Reviewer’s report
Title: Patient Characteristics, Clinical Manifestations, Prognosis, and Factors Associated with
Gastrointestinal Cytomegalovirus Infection in Immunocompetent Patients
Version: 0 Date: 26 Dec 2019
Reviewer: Chih-Chien Yao
Reviewer's report:
This  is  a  retrospective  study reviewed  medical  records  of 173 patients  diagnosed  with  GI-CMV
infection. The aim of this study was to compare the clinical characteristics of GI-CMV infection in
immunocompromise patients with immunocompetent patients. The authors found GI-CMV infection in
immunocompetent  patients  were  elderly,  with  severe  concomitant  illness  and  comorbidities.The
mortality rate is also higher in immunocompetent patients. 
This is an interesting study and I have the following comments:
Major comments:
1. What is the leading cause or disease of immunocompetent CMV-infected patients suffering from
critical illness and need to ICU admission? Is CMV infection in these patients the major problem or
concomitant disease ? Due to the presentation of most CMV-infected cases in this study were GI
hemorrhage and its not reasonable and not comparable to our daily practice that CMV-related GI
bleeding would cause respiratory failure,shock or severe sepsis in immunocompetent patients. Due to
the  result  in  this  study  concluded  that  the  mortality  rate  is  significant  higher  in  CMV-infected
immunocompetent than immunocompromise patients, I think its important to detail description of the
leading disease in these patients and mentioned that the CMV-GI hemorrhage is the major problem or
not.  
Minor comments :
1.  In  introduction  part  (line  61):  what  is  the  abbreviation  "ICT  "meaning  ?  is  it  mean
immunocompetent ? It seemed to be seen only here in whole article.
2. In method part, result part and Table 1 : The 173 CMV infection was diagnosed by pathologic
tissue specimens in definition , but only 162 patients had endoscopic findings showed in table
1( 43 EGD and 119 Colonscopy). So How and where the tissue came from in other 11 patients?
Is it the surgical specimen or missing data ? If they are surgical specimen, Why and how did the
surgical approach perform for these patients ? 
3. In definition of immune status part : Due to the result of these studies showed that DM is the
important susceptibility factors of CMV infection in immunocompetent patients, I think its
important to evaluate the DM severity and disease control situation (like HbA1c level). Because
poor DM control and decompensated cirrhosis are thought to be relative immunocompromise
condition. 
4. In discussion part line 304-306 and conclusion part : In conclusion part said that the higher
mortality in immunocompetent patients maybe due to severe concomitant illness. But in your
result also showed that this group had significant lower anti-viral treatments rate and antiviral
agents is the independent protective factors in multivariate analysis also. So maybe need to
modify the description in conclusion and mention about the treatment effects (like discussion
line 304-306 said). 
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.
Yes
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.
I am able to assess the statistics
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 publication 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 that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests
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 Creative 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 comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title: Patient Characteristics, Clinical Manifestations, Prognosis, and Factors Associated with
Gastrointestinal Cytomegalovirus Infection in Immunocompetent Patients
Version: 0 Date: 26 Dec 2019
Reviewer: Chih-Chien Yao
Reviewer's report:
This  is  a  retrospective  study reviewed  medical  records  of 173 patients  diagnosed  with  GI-CMV
infection. The aim of this study was to compare the clinical characteristics of GI-CMV infection in
immunocompromise patients with immunocompetent patients. The authors found GI-CMV infection in
immunocompetent  patients  were  elderly,  with  severe  concomitant  illness  and  comorbidities.The
mortality rate is also higher in immunocompetent patients. 
This is an interesting study and I have the following comments:
Major comments:
1. What is the leading cause or disease of immunocompetent CMV-infected patients suffering from
critical illness and need to ICU admission? Is CMV infection in these patients the major problem or
concomitant disease ? Due to the presentation of most CMV-infected cases in this study were GI
hemorrhage and its not reasonable and not comparable to our daily practice that CMV-related GI
bleeding would cause respiratory failure,shock or severe sepsis in immunocompetent patients. Due to
the  result  in  this  study  concluded  that  the  mortality  rate  is  significant  higher  in  CMV-infected
immunocompetent than immunocompromise patients, I think its important to detail description of the
leading disease in these patients and mentioned that the CMV-GI hemorrhage is the major problem or
not.  
