Reviewer ’s report  
 
Title:  Liver Abscess and Bac teremia Caused by Lactobacillus: Role of Probiotics? Case Report 
and Review of the Literature  
 
Version: 0 Date: 25 Dec 2015 
 
Reviewer:  Conrado M  Fernandez Rodriguez  
 
Reviewer’s report:  
 
This is an inter esting case report describing a female patient suffering a liver pyogenic abscess 
by lactobacilus sp. There are few reports of serious infection produced by this microorganism 
commonly used as a probiotic in a variety of conditions. In adition to age, this  elderly patient had 
several factors of inmmunodepression (DM -2 and ESRD). I would like the authors to further 
clarify some minor points.  
 
1. Did they have the opportunity of culturing the source of probiotics in order to verify that was 
the same microorga nism (Eg the same antibiotic sensitivity prophile). Was the bacteria resistant 
to metronidazole that the patient was receiving for her C. difficile infection?  
 
2. Table 1 should be edited for easier reading.  
  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the public ation of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare t hat I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I have nothing to disclose regarding this manuscript  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Cr eative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comme nts 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  Liver Abscess and Bac teremia Caused by Lactobacillus: Role of Probiotics? Case Report 
and Review of the Literature  
 
Version: 0 Date: 25 Dec 2015 
 
Reviewer:  Conrado M  Fernandez Rodriguez  
 
Reviewer’s report:  
 
This is an inter esting case report describing a female patient suffering a liver pyogenic abscess 
by lactobacilus sp. There are few reports of serious infection produced by this microorganism 
commonly used as a probiotic in a variety of conditions. In adition to age, this  elderly patient had 
several factors of inmmunodepression (DM -2 and ESRD). I would like the authors to further 
clarify some minor points.  
 
1. Did they have the opportunity of culturing the source of probiotics in order to verify that was 
the same microorga nism (Eg the same antibiotic sensitivity prophile). Was the bacteria resistant 
to metronidazole that the patient was receiving for her C. difficile infection?  
 
2. Table 1 should be edited for easier reading.  
  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the public ation of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare t hat I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I have nothing to disclose regarding this manuscript  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Cr eative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comme nts 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  Liver Abscess and Bac teremia Caused by Lactobacillus: Role of Probiotics? Case Report 
and Review of the Literature  
 
Version: 0 Date: 25 Dec 2015 
 
Reviewer:  Conrado M  Fernandez Rodriguez  
 
Reviewer’s report:  
 
This is an inter esting case report describing a female patient suffering a liver pyogenic abscess 
by lactobacilus sp. There are few reports of serious infection produced by this microorganism 
commonly used as a probiotic in a variety of conditions. In adition to age, this  elderly patient had 
several factors of inmmunodepression (DM -2 and ESRD). I would like the authors to further 
clarify some minor points.  
 
1. Did they have the opportunity of culturing the source of probiotics in order to verify that was 
the same microorga nism (Eg the same antibiotic sensitivity prophile). Was the bacteria resistant 
to metronidazole that the patient was receiving for her C. difficile infection?  
 
2. Table 1 should be edited for easier reading.  
  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the public ation of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare t hat I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I have nothing to disclose regarding this manuscript  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Cr eative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comme nts 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
assistant