Follow-up, outcomes assessment and relative risk in the trials included in the meta-analysis.

<p>Abbreviations: P, parasitological; C, clinical cure.</p><p>®Relative risks were calculated separately for each study outcome using the software Rev Man5.</p

Forest plot showing the effects of albendazole and metronidazole on human giardiasis.

<p>Relative risk was calculated for each study separately. n/N = number described as cured over number of participants completing study.</p

Flow diagram deciphering the article selection process for this meta-analysis study.

<p>Individual searches do not add up to 56 as some of the same articles were retrieved by multiple search engines.</p

Internal validity (methodological and parasitological) of included trials.

<p>§Range 0–5 (5 exemplifies articles with the highest quality).</p><p>¥Range 0–15, (15 indicates most optimal diagnostic procedure employed).</p><p>€Represents generation of allocation sequence.</p><p>®Represents allocation concealment.</p

Sensitivity-analysis of the effect of the quality of methods implemented for the measurement of parasitological cure.

<p>A, all eight studies included <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000682#pntd.0000682-Misra1" target="_blank">[29]</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000682#pntd.0000682-Alizadeh1" target="_blank">[39]</a>–<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000682#pntd.0000682-Dutta1" target="_blank">[45]</a>.</p><p>B, one study with unclear outcome measure excluded <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000682#pntd.0000682-Dutta1" target="_blank">[45]</a>.</p><p>C, studies using a single diagnostic method excluded <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000682#pntd.0000682-Alizadeh1" target="_blank">[39]</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000682#pntd.0000682-Karabay1" target="_blank">[40]</a>.</p><p>D, one study which used the most sensitive methods excluded <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000682#pntd.0000682-Yereli1" target="_blank">[41]</a>.</p

Characteristics of the randomized controlled trials included in the meta-analysis.

<p>Abbreviations: N.S., Not Stated; s.i.d., once a day; t.i.d., three times a day; RCT, randomized clinical trial.</p><p>¥Albendazole group.</p><p>‡Metronidazole group.</p><p>#The included patients were probably symptomatic individuals referred to three hospitals in India.</p><p>€Initially 768 children were screened in an urban slum in Dhaka from which 678 children were found to be infected with <i>Giradia</i>. The infected children were probably asymptomatic cyst-passers.</p><p>*The person who performed the stool microscopy was blinded to the treatments regimens.</p><p>&The stool sample examiner was blinded to the treatment regimens.</p><p>§Stool examination was done blinded to the treatment status of the patient.</p

Giardiasis as a neglected disease in Brazil: Systematic review of 20 years of publications

<div><p>Introduction</p><p>Giardiasis is an intestinal infection that affects more than two hundred million people annually worldwide; it is caused by the flagellated protozoan <i>Giardia duodenalis</i>. In tropical countries and in low or middle-income settings, like Brazil, its prevalence can be high. There is currently no systematic review on the presence of <i>G</i>. <i>duodenalis</i> in patients, animals or water sources in Brazil.</p><p>Methods</p><p>This systematic review was performed according to recommendations established by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). As databases for our searches, we have used PubMed, Embase, Scopus and the Brazilian database SciELO using the keywords «<i>Giardia</i>^<i>*</i>» and «Brazil».</p><p>Results</p><p>This systematic review identified research studies related to <i>G</i>. <i>duodenalis</i> in water, giardiasis in animals, prevalence of giardiasis across Brazilian regions, genotyping of strains isolated in humans, and giardiasis in indigenous populations. We also propose a network of <i>G</i>. <i>duodenalis</i> transmission in Brazil based on genotypes analyses.</p><p>Conclusion</p><p>This is the first time within the last twenty years that a review is being published on the occurrence of <i>G</i>. <i>duodenalis</i> in Brazil, addressing relevant issues such as prevalence, molecular epidemiology and analytical methods for parasite detection.</p></div

Detection of <i>G</i>. <i>duodenalis</i> cysts in water sources derived through different regions of Brazil.

<p>Only studies using the membrane filtration technique and immunofluorescence or molecular assays are included.</p

Prevalence of giardiasis found in indigenous population in Brazil.

<p>The table shows the indigenous tribe, the localization of the tribe across the country, prevalence, number of individuals enrolled in each study and the year of publication.</p

Brazilian isolates sequences available on NCBI for <i>bg</i>, <i>gdh</i> and <i>tpi</i> genes.

<p>Isolate sequences were extracted from Genbank or NCBI database.</p