Introduction: Intestinal parasitic infections represent a significant source of morbidity among pediatric populations in developing nations, particularly among immunocompromised individuals, where the progression of the disease often manifests in severe and occasionally life-threatening forms. The heterogeneous geography and socio-economic factors prevalent in
Iran contribute to disparate patterns of infection among children exhibiting immune deficiencies. The main objective of this study was to determine the prevalence of intestinal parasitic infections among immunocompromised and healthy children under ۱۵ years of age in Iran. Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Scopus, SID,
Iran Medex, and Web of Science for research articles published from ۲۰۱۰ to ۲۰۲۵, utilizing search terms such as "intestinal parasites," "immunocompromised children," "Iran." and names of specific protozoa and helminths. A total of fifty-seven studies focusing on immunocompromised children and forty-five studies on healthy children fulfilled the inclusion criteria and were subsequently analyzed. Results: Immunocompromised pediatric populations-specifically those exhibiting selective IgA deficiency, common variable immunodeficiency (CVID), severe combined immunodeficiency (SCID), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), nephrotic syndrome, and those undergoing organ transplantation demonstrated a significantly elevated prevalence of intestinal parasitic infections in comparison to their healthy counterparts. The most frequently identified parasites included Giardia lamblia (۲۸-۴۵% in immunocompromised individuals versus ۱۰-۱۵% in healthy children), Cryptosporidium spp. (۱۸-۳۸% versus ۳.۸% in general pediatric populations of Iran), Blastocystis hominis (۱۰-۲۰% relative to ~۷%), Entamoeba histolytica (۸-۱۵% against ۲-۵%), and Strongyloides stercoralis (۵-۱۲% contrasted with ۱%). The prevalence rates were notably highest in regions such as Sistan and Baluchestan (Giardia, Entamoeba), Khuzestan (Giardia, Blastocystis), Fars (Cryptosporidium, Strongyloides), as well as in Tehran and Isfahan, where associations with HIV/CVID-related infections were observed. Selective IgA deficiency was particularly correlated with increased incidences of giardiasis and cryptosporidiosis. Conclusion: Immunocompromised children in
Iran are at markedly increased risk for intestinal parasitic infections, shaped by both immunological and geographical determinants. Strategies such as molecular-based screening, parental education, improved hygiene, and early diagnosis of immune disorders are critical for reducing morbidity in this population.
