Objective: Our study aimed to recapitulate and summarize the findings from the literature to provide an overview on the correlation between infection and PD.

Background: Parkinson Disease (PD) is a progressive neurodegenerative disorder that presents preponderantly as tremors. However, cogwheel rigidity, bradykinesia, and postural instability are evident in advanced stages. Several factors may be involved in PD development, and many studies examined the association between PD and bacterial, viral, or parasitic infections, however, their findings are contradictory.

Methods: A systematic search of 13 databases was performed to include original studies that address an association between infection and PD in humans. Quality assessment was conducted via National Institute of Health (NIH) tool. The protocol has been registered in PROSPERO (CRD42017079452).

Results: Our study comprised 24 original papers including over 9 million participants. Small intestinal overgrowth showed a significant association with PD compared to healthy controls [OR (95% CI) = 7.45 (2.82-19.64), p ˂ 0.001]. In contrast, PD patients showed less incidence of TB infection [OR (95% CI) = 0.80 (0.76-0.85), p ˂ 0.001]. Other bacterial infections were more abundant in patients with PD, however, no statistically significant difference was observed. Human immunodeficiency virus (HIV) and Cytomegalovirus (CMV) reported remarkable association with PD; with [OR (95% CI) = 43.73 (25.90-73.83), p ˂ 0.001] and [OR (95% CI) = 4.56 (2.44-8.54), p ˂ 0.001], respectively. Rubella showed a similar significant association [OR (95% CI) = 2.49 (1.23-5.01), p = 0.011]. Most of other viral infections showed increased incidence in PD patients but no statistically significant difference was found. Remarkably, patients with PD showed less incidence of varicella zoster viral infection [OR (95% CI) = 0.86 (0.57-1.29), p = 0.470]. In the same context, one study reported increased association of PD with both Toxocara canis [OR (95% CI) = 7.44 (0.37-147.92), p = 0.188] and Toxoplasma infections [OR (95% CI) = 1.22 (0.75-1.98), p = 0.417]. Interestingly, one study showed a decreased incidence of malaria in patients with PD [OR (95% CI) = 0.94 (0.43-2.05), p = 0.879].

Conclusions: Our study demonstrates numerous cases with infections associated with PD. Future large scale research studies should be considered and healthcare professionals should pay more attention to appearance of PD symptoms in patients with infections.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-association-between-infections-and-parkinson-disease-a-systematic-review-and-meta-analysis/