<i>Cryptosporidium</i> spp. infections in Tunisia: Epidemiology and public health implications

BACKGROUND: Cryptosporidiosis is an emerging worldwide zoonosis caused by an opportunistic protozoon, Cryptosporidium spp. In Tunisia, the lack of knowledge on the occurrence and genetic characteristics of Cryptosporidium spp. limits the understanding of its epidemiology, impact and transmission routes. OBJECTIVES: The present review aims to collect, compile and summarise data on the prevalence of Cryptosporidium spp. infections in humans, animals and the environment contamination in Tunisia. METHODS: A systematic review was conducted across international databases using PRISMA 2020 Guidelines. Data from 15 selected studies were extracted and organised into thematic categories, including prevalence rates, risk factors, diagnostic methods, and population groups affected. A qualitative synthesis approach was used to analyse and compare findings across studies, highlighting trends, gaps, and public health implications. RESULTS: The publications indicate that Cryptosporidium spp. infections are prevalent in both humans and animals, but the results remain confusing and may not reflect the real impact of the disease. In animals, only three studies were conducted in livestock and poultry. Only Cryptosporidium parvum (IIa and IId) was identified in the three studies from adult asymptomatic animals. Therefore, this finding may not reveal the true impact of the parasite on animal health. In humans, all studies were conducted in hospitals on adult and child patients diagnosed with either cancer or immunodeficiency. Cryptosporidium parvum and Cryptosporidium hominis were by far the predominant species suggesting potential zoonotic and anthroponotic transmission routes in humans. Of the two studies conducted on wastewater, five Cryptosporidium species (C. parvum, C. hominis, Cryptosporidium meleagridis, Cryptosporidium muris, Cryptosporidium andersoni, Cryptosporidium ubiquitum) and three genotypes were identified, highlighting the potential role of water as a potential route of Cryptosporidium spp. CONCLUSIONS: The current review give an overview of the circulating Cryptosporidium spp. species and genotypes but they remain insufficient to fully understand the transmission dynamics, zoonotic potential and animal welfare implications of Cryptosporidium spp. in Tunisia.