Edible plants as significant sources of Blastocystis spp. infections: A systematic review and meta-analysis

This systematic review and meta-analysis were conducted to comprehensively overview the global epidemiology and subtypes (STs) distribution of Blastocystis spp. in edible plants. A comprehensive search of various electronic databases (PubMed, Scopus, Google Scholar, and Web of Science) until May 19, 2024, found 27 studies/41 datasets meeting inclusion criteria, covering 8794 edible plants from 15 countries globally. Examined edible plants were composed of fruits (six datasets, 1198 samples), non-leafy green vegetables (10 datasets, 1158 samples), leafy green vegetables (18 datasets, 4245 samples), and uncategorized plants (seven datasets, 2193). This study revealed that 9.4 % (95 % CI: 6.6-13.4 %) of global edible plants harbored Blastocystis spp. Fruits had the highest Blastocystis spp. contamination rate among edible plants at 12.5 % (95 % CI: 5.4-26.6 %), followed by uncategorized plants at 10.2 % (95 % CI: 4.5-21.5 %), leafy green vegetables at 9.3 % (95 % CI: 6.1-13.9 %), and non-leafy green vegetables at 5.6 % (95 % CI: 2.5-12.1 %). Sensitivity analysis evaluated weighted prevalence changes after excluding specific studies. Subgroup analysis was conducted considering publication years, countries, continents, WHO regions, sample sizes, and diagnostic methods. Interestingly, zoonotic STs (ST1 and ST3) of Blastocystis spp. have been found in edible plants. These results highlight the potential risk of Blastocystis spp. transmission through consuming contaminated edible plants, emphasizing the importance of implementing adequate food safety measures to decrease the prevalence of this parasite in the food chain.