Review http://dx.doi.org/10.1016/j.apjtm.2017.03.017 Microsporidiosis in Iran: A systematic review and meta-analysis Q3 Roghayeh Ghoyounchi 1,2,# , Ehsan Ahmadpour 3,# , Adel Spotin 2 , Mahmoud Mahami-Oskouei 1,2✉ , Azim Rezamand 1,4 , Nayyereh Aminisani 5 , Morteza Ghojazadeh 6 , Reza Berahmat 2 , Tahereh Mikaeili-Galeh 2 1 Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2 Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 3 Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 4 Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 5 Department of Statistics and Epidemiology, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran 6 Research Center of Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran ARTICLE INFO Article history: Received 6 Jan 2017 Received in revised form 11 Feb 2017 Accepted 12 Mar 2017 Available online xxx Keywords: Microsporidia Microsporidiosis Genotypes Iran Prevalence Epidemiology ABSTRACT Objective: To examine all evidences about Microsporidia infection in vertebrate/ invertebrate hosts and Iranian populations distributed in different regions of the country. Methods: All published articles up to December 2015, including descriptive and cross- sectional studies related to the prevalence and genotyping of Microsporidia infection in Iran, was considered in this systematic review. The meta-analysis was done using the random-effects model and Stats Direct statistical software. MEGA 5.05 software and maximum likelihood algorithm with Kimura 2-parameter model were used for phylo- genetic analysis. Results: Of the 1152 investigated studies, 33 eligible studies reported a prevalence of Microsporidia infection in vertebrate and invertebrate hosts. According to this systematic review, the overall prevalence rate of Microsporidia infection in immunocompromised patients in Iran was 8.18%. Furthermore, the overall prevalence rate of Microsporidia infection in immunocompromised patients with chronic diarrhoea, patients with non- diarrhoea, gastroenteritis, and patients with CD4 (<200 cells/mL) was 15.4%, 4.1%, 0.5%, and 12.9% respectively. The highest prevalence rate of human and animal Microsporidia was estimated in Kerman (29%) and Khuzestan (26.5%). The overall prevalence rate of Microsporidia infection in honeybees using the random-effects model was 40%. Furthermore, the highest prevalence rate of nosemosis was described in East Azerbaijan (48.2%). The maximum number of Microsporidia isolates from immuno- compromised patients and pigeons in Iran belonged to genotypes D (n = 16; 50%) and E (n = 6; 20.6%) of Enterocytozoon bieneusi. Conclusions: This study may be the first systematic review and meta-analysis that provides a broad outlook on the prevalence of microsporidiosis in Iran. It is necessary to investigate Microsporidia infection in vertebrate and invertebrate hosts and environmental resources in Iran. First author: Roghayeh Ghoyounchi, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. ✉ Corresponding author: Mahmoud Mahami-Oskouei, Pediatric Health Research Center and Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Tel/Fax: +98 4133373745 E-mail: mahamim@tbzmed.ac.ir Peer review under responsibility of Hainan Medical University. # These two authors contributed equally to this work. HOSTED BY Contents lists available at ScienceDirect Asian Pacific Journal of Tropical Medicine journal homepage: http://ees.elsevier.com/apjtm Asian Pacific Journal of Tropical Medicine 2017; ▪(▪): 1–10 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 APJTM433_proof ■ 10 April 2017 ■ 1/10 1995-7645/Copyright © 2017 Hainan Medical University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Ghoyounchi R, et al., Microsporidiosis in Iran: A systematic review and meta-analysis, Asian Pacific Journal of Tropical Medicine (2017), http://dx.doi.org/10.1016/ j.apjtm.2017.03.017