Factors associated with cutaneous colonization of Mucormycetes in diabetic and non-diabetic individuals

  1. Bhuvan Saud
  2. Kajal Chand
  3. Neetu Amatya
  4. Govinda Paudel
  5. Saroj Adhikari
  6. Vikram Shrestha

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Abstract

This study was conducted to assess factors associated with cutaneous colonization of Mucormycetes in diabetic and non-diabetic individuals. A total of 800 swab samples from 200 participants including 100 diabetics and 100 non-diabetics were collected from four different body sites: (1) the forehead, (2) nasal cavity, (3) hands and (4) feet. Fungal isolation, fungal identification and antibiotic sensitivity tests were performed on the isolates. Overall, 12.0 % of the participants showed Mucormycetes colonization while the commonest fungal isolates were Mucor Species (Spp.). followed by Rhizopus spp. Diabetics had a 11 times higher odds of colonization compared to non-diabetics. The majority of the isolates were resistant to itraconazole; however, all isolates were sensitive to amphotericin B. A significant association was observed between profession and Mucormycetes ( P =0.03) with significantly higher colonization in retired people compared to business people. Higher odds of colonization were demonstrated among older ages, lower class status and individuals with prolonged contact time with soil.

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  1. Version published to 10.1099/acmi.0.000495.v4 on Access Microbiology
  2. Access Microbiology

    Thank you for thoroughly revising the English language used throughout your article. It is now much improved and at a level that adequately conveys the information and will be understandable by readers. I appreciate the effort and time taken to do this and am now pleased to be able to accept the manuscript for publications. Congratulations!

  3. Version published to 10.1099/acmi.0.000495.v3 on Access Microbiology
  5. Access Microbiology

    Comments to Author

    The authors have satisfactorily resolved many of the issues from the previous review comments. However, the writing of the manuscript has not been substantially improved since the last submission. There are errors of grammar or syntax in almost every paragraph. The authors may require editing help from someone with full professional proficiency in English.

    Please rate the manuscript for methodological rigour

    Good

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  6. Version published to 10.1099/acmi.0.000495.v2 on Access Microbiology
  7. Access Microbiology

    Dear Dr Saud, Thank you for your submission. The reviewers have indicated that the work, while interesting and valuable, requires revisions both typographic and potentially methodological. Please address their comments and if deemed necessary, the journal provides a discount translation service that may be of use. This study would be a valuable contribution to the existing literature. The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments. Please include more rigour criteria and resources in your methods section, as highlighted by the SciScore reports. Including RRIDs and negative statements to explain why things were not performed should increase the rigour and reproducibility of your work. You can find tips on how to improve your article here: https://sciscore.com/reports/Core-Report.php The language used is poor, which can cause ambiguity at times. Please carefully rewrite it. We offer a discounted translation service, Editage (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 for more information). Best wishes, John.

  8. Access Microbiology

    Comments to Author

    This is an interesting paper dealing with colonization by Mucorales in diabetic and no diabetic people. However, some points that needs some clarification before further review. It would be very important to improve the discussion separating colonization from infection by Mucorales. How significant are the colonization data in comparison with previous studies? Is the study inedited? There is no earlier data considered for the discussion? These points are not well explained in the Discussion section. The discussion should be better organized, addressing the results, and keeping the interpretations limited to the type of study. For example, the sentence "Early diagnosis, management and rapid intervention, advance heath care system, and specific guidelines are paramount for substantially reducing morbidity and mortality associated with Mucormycosis." is out of scope. In my opinion, the Discussion would benefit from a more focused scope on colonization and risk of infection. The authors should inform the document they used or adopted parameters for concluding resistance of susceptibility of Mucorales isolates, since no cutoffs are defined for this fungal group. In Results and Discussion, I recommend clarifying which profession presented the highest risk to be colonized with Mucorales, to improve understanding. The conclusion did not be supported by the results obtained in this work since risk factors for colonization with no statistical strength were used for conclusions. There are many syntaxes and writing errors (e.g. Participants with previously diagnosed fungal infection, those under antifungal or immunosuppressive treatment excluded OR Swab samples inoculated on Sabouraud dextrose agar containing chloramphenicol 50 mg/l and then incubated aerobically for 3-5 days at room temperature (25-30ºC). Amphotericin B was sensitive to all isolates OR all isolates were susceptible to Amphotericin B? The English would need extremely extensive editing. Finally, the statistical analysis may be more robust. With so many confounding conditions in colonized patients, the analysis could provide misleading results. E.g. it would not be surprising that retired people got more colonization, and may just reflect the more soil exposition of this population. Minor concerns: Line 52. What is the meaning of "neon disease"? Line 79. Unit system must be corrected. "ml" is wrong. According to International System of Units, "L" is for liters and "l" is for length (this was accepted as an alternative symbol for liter in 1979). All manuscript must be reviewed. The European Union has a directive banning non-SI markings after 31 December 2009 on any goods imported into the European Union, which will to include manuscripts. Lines 81-83. The methodology for testing antifungal drugs needs references for both: perform the essays and for interpret results. Some imprecisions (e.g. undiluted suspensions of the isolates) should be avoid to improve understanding. Use capital letter in Mueller Hinton and in Sabouraud since they refer people names. Line 84. Manufacturer names for commercially available antifungal discs should be provided. Line 97. Please, clarify the relation between the percentages in "The prevalence of mucormycetes was 12.0% (24/200) of which 22.0% (22/100)…" Line 104. What is the meaning of "types"? Line 105. Prefer sensible, instead of sensitive. Line 108. The nasal samples have no relatively higher risk of of getting infection. Please, re-phrase. Line 120. Who is "They"? Moreover, no reference was cited to support that in middle-income countries there is no proper education system, health care facilities, socio-economic status and adequate knowledge about fungal infections. Line 123. Please, clarify if the data is related to colonization or infection by Mucorales in diabetic patients. Line 131. Mucormycosis is misspelled Line 145. Please, remove "In this study" In Table 1: -Please, correct the columns titles: Overall values n (%) - On the footnote, define what is the acronym "Ref". Is it variable of reference? 5. Any other relevant comments

    Please rate the manuscript for methodological rigour

    Very poor

    Please rate the quality of the presentation and structure of the manuscript

    Poor

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  9. Version published to 10.1099/acmi.0.000495.v1 on Access Microbiology
  10. Access Microbiology

    Comments to Author

    In this Short Communication, Saud et al. present sampling and antifungal susceptibility data for mucoromycetes isolated from diabetic and non-diabetic individuals. Methodological rigour, reproducibility and availability of underlying data The methods are currently insufficient to be able to reproduce the analysis. For example, for antifungal susceptibility testing, there is no description of quality control strains or other controls being used. The different methodologies also need to be separated and grouped under descriptive subheadings in the methods section. Regarding the statistical analysis, Chi-square tests are appropriate where sample numbers are large. Where sample numbers are small (

    Please rate the manuscript for methodological rigour

    Satisfactory

    Please rate the quality of the presentation and structure of the manuscript

    Poor

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes