{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:10:07Z","timestamp":1760029807288,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Objetive: The aim of this study was to describe the impact of non-pharmaceutical interventions (NPIs) against SARS-CoV-2 in patients with symptoms of enteric protozoa (EP), including Blastocystis spp., Dientamoeba fragilis, Giardia lamblia, Cryptosporidium spp., Entamoeba histolytica, and Cyclospora cayetanensis, in the overall population and in patients who were consulted at a National Referral Center for Imported Tropical Diseases (NRCITD patients) from a healthcare area in Madrid (Spain). Method: Data on patients with positive RT-PCR results for EP were collected. The periods analyzed were prepandemic (P0, 1 April 2019\u201331 March 2020), and the first (P1, 1 April 2020\u201331 March 2021), second (P2, 1 April 2021\u201331 March 2022), and third (P3, 1 April 2022\u201331 March 2023) pandemic years. We compared the prevalence, median age, absolute incidence (EP per 100,000 population of each period), and patient profile (NRCITD vs. non-NRCITD) during the study periods using Fisher\u2019s test (p &lt; 0.05) and the T-test (p &lt; 0.001). Results: During P0, 24.8%, [95% CI: 23.9\u201325.6] of patients tested for EP RT-PCR were positive, 22.6% [95% CI: 21.5\u201323.7] were positive in P1, 20.4%, [95% CI: 19.5\u201321.3] were positive during P2, and 20% [95% CI: 19.2\u201320.9] of patients tested during P3 were positive. During the study, there was no difference in the median ages. The prevalence and absolute incidence of EP showed a decreasing trend during the pandemic for the NRCITD and non-NRCITD patients (p &lt; 0.05). Conclusion: Blastocystis spp. and D. fragilis showed a lower decrease in prevalence during P1 (p &gt; 0.05) due to the higher detection of colonized patients during the SARS-CoV-2 pandemic. However, G. lamblia and Cryptosporidium spp. showed the highest decrease in prevalence and absolute incidence during P2 (p &lt; 0.05) because of the NPIs implemented during the SARS-CoV-2 pandemic. The NTRCID patients showed a higher prevalence of Blastocystis spp. than the non-NTRCID patients during every period studied (p &lt; 0.001). E. histolytica and C. cayetanensis showed a homogeneous trend.<\/jats:p>","DOI":"10.3390\/medsci13010023","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T05:52:16Z","timestamp":1740981136000},"page":"23","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of the SARS-CoV-2 Pandemic on the Prevalence and Incidence of Enteric Protozoa in a Spanish Tertiary-Care Hospital and a Referral Center for Tropical Diseases, 2019\u20132023"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1856-1725","authenticated-orcid":false,"given":"Alfredo","family":"Maldonado-Barrueco","sequence":"first","affiliation":[{"name":"Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"de la Calle-Prieto","sequence":"additional","affiliation":[{"name":"National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, Hospital Universitario La Paz-Carlos III-CB, 14049 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"D\u00edaz-Men\u00e9ndez","sequence":"additional","affiliation":[{"name":"National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, Hospital Universitario La Paz-Carlos III-CB, 14049 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5522-3728","authenticated-orcid":false,"given":"Marta","family":"Arsuaga","sequence":"additional","affiliation":[{"name":"National Referral Unit for Imported Diseases and International Health, High Level Isolation Unit, Hospital Universitario La Paz-Carlos III-CB, 14049 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio","family":"Garc\u00eda-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8957-6596","authenticated-orcid":false,"given":"Guillermo","family":"Ruiz-Carrascoso","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, 28046 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,1]]},"reference":[{"key":"ref_1","unstructured":"(2024, December 15). Government of Spain Royal Decree 463\/2020 of 14 March Declaring a State of Alarm for the Management of the Health Crisis Situation Caused by COVID-19. Available online: https:\/\/es.andersen.com\/en\/publications-and-news\/royal-decree-4632020-of-14-march-declaring-the-state-of-alert-for-the-management-of-the-health-crisis-caused-by-covid-19.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1177\/00472875211048932","article-title":"International Tourism and Infectious Disease Transmission Nexus: A Cross-Country and Regional Study","volume":"61","author":"Selvanathan","year":"2022","journal-title":"J. Travel Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.vacune.2023.05.001","article-title":"The End of COVID-19 Public Health Emergency of International Concern (PHEIC): And Now What?","volume":"24","author":"Torner","year":"2023","journal-title":"Vacunas (Engl. Ed.)"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e02669-21","DOI":"10.1128\/spectrum.02669-21","article-title":"Impact of the SARS-CoV-2 Pandemic on the Prevalence and Incidence of Gastrointestinal Viruses in Children up to Five Years Old: A Retrospective Cohort Study","volume":"10","year":"2022","journal-title":"Microbiol. Spectr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1089\/fpd.2023.0124","article-title":"Impact of the SARS-CoV-2 Pandemic on Prevalence and Incidence of Bacterial Gastroenteritis in Spain, 2019\u20132022","volume":"21","year":"2024","journal-title":"Foodborne Pathog. