**Background:** Buffaloes are critical to the livestock economy in many countries, especially in Asia, with a global population exceeding 200 million. Tick-borne pathogens (TBPs) cause significant morbidity and economic losses in buffaloes and other livestock, yet comprehensive epidemiological data on TBPs in buffaloes have been lacking. This study provides the first systematic review and meta-analysis of TBPs infecting buffaloes worldwide.
**Methods:** The authors systematically searched PubMed, Scopus, ScienceDirect, and Google Scholar for studies on TBPs in buffaloes, with no date limit, restricted to English-language research articles. Keywords included tick-borne pathogen names combined with "buffaloes" using Boolean operators. Two authors independently screened studies; disagreements were resolved by a third author. Eligible studies had to investigate TBPs in water buffalo (Bubalus bubalis) or African buffalo (Syncerus caffer) and report numbers of examined and positive animals. Reviews, book chapters, and studies on non-buffalo animals were excluded. Data extracted included authors, year, country, sample size, positives, detection methods, and pathogen species. Meta-analyses were performed using OpenMeta[Analyst] software with a random-effects model (DerSimonian–Laird method) at a 95% confidence interval. Heterogeneity was assessed using the I² statistic, with values >50% considered high. Publication bias was not assessed as it is not considered relevant for prevalence studies.
**Key Results:** From 116 eligible studies (107 used for meta-analysis), 145 datasets were extracted. Most studies came from Asia (n=75), followed by Africa (n=23), South America (n=12), Europe (n=4), and North America (n=2). For Babesia spp., the pooled global PCR-based prevalence was 12.0% (95% CI 9.2–14.7%; 25 datasets, 3593 animals), while microscopy yielded 10.0% (95% CI 7.0–13.0%; 15 datasets, 5517 animals), and ELISA showed 32.7% (95% CI 13.2–52.2%; 10 datasets, 1633 samples). For Theileria spp., PCR-based pooled prevalence was 24.6% (95% CI 18.7–30.4%; 27 datasets, 3427 samples), microscopy 16.2% (95% CI 10.6–21.9%; 11 datasets, 2447 samples), and ELISA 20.9% (95% CI 8.7–33.2%; 2 datasets, 578 samples). Theileria prevalence was notably higher in Africa (PCR: 42.0%) than in Asia (PCR: 20.7%). For Anaplasma spp., PCR-based pooled prevalence was 21.0% (95% CI 16.5–25.4%; 28 datasets, 5219 samples), microscopy 8.8% (95% CI 3.0–14.5%; 8 datasets, 886 samples), and ELISA 27.8% (95% CI 2.4–53.2%; 4 datasets, 868 samples). Coxiella burnetii showed a pooled PCR prevalence of 4.5% (95% CI 1.9–7.1%; 9 datasets, 1360 samples) and ELISA prevalence of 5.3% (95% CI 1.4–9.2%; 5 datasets, 987 samples). For Borrelia spp., seroprevalence in Brazil was 68.2% (95% CI 53.2–83.1%; 3 datasets, 5617 samples). Bartonella spp. PCR prevalence was 1.5% (95% CI −1.9 to 5.0%; 3 datasets). Ehrlichia spp. PCR prevalence was 3.1% (95% CI −0.3 to 6.5%; 4 datasets, 328 samples). CCHFV seroprevalence was 16.0% (95% CI 9.9–22.1%; 4 datasets, 880 samples). No Rickettsia spp. were detected in 220 buffaloes tested by PCR. Species identified included Babesia bovis, B. bigemina, B. orientalis, B. occultans, B. naoakii; Theileria annulata, T. orientalis complex, T. parva, T. mutans, T. sinensis, T. velifera, T. lestoquardi-like, T. taurotragi, T. sp. (buffalo), T. ovis; Anaplasma marginale, A. centrale, A. platys, A. platys-like, and "Candidatus Anaplasma boleense". Heterogeneity was high (I² >50%) in most analyses.
**Clinical Implications:** This meta-analysis reveals that TBPs are highly prevalent and diverse in buffalo populations globally, with many species shared between buffaloes and cattle, posing cross-species transmission risks. The high seroprevalence of zoonotic pathogens such as CCHFV (16.0%), Borrelia (68.2% in Brazil), and Coxiella burnetii underscores potential public health risks, particularly for individuals in contact with buffaloes or their products. The findings emphasize the need for integrated tick control, surveillance programs, and biosecurity measures in regions with high buffalo densities, especially Asia and Africa. Limitations include high heterogeneity across studies, variability in diagnostic methods, and limited data from some regions and pathogens (e.g., Rickettsia).