google Scholar 

  105. 105.

    Ahmed SA, Guerrero Florez M, Karanis P. The impact of water crises and climate changes on the transmission of protozoan parasites in Africa. Pathogen Glob Health. 2018;112:281–93.

    Article  Google Scholar 

  106. 106.

    Liu X, Yan Y, Li F, Zhang D. Fruit and vegetable consumption and the risk of depression: A meta-analysis. Nutrition (Burbank, Los Angeles County, Calif). 2016;32:296–302.

  107. 107.

    Van WS, Deurenberg P, Burema J, De LG, Hautvast J. Seasonal variation in food intake, pattern of physical activity and change in body weight in a group of young adult Dutch women consuming self-selected diets. Int J Obes. 1986;10:133–45.

    Google Scholar 

  108. 108.

    Ziegler R, Wilcox H 3rd, Mason T, Bill J, Virgo P. Seasonal variation in intake of carotenoids and vegetables and fruits among white men in New Jersey. Am J Clin Nut. 1987;45:107–14.

    CAS  Article  Google Scholar 

  109. 109.

    Rzezutka A, Nichols RA, Connelly L, Kaupke A, Kozyra I, Cook N, et al. Cryptosporidium oocysts on fresh produce from areas of high livestock production in Poland. Int J Food Microbiol. 2010;139:96–101.

    CAS  Article  Google Scholar 

  110. 110.

    Tomass Z, Kidane D. Parasitological contamination of wastewater irrigated and raw manure fertilized vegetables in Mekelle city and its suburb, Tigray, Ethiopia. Momona Ethiop J Sci. 2012;4:77–89.

    Article  Google Scholar 

Download references


The authors would like to appreciate all colleagues of the Foodborne and Waterborne Diseases Research Center, Gastroenterology and Liver Diseases Research Institute for their support during this study.

Author information




Conceptualization: HM MRZ PK. Data gathering and testing eligibility of studies: HM EJ FS ESM. Geographical analysis: HM EJ FS. Data synthesis and meta-analysis: MO EG. Wrote the paper: HM EJ ESM PK. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Hamed Mirjalali.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

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

Electronic supplementary material


(DOC 66 kb)


(DOCX 16 kb)


(DOCX 40 kb)


(DOCX 12 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Javanmard, E., Mirsamadi, E.S., Olfatifar, M. et al. Prevalence of Cryptosporidium and Giardia in vegetables in Iran: a nineteen-years meta-analysis review. J Environ Health Sci Engineer (2020).

Download citation


  • Giardia
  • Cryptosporidium
  • Vegetable farms
  • Climate conditions
  • Meta-analysis
  • Systematic review