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102836","DOI":"10.1016\/j.anaerobe.2024.102836","article-title":"Increase of Healthcare-Onset Clostridioides Difficile Infection in Adult Population since SARS-CoV-2 Pandemic: A Retrospective Cohort Study in a Tertiary Care Hospital from 2019 to 2022","volume":"86","year":"2024","journal-title":"Anaerobe"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Miller, J.M., Binnicker, M.J., Campbell, S., Carroll, K.C., Chapin, K.C., Gonzalez, M.D., Harrington, A., Jerris, R.C., Kehl, S.C., and Leal, S.M. (2024). Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin. Infect. Dis., ciae104.","DOI":"10.1093\/cid\/ciae104"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.cmi.2023.09.003","article-title":"The Clinical Significance of Dientamoeba fragilis and Blastocystis in Human Stool\u2014Retrospective Cohort Study","volume":"30","author":"Shasha","year":"2024","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1186\/s13071-021-04859-3","article-title":"Blastocystis in the Faeces of Children from Six Distant Countries: Prevalence, Quantity, Subtypes and the Relation to the Gut Bacteriome","volume":"14","author":"Cinek","year":"2021","journal-title":"Parasites Vectors"},{"key":"ref_10","unstructured":"Ministry of Health (2024, December 15). Update No. 672. Coronavirus Disease (COVID-19), Available online: https:\/\/www.sanidad.gob.es\/areas\/alertasEmergenciasSanitarias\/alertasActuales\/nCov\/documentos\/Actualizacion_672_COVID-19.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"36911","DOI":"10.1007\/s11356-021-18192-w","article-title":"Intestinal Parasitic Infections among Patients Referred to Hospitals Affiliated to Shiraz University of Medical Sciences, Southern Iran: A Retrospective Study in Pre- and Post-COVID-19 Pandemic","volume":"29","author":"Teimouri","year":"2022","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"94","DOI":"10.47665\/tb.38.2.038","article-title":"Shift in Parasitic Infections during the Corona Pandemic: A Hospital-Based Retrospective Study","volume":"38","author":"Hawash","year":"2021","journal-title":"Trop. Biomed."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5359823","DOI":"10.1155\/2023\/5359823","article-title":"The Frequency of Intestinal Parasitic Infections in COVID-19 Patients: A Case-Control Study in Tehran, Capital of Iran","volume":"2023","author":"Taghipour","year":"2023","journal-title":"J. Trop. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"826","DOI":"10.3855\/jidc.17495","article-title":"Prevalence of Intestinal Parasites during Pre- and Post-COVID-19 Pandemic at a Tertiary Care Center in Lebanon","volume":"17","author":"Ghandour","year":"2023","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4274\/tpd.galenos.2023.22438","article-title":"The Effect of the COVID-19 Pandemic Process on the Incidence of Intestinal Parasites; Ayd\u0131n Province Example","volume":"47","year":"2023","journal-title":"Turk. Parazitol. Derg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Seid, M., Yohanes, T., Goshu, Y., Jemal, K., and Siraj, M. (2022). The Effect of Compliance to Hand Hygiene during COVID-19 on Intestinal Parasitic Infection and Intensity of Soil Transmitted Helminthes, among Patients Attending General Hospital, Southern Ethiopia: Observational Study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270378"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4274\/tpd.galenos.2022.57338","article-title":"The Impact of COVID-19 Pandemic on Access to Healthcare: The Experience of the Diagnostic Parasitology Laboratory of Ege University","volume":"46","author":"Zorbozan","year":"2022","journal-title":"Turk. Parazitol. Derg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1055\/s-0043-1768169","article-title":"Spectrum and Trends of Intestinal Parasitic Infections at a Tertiary Care Hospital during Pandemic Times: A Laboratory-Based Retrospective Study","volume":"15","author":"Meena","year":"2023","journal-title":"J. Lab. Physicians"},{"key":"ref_19","unstructured":"(2024, December 15). Government of Spain Royal Decree-Law 21\/2020 of 9 June on Urgent Prevention, Containment and Coordination Measures to Deal with the Health Crisis Caused by COVID-19. Available online: https:\/\/www.lexology.com\/library\/detail.aspx?g=9cd344fa-04d2-45d8-8b79-921e10707fbb."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.gtc.2021.02.011","article-title":"Parasitic Infections of the Gastrointestinal Track and Liver","volume":"50","author":"Braseth","year":"2021","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.2166\/wh.2023.094","article-title":"Waterborne Transmission of Protozoan Parasites: A Review of Worldwide Outbreaks\u2014An Update 2017\u20132022","volume":"21","author":"Bourli","year":"2023","journal-title":"J. Water Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"66","DOI":"10.32552\/2022.ActaMedica.715","article-title":"Distribution of Intestinal Parasites Detected in Ankara Training and Research Hospital between 2017 and 2020","volume":"53","author":"Kaya","year":"2022","journal-title":"Acta Medica"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1128\/CMR.00022-08","article-title":"New Insights on