Research is required to determine whether the coinfections by Fasciola spp. and other parasite species result from poor rural hygiene or reflect underlying epidemiological patterns and causes. Therefore, the role of fascioliasis is analyzed concerning coinfection complexity, risk of multiparasitism, parasite associations, pathogenic implications and their multifactorial causes. Helminth and protozoan coinfections are studied in 2575 previously untreated individuals from four rural hyperendemic areas (Northern Bolivian Altiplano, Peruvian Altiplano and Cajamarca valley, and the Egyptian Nile Delta). This cross-sectional study was conducted from January 2011 to December 2023. Coinfections were coprologically assessed by the merthiolate–iodine–formalin and formol–ether concentration techniques. Infection intensity was measured as eggs/gram of feces (epg) with the Kato–Katz technique...