Reviewer's report
Title:New foe treated with old guns - Role of steroids for the treatment of acute
severe hepatitis E
Version:3Date:3 June 2014
Reviewer: Joop Arends
Reviewer's report:
This report is well written and tries to conclude that streroid therapy is an
alternative therapy for acute liver failure (ALF) caused by HEV. This is a rare
case of an immunocompetent patients with ALF with a primairy diagnosis of
toxic/ medication induced hepatitis after which prednison was started. Despite
initial negative HEV PCR and serology the authors tested again for HEV finding
the diagnosis.
Minor Essential Revisions
- as discussed though not very extensively, this could also have been
spontaneous clearance of HEV. I would like this point to be more clear, both from
the title and the conclusion. Stating on one patients that in steroid therapy might
be used in developing countries (other genotypes, other health care systems), is
to strongly put.
- Why did the authors decide to do a second round of HEV testing? In the
manuscript this is phrased as "we suspected acute HEV"; suspected based on
what? And if there was such a strong suspicion why was ribavirin not started as
well?
- Moreover, since the chain of events normally is that a patient with ALF presents
at the hospital, you do diagnotic tests, and in the time awaiting results have to
decide whether or not to treat a patient depending on the most likely diagnosis at
the time. For this patient, the pathology report was toxic/ medication iinduced. As
clearly discussed, in ALF there is a sort of immunological phenomenon ongoing
which responds well to steroids. So this case highlights in my view that starting
prednison for ALF (without a diagnosis at the time) does not hamper
(spontaneous or steroid induced) viral clearance of acute HEV infection.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:New foe treated with old guns - Role of steroids for the treatment of acute
severe hepatitis E
Version:3Date:3 June 2014
Reviewer: Joop Arends
Reviewer's report:
This report is well written and tries to conclude that streroid therapy is an
alternative therapy for acute liver failure (ALF) caused by HEV. This is a rare
case of an immunocompetent patients with ALF with a primairy diagnosis of
toxic/ medication induced hepatitis after which prednison was started. Despite
initial negative HEV PCR and serology the authors tested again for HEV finding
the diagnosis.
Minor Essential Revisions
- as discussed though not very extensively, this could also have been
spontaneous clearance of HEV. I would like this point to be more clear, both from
the title and the conclusion. Stating on one patients that in steroid therapy might
be used in developing countries (other genotypes, other health care systems), is
to strongly put.
- Why did the authors decide to do a second round of HEV testing? In the
manuscript this is phrased as "we suspected acute HEV"; suspected based on
what? And if there was such a strong suspicion why was ribavirin not started as
well?
- Moreover, since the chain of events normally is that a patient with ALF presents
at the hospital, you do diagnotic tests, and in the time awaiting results have to
decide whether or not to treat a patient depending on the most likely diagnosis at
the time. For this patient, the pathology report was toxic/ medication iinduced. As
clearly discussed, in ALF there is a sort of immunological phenomenon ongoing
which responds well to steroids. So this case highlights in my view that starting
prednison for ALF (without a diagnosis at the time) does not hamper
(spontaneous or steroid induced) viral clearance of acute HEV infection.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:New foe treated with old guns - Role of steroids for the treatment of acute
severe hepatitis E
Version:3Date:3 June 2014
Reviewer: Joop Arends
Reviewer's report:
This report is well written and tries to conclude that streroid therapy is an
alternative therapy for acute liver failure (ALF) caused by HEV. This is a rare
case of an immunocompetent patients with ALF with a primairy diagnosis of
toxic/ medication induced hepatitis after which prednison was started. Despite
initial negative HEV PCR and serology the authors tested again for HEV finding
the diagnosis.
Minor Essential Revisions
- as discussed though not very extensively, this could also have been
spontaneous clearance of HEV. I would like this point to be more clear, both from
the title and the conclusion. Stating on one patients that in steroid therapy might
be used in developing countries (other genotypes, other health care systems), is
to strongly put.
- Why did the authors decide to do a second round of HEV testing? In the
manuscript this is phrased as "we suspected acute HEV"; suspected based on
what? And if there was such a strong suspicion why was ribavirin not started as
well?
- Moreover, since the chain of events normally is that a patient with ALF presents
at the hospital, you do diagnotic tests, and in the time awaiting results have to
decide whether or not to treat a patient depending on the most likely diagnosis at
the time. For this patient, the pathology report was toxic/ medication iinduced. As
clearly discussed, in ALF there is a sort of immunological phenomenon ongoing
which responds well to steroids. So this case highlights in my view that starting
prednison for ALF (without a diagnosis at the time) does not hamper
(spontaneous or steroid induced) viral clearance of acute HEV infection.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
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