Classification, Identification, and Clinical Relevance of Blastocystis Spp.","volume":"21","author":"Tan","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"taac143","DOI":"10.1093\/jtm\/taac143","article-title":"Should We Treat Blastocystis Sp.? A Double-Blind Placebo-Controlled Randomized Pilot Trial","volume":"30","author":"Cobuccio","year":"2023","journal-title":"J. Travel Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"taac011","DOI":"10.1093\/jtm\/taac011","article-title":"Persistent Abdominal Symptoms in Returning Travellers: Clinical and Molecular Findings","volume":"29","author":"Biber","year":"2022","journal-title":"J. Travel Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"211","DOI":"10.4103\/2141-9248.105679","article-title":"Conventional Microscopy versus Molecular and Immunological Methods in the Diagnosis of Amoebiasis","volume":"2","author":"Ramana","year":"2012","journal-title":"Ann. Med. Health Sci. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1128\/CMR.00076-15","article-title":"Dientamoeba fragilis, the Neglected Trichomonad of the Human Bowel","volume":"29","author":"Stark","year":"2016","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_28","first-page":"422","article-title":"The High Co-Existence Rate of Blastocystis and Dientamoeba fragilis in Human Faecal Samples and the Analysis of Demographic and Clinical Findings","volume":"4","author":"TiLekliOglu","year":"2021","journal-title":"J. Health Sci. Med."},{"key":"ref_29","unstructured":"Epidemiological Report on the Situation of Giardiasis in Spain (2022). Year 2022. Results of the National Epidemiological Surveillance Network, Carlos III Institute. Available online: https:\/\/cne.isciii.es\/documents\/d\/cne\/informe_giardia_2022_final-pdf."},{"key":"ref_30","unstructured":"Carrera, S., and Luk, N.C. (2020). In the Name of COVID-19: An Assessment of the Schengen Internal Border Controls and Travel Restrictions in the EU, European Parliament."},{"key":"ref_31","unstructured":"Government of Spain (2024, December 15). Mobility and Transport in Times of COVID. Monographic Report. Observatory of Transport and Logistics in Spain. Ministry of Transport, Mobility and Urban Agenda, Available online: https:\/\/cdn.mitma.gob.es\/portal-web-drupal\/OTLE\/elementos_otle\/20210323_informe_otle_2020.pdf."},{"key":"ref_32","unstructured":"Carlos III Institute (2021). Epidemiological Report on the Situation of Cryptosporidiosis in Spain. Year 2021. Results of the National Epidemiological Surveillance Network, Carlos III Institute. Available online: https:\/\/cne.isciii.es\/documents\/d\/cne\/informe_criptosporidium_2021_final-pdf."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1099\/mic.0.000764","article-title":"Cryptosporidium: This Article Is Part of the Microbe Profiles Collection","volume":"165","author":"Chalmers","year":"2019","journal-title":"Microbiology"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Coelho, N.M.D., Coelho, W.M.D., Gomes, J.F., Meireles, M.V., Nagata, W.B., De Lima, V.M.F., Santos-Doni, T.R., Silva, V.B., Da Silveira Neto, L., and Nakamura, A.A. (2023). Evidence of the Zoonotic Transmission of Cryptosporidium among Children and Pets. Pathogens, 12.","DOI":"10.3390\/pathogens12121393"},{"key":"ref_35","unstructured":"Epidemiological Report on the Situation of Cryptosporidiosis in Spain (2024, December 15). Year 2029\u20132022. Results of the National Epidemiological Surveillance Network., Available online: https:\/\/cne.isciii.es\/documents\/d\/cne\/informe-202019_2020_criptosporidiosis_final-pdf."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s13312-017-1093-3","article-title":"Epidemiology of Cryptosporidium in Pediatric Diarrheal Illnesses","volume":"54","author":"Dabas","year":"2017","journal-title":"Indian Pediatr."},{"key":"ref_37","first-page":"2300733","article-title":"Marked Increase in Cryptosporidiosis Cases, Spain, 2023","volume":"29","author":"Carmena","year":"2024","journal-title":"Eurosurveillance"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1056\/NEJMra1207777","article-title":"Enteropathogens and Chronic Illness in Returning Travelers","volume":"368","author":"Ross","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Almeria, S., Cinar, H.N., and Dubey, J.P. (2019). Cyclospora Cayetanensis and Cyclosporiasis: An Update. Microorganisms, 7.","DOI":"10.3390\/microorganisms7090317"},{"key":"ref_40","first-page":"42","article-title":"Frequency of Intestinal Parasitic Infections among Schoolchildren in IBB City-Yemen","volume":"5","author":"Qasem","year":"2020","journal-title":"Univers. J. Pharm. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1590\/s1678-9946201759082","article-title":"Intestinal Parasitic Infections among Expatriate Workers in Various Occupations in Sharjah, United Arab Emirates","volume":"59","author":"Dafalla","year":"2017","journal-title":"Rev. Inst. Med. Trop. S\u00e3o Paulo"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/1\/23\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:45:15Z","timestamp":1760028315000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/1\/23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["medsci13010023"],"URL":"https:\/\/doi.org\/10.3390\/medsci13010023","relation":{},"ISSN":["2076-3271"],"issn-type":[{"type":"electronic","value":"2076-3271"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}