Reviewer's report
Title:Susceptibility to intestinal infection and diarrhoea in Zambian adults in
relation to HIV status and CD4 count
Version: 1Date:5 July 2008
Reviewer: Eric Houpt
Reviewer's report:
I reviewed the manuscript “Susceptibility to intestinal infection and diarrhoea in
Zambian adults in relation to HIV status and CD4 count.”
Overall the manuscript is important and should be published because its size is
excellent and it addresses important uncertainties in the etiology of
HIV-associated enteric disease in Africa. The weakness is the reliance on
microscopy (was this read by a single microscopist, or more than one?) without
antigen detection or PCR. The authors should also elaborate on details of enteric
culture (which media, etc) since this can skew results. It is also not mentioned
clearly how mixed infections were handled.
I would suggest softening the language, for instance “Certain parasites were less
frequently detected in more watery stools, confirming their lack of pathogenicity”
would be better stated “consistent with their lack of pathogenicity,” because it is
not possible to state with complete confidence that, for instance, I. butschlii can
never be a pathogen. Likewise, “Certain protozoa were less common in HIV
infected participants, probably due to self-treatment with antimicrobials” is
overstated and would be better termed “possibly,” since certainly the flora of an
HIV patient could be different for other reasons such as immunosuppression, and
use of antimicrobials was not described in this paper.
Finally, the high rate of recovery of Citrobacter rodentium should be discussed,
since this is not frequently reported.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Susceptibility to intestinal infection and diarrhoea in Zambian adults in
relation to HIV status and CD4 count
Version: 1Date:5 July 2008
Reviewer: Eric Houpt
Reviewer's report:
I reviewed the manuscript “Susceptibility to intestinal infection and diarrhoea in
Zambian adults in relation to HIV status and CD4 count.”
Overall the manuscript is important and should be published because its size is
excellent and it addresses important uncertainties in the etiology of
HIV-associated enteric disease in Africa. The weakness is the reliance on
microscopy (was this read by a single microscopist, or more than one?) without
antigen detection or PCR. The authors should also elaborate on details of enteric
culture (which media, etc) since this can skew results. It is also not mentioned
clearly how mixed infections were handled.
I would suggest softening the language, for instance “Certain parasites were less
frequently detected in more watery stools, confirming their lack of pathogenicity”
would be better stated “consistent with their lack of pathogenicity,” because it is
not possible to state with complete confidence that, for instance, I. butschlii can
never be a pathogen. Likewise, “Certain protozoa were less common in HIV
infected participants, probably due to self-treatment with antimicrobials” is
overstated and would be better termed “possibly,” since certainly the flora of an
HIV patient could be different for other reasons such as immunosuppression, and
use of antimicrobials was not described in this paper.
Finally, the high rate of recovery of Citrobacter rodentium should be discussed,
since this is not frequently reported.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Susceptibility to intestinal infection and diarrhoea in Zambian adults in
relation to HIV status and CD4 count
Version: 1Date:5 July 2008
Reviewer: Eric Houpt
Reviewer's report:
I reviewed the manuscript “Susceptibility to intestinal infection and diarrhoea in
Zambian adults in relation to HIV status and CD4 count.”
Overall the manuscript is important and should be published because its size is
excellent and it addresses important uncertainties in the etiology of
HIV-associated enteric disease in Africa. The weakness is the reliance on
microscopy (was this read by a single microscopist, or more than one?) without
antigen detection or PCR. The authors should also elaborate on details of enteric
culture (which media, etc) since this can skew results. It is also not mentioned
clearly how mixed infections were handled.
I would suggest softening the language, for instance “Certain parasites were less
frequently detected in more watery stools, confirming their lack of pathogenicity”
would be better stated “consistent with their lack of pathogenicity,” because it is
not possible to state with complete confidence that, for instance, I. butschlii can
never be a pathogen. Likewise, “Certain protozoa were less common in HIV
infected participants, probably due to self-treatment with antimicrobials” is
overstated and would be better termed “possibly,” since certainly the flora of an
HIV patient could be different for other reasons such as immunosuppression, and
use of antimicrobials was not described in this paper.
Finally, the high rate of recovery of Citrobacter rodentium should be discussed,
since this is not frequently reported.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
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