Minor comments :
1.  In  introduction  part  (line  61):  what  is  the  abbreviation  "ICT  "meaning  ?  is  it  mean
immunocompetent ? It seemed to be seen only here in whole article.
2. In method part, result part and Table 1 : The 173 CMV infection was diagnosed by pathologic
tissue specimens in definition , but only 162 patients had endoscopic findings showed in table
1( 43 EGD and 119 Colonscopy). So How and where the tissue came from in other 11 patients?
Is it the surgical specimen or missing data ? If they are surgical specimen, Why and how did the
surgical approach perform for these patients ? 
3. In definition of immune status part : Due to the result of these studies showed that DM is the
important susceptibility factors of CMV infection in immunocompetent patients, I think its
important to evaluate the DM severity and disease control situation (like HbA1c level). Because
poor DM control and decompensated cirrhosis are thought to be relative immunocompromise
condition. 
4. In discussion part line 304-306 and conclusion part : In conclusion part said that the higher
mortality in immunocompetent patients maybe due to severe concomitant illness. But in your
result also showed that this group had significant lower anti-viral treatments rate and antiviral
agents is the independent protective factors in multivariate analysis also. So maybe need to
modify the description in conclusion and mention about the treatment effects (like discussion
line 304-306 said). 
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.
Yes
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.
I am able to assess the statistics
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 publication 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 that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests
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 Creative 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 comments
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: Patient Characteristics, Clinical Manifestations, Prognosis, and Factors Associated with
Gastrointestinal Cytomegalovirus Infection in Immunocompetent Patients
Version: 0 Date: 26 Dec 2019
Reviewer: Chih-Chien Yao
Reviewer's report:
This  is  a  retrospective  study reviewed  medical  records  of 173 patients  diagnosed  with  GI-CMV
infection. The aim of this study was to compare the clinical characteristics of GI-CMV infection in
immunocompromise patients with immunocompetent patients. The authors found GI-CMV infection in
immunocompetent  patients  were  elderly,  with  severe  concomitant  illness  and  comorbidities.The
mortality rate is also higher in immunocompetent patients. 
This is an interesting study and I have the following comments:
Major comments:
1. What is the leading cause or disease of immunocompetent CMV-infected patients suffering from
critical illness and need to ICU admission? Is CMV infection in these patients the major problem or
concomitant disease ? Due to the presentation of most CMV-infected cases in this study were GI
hemorrhage and its not reasonable and not comparable to our daily practice that CMV-related GI
bleeding would cause respiratory failure,shock or severe sepsis in immunocompetent patients. Due to
the  result  in  this  study  concluded  that  the  mortality  rate  is  significant  higher  in  CMV-infected
immunocompetent than immunocompromise patients, I think its important to detail description of the
leading disease in these patients and mentioned that the CMV-GI hemorrhage is the major problem or
not.  
Minor comments :
1.  In  introduction  part  (line  61):  what  is  the  abbreviation  "ICT  "meaning  ?  is  it  mean
immunocompetent ? It seemed to be seen only here in whole article.
2. In method part, result part and Table 1 : The 173 CMV infection was diagnosed by pathologic
tissue specimens in definition , but only 162 patients had endoscopic findings showed in table
1( 43 EGD and 119 Colonscopy). So How and where the tissue came from in other 11 patients?
Is it the surgical specimen or missing data ? If they are surgical specimen, Why and how did the
surgical approach perform for these patients ? 
3. In definition of immune status part : Due to the result of these studies showed that DM is the
important susceptibility factors of CMV infection in immunocompetent patients, I think its
important to evaluate the DM severity and disease control situation (like HbA1c level). Because
poor DM control and decompensated cirrhosis are thought to be relative immunocompromise
condition. 
4. In discussion part line 304-306 and conclusion part : In conclusion part said that the higher
mortality in immunocompetent patients maybe due to severe concomitant illness. But in your
result also showed that this group had significant lower anti-viral treatments rate and antiviral
agents is the independent protective factors in multivariate analysis also. So maybe need to
modify the description in conclusion and mention about the treatment effects (like discussion
line 304-306 said). 
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.
Yes
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.
I am able to assess the statistics
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 publication 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 that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests
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 Creative 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 comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
assistant