Reviewer ’s report  
 
Title: Gastrointestinal tuberculosis following renal transpla ntation accompanied with septic 
shock  and acute respiratory distress syndrome: a survival case presentation  
 
Version: 0 Date: 07 Aug 2017  
 
Reviewer: Maria Gloria Mumolo  
 
Reviewer's report:  
 
Major comments  
 
1)The section  on post -transplantation  TB simply corroborates the evidence emerging from 
previous reports  on gastrointestinal TB in renal transplant patients, where, due to  the indolent 
evolution induced by immunosuppression, the need to maintain  a hig h index of suspicion for TB 
in case of  fever  or non specific abdominal symptoms has been highly recommended,   as well  
as the risks linked to the interactions among anti tubercular drugs and the immunosuppressive 
agent has been  emphasized . The time fr om kidney transplantation to TB development is in line 
with literature (6.7±3.4 years in a case series by Rocha A et al)  
 
The element of novelty  lies in the catastrophic cascade of  life -threatening infectious events 
which complicated the clinical course, followed by complete recovery   
 
 
 
2) The authors  did not specify if the patient  had a  long duration of pre -transplantation 
hemodialisys  or  if she received the graft from a deceased donor, which are regarded as 
important risk factors for developing TB in  kidney transplantation recipients  
 
 
 
3). Because the authors propose  the clinical management  as recommendations to increase the 
chances of survival in post -transplantation intestinal TB, the life -threatening risk of multiple 
nosocomial infectios  (possibly including S haemoliticus, which could be related to the repeated 
admissions to hospital in the previous months) should be more thoroughly discussed, from 
predisposing factors to prophylactic  measures.  Being a case report , the term "roadmap" i n 
inappropriate to describe the clinical management of the patient  
 
 
 
Minor comments  
 
In the" Discussion" section  the English language should be carefully reviewed  
 
"ICU" and "GCS 3" should be added to the list of abbreviations  
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 you r 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.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statis tical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not re levant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 f or 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.  
 
none 
 
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 a n 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 pee r review policy of the journal  
Reviewer ’s report  
 
Title: Gastrointestinal tuberculosis following renal transpla ntation accompanied with septic 
shock  and acute respiratory distress syndrome: a survival case presentation  
 
Version: 0 Date: 07 Aug 2017  
 
Reviewer: Maria Gloria Mumolo  
 
Reviewer's report:  
 
Major comments  
 
1)The section  on post -transplantation  TB simply corroborates the evidence emerging from 
previous reports  on gastrointestinal TB in renal transplant patients, where, due to  the indolent 
evolution induced by immunosuppression, the need to maintain  a hig h index of suspicion for TB 
in case of  fever  or non specific abdominal symptoms has been highly recommended,   as well  
as the risks linked to the interactions among anti tubercular drugs and the immunosuppressive 
agent has been  emphasized . The time fr om kidney transplantation to TB development is in line 
with literature (6.7±3.4 years in a case series by Rocha A et al)  
 
The element of novelty  lies in the catastrophic cascade of  life -threatening infectious events 
which complicated the clinical course, followed by complete recovery   
 
 
 
2) The authors  did not specify if the patient  had a  long duration of pre -transplantation 
hemodialisys  or  if she received the graft from a deceased donor, which are regarded as 
important risk factors for developing TB in  kidney transplantation recipients  
 
 
 
3). Because the authors propose  the clinical management  as recommendations to increase the 
chances of survival in post -transplantation intestinal TB, the life -threatening risk of multiple 
nosocomial infectios  (possibly including S haemoliticus, which could be related to the repeated 
admissions to hospital in the previous months) should be more thoroughly discussed, from 
predisposing factors to prophylactic  measures.  Being a case report , the term "roadmap" i n 
inappropriate to describe the clinical management of the patient  
 
 
 
Minor comments  
 
In the" Discussion" section  the English language should be carefully reviewed  
 
"ICU" and "GCS 3" should be added to the list of abbreviations  
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 you r 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.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statis tical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not re levant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 f or 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.  
 
none 
 
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 a n 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 pee r review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Gastrointestinal tuberculosis following renal transpla ntation accompanied with septic 
shock  and acute respiratory distress syndrome: a survival case presentation  
 
Version: 0 Date: 07 Aug 2017  
 
Reviewer: Maria Gloria Mumolo  
 
Reviewer's report:  
 
Major comments  
 
1)The section  on post -transplantation  TB simply corroborates the evidence emerging from 
previous reports  on gastrointestinal TB in renal transplant patients, where, due to  the indolent 
evolution induced by immunosuppression, the need to maintain  a hig h index of suspicion for TB 
in case of  fever  or non specific abdominal symptoms has been highly recommended,   as well  
as the risks linked to the interactions among anti tubercular drugs and the immunosuppressive 
agent has been  emphasized . The time fr om kidney transplantation to TB development is in line 
with literature (6.7±3.4 years in a case series by Rocha A et al)  
 
The element of novelty  lies in the catastrophic cascade of  life -threatening infectious events 
which complicated the clinical course, followed by complete recovery   
 
 
 
2) The authors  did not specify if the patient  had a  long duration of pre -transplantation 
hemodialisys  or  if she received the graft from a deceased donor, which are regarded as 
important risk factors for developing TB in  kidney transplantation recipients  
 
 
 
3). Because the authors propose  the clinical management  as recommendations to increase the 
chances of survival in post -transplantation intestinal TB, the life -threatening risk of multiple 
nosocomial infectios  (possibly including S haemoliticus, which could be related to the repeated 
admissions to hospital in the previous months) should be more thoroughly discussed, from 
predisposing factors to prophylactic  measures.  Being a case report , the term "roadmap" i n 
inappropriate to describe the clinical management of the patient  
 
 
 
Minor comments  
 
In the" Discussion" section  the English language should be carefully reviewed  
 
"ICU" and "GCS 3" should be added to the list of abbreviations  
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 you r 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.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statis tical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not re levant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 f or 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.  
 
none 
 
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 a n 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 pee r review policy of the journal  
assistant