Lyme Borreliosis in Iran: True or myth? A systematic review

Despite growing global attention to Lyme disease (LD), its epidemiology remains poorly defined in the Middle East, including Iran. This systematic review addresses a critical gap by synthesizing available evidence on LD occurrence, vectors, and reservoirs in Iran. We followed PRISMA guidelines to systematically search international and Iranian databases for studies published in English or Persian up to March 1, 2025. Eligible studies employed serological (ELISA, Western blot) or molecular (PCR-based) diagnostics. Study quality was assessed using the Joanna Briggs Institute checklist. Twenty-six studies were included: five human case reports and 21 cross-sectional studies involving humans, animals, and ticks. Reports of Borrelia burgdorferi sensu lato species were confirmed in multiple hosts and vectors, with scattered geographical distribution. This review provides the first national synthesis of LD-related data in Iran, suggesting underdiagnosis and calling for enhanced surveillance and standardized diagnostic protocols.