Reviewer’s report
Title: 
Parasitic infections in Swiss children – are we overtesting?
Version: 
0 
Date: 
11 Aug 2020
Reviewer's report:
Interesting report from a single-center in Switzerland. Reports on findings from
stool parasite testing among 571 children over a period of 10 years. Several
children had multiple tests. Blastocystis was the most common organism
identified (identified on all positive samples n=24). A second organism was
common and present in 6 of the 24, with E. nana being the most common.
Immigrant status was associated with a positive parasite/organism in stool.
Among the positive cases, a repeated evaluation was common. The investigators
recommend, based on their data, that providers consider at least two parasite
exams when evaluating children with persistent GI complaints. Although an
interesting report, may not be substantive enough to form the basis for guideline
recommendations. Maybe more suitable for publication as a Letter unless
additional data can be presented.
The brief report is consistent with data from other developed countries. But lacks
significant details which would help provide additional context and substance to
support recommendations. The lack of a control group or additional details with
respect to clinical presentations (diarrhea/abdominal pain duration, associated
symptoms, results of other stool testing) would help understand the relevance of
Blastocystis and E. nana in this population - which are the authors state, remain
controversial in terms of relevance as pathogens, especially when associated
with other bacterial or more virulent organisms. Although, as the final diagnoses
listed did not include bacterial pathogens suspect these diagnoses were absent.
That said, details on testing for other stool pathogens would be helpful. With the
advent of film array and other technologies, evaluation of multiple pathogens
may become increasingly available and worth mention in terms of impact to any
guidelines. Don't feel the data presented provides sufficient basis to make
guideline recommendations. 
The authors report that repeated tests should be sought, but did not clearly state if
negative sample subjects also had repeated assessments.
Post-infectious and functional GI disorders are mentioned as common diagnoses
among individuals in this cohort. Prior episodes of infectious diarrhea.
Minor comments: Please revise grammar and spelling errors (e.g.. - "feces"
instead of "faces").
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Yes
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' below.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Parasitic infections in Swiss children – are we overtesting?
Version: 
0 
Date: 
11 Aug 2020
Reviewer's report:
Interesting report from a single-center in Switzerland. Reports on findings from
stool parasite testing among 571 children over a period of 10 years. Several
children had multiple tests. Blastocystis was the most common organism
identified (identified on all positive samples n=24). A second organism was
common and present in 6 of the 24, with E. nana being the most common.
Immigrant status was associated with a positive parasite/organism in stool.
Among the positive cases, a repeated evaluation was common. The investigators
recommend, based on their data, that providers consider at least two parasite
exams when evaluating children with persistent GI complaints. Although an
interesting report, may not be substantive enough to form the basis for guideline
recommendations. Maybe more suitable for publication as a Letter unless
additional data can be presented.
The brief report is consistent with data from other developed countries. But lacks
significant details which would help provide additional context and substance to
support recommendations. The lack of a control group or additional details with
respect to clinical presentations (diarrhea/abdominal pain duration, associated
symptoms, results of other stool testing) would help understand the relevance of
Blastocystis and E. nana in this population - which are the authors state, remain
controversial in terms of relevance as pathogens, especially when associated
with other bacterial or more virulent organisms. Although, as the final diagnoses
listed did not include bacterial pathogens suspect these diagnoses were absent.
That said, details on testing for other stool pathogens would be helpful. With the
advent of film array and other technologies, evaluation of multiple pathogens
may become increasingly available and worth mention in terms of impact to any
guidelines. Don't feel the data presented provides sufficient basis to make
guideline recommendations. 
The authors report that repeated tests should be sought, but did not clearly state if
negative sample subjects also had repeated assessments.
Post-infectious and functional GI disorders are mentioned as common diagnoses
among individuals in this cohort. Prior episodes of infectious diarrhea.
Minor comments: Please revise grammar and spelling errors (e.g.. - "feces"
instead of "faces").
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
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' below.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Parasitic infections in Swiss children – are we overtesting?
Version: 
0 
Date: 
11 Aug 2020
Reviewer's report:
Interesting report from a single-center in Switzerland. Reports on findings from
stool parasite testing among 571 children over a period of 10 years. Several
children had multiple tests. Blastocystis was the most common organism
identified (identified on all positive samples n=24). A second organism was
common and present in 6 of the 24, with E. nana being the most common.
Immigrant status was associated with a positive parasite/organism in stool.
Among the positive cases, a repeated evaluation was common. The investigators
recommend, based on their data, that providers consider at least two parasite
exams when evaluating children with persistent GI complaints. Although an
interesting report, may not be substantive enough to form the basis for guideline
recommendations. Maybe more suitable for publication as a Letter unless
additional data can be presented.
The brief report is consistent with data from other developed countries. But lacks
significant details which would help provide additional context and substance to
support recommendations. The lack of a control group or additional details with
respect to clinical presentations (diarrhea/abdominal pain duration, associated
symptoms, results of other stool testing) would help understand the relevance of
Blastocystis and E. nana in this population - which are the authors state, remain
controversial in terms of relevance as pathogens, especially when associated
with other bacterial or more virulent organisms. Although, as the final diagnoses
listed did not include bacterial pathogens suspect these diagnoses were absent.
That said, details on testing for other stool pathogens would be helpful. With the
advent of film array and other technologies, evaluation of multiple pathogens
may become increasingly available and worth mention in terms of impact to any
guidelines. Don't feel the data presented provides sufficient basis to make
guideline recommendations. 
The authors report that repeated tests should be sought, but did not clearly state if
negative sample subjects also had repeated assessments.
Post-infectious and functional GI disorders are mentioned as common diagnoses
among individuals in this cohort. Prior episodes of infectious diarrhea.
Minor comments: Please revise grammar and spelling errors (e.g.. - "feces"
instead of "faces").
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
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' below.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant