A post-transplant infection by Nocardia cyriacigeorgica
This article has been Reviewed by the following groups
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- Evaluated articles (Access Microbiology)
Abstract
Nocardia are Gram-positive, acid-fast, filamentous bacteria that cause opportunistic infections in susceptible populations. We describe a case of post-transplant infection of pulmonary nocardiosis caused by the rare strain Nocardia cyriacigeorgica and the challenges faced in reaching a definitive diagnosis. This case report emphasizes on keeping nocardiosis as a differential diagnosis in transplant recipients, as this disease is largely underdiagnosed and underreported.
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The reviewers indicated further work is necessary to improve the manuscript for publication. Please address all reviewer comments in a point-by-point response, paying specific attention to the following points: clarity and information is required on the diagnostic parameters, patient history including any interventions and medicines, and the antibiotic susceptibility interpretation and comparison to CLSI standards.
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Comments to Author
1. Description of the case(s): Good description of case but can be done better by including some diagnostic parameters that support the evidence of infection by an opportunistic microorganism. 2. Presentation of results: The results can be presented in a better fashion by presenting the diagnostic parameters along the course of hospital stay, showing improvement on diagnosis by department of microbiology and how the antibiotic susceptibility helped the treatment of the individual. 3. How the style and organization of the paper communicates and represents key findings. The organization of the paper is good and represents most of the key features. 4. Literature analysis or discussion: Not up to the mark. Please discuss more cases with their antibiotic susceptibility patterns and please provide a …
Comments to Author
1. Description of the case(s): Good description of case but can be done better by including some diagnostic parameters that support the evidence of infection by an opportunistic microorganism. 2. Presentation of results: The results can be presented in a better fashion by presenting the diagnostic parameters along the course of hospital stay, showing improvement on diagnosis by department of microbiology and how the antibiotic susceptibility helped the treatment of the individual. 3. How the style and organization of the paper communicates and represents key findings. The organization of the paper is good and represents most of the key features. 4. Literature analysis or discussion: Not up to the mark. Please discuss more cases with their antibiotic susceptibility patterns and please provide a substantial reason as to why broth micro dilution was not performed for the isolate. 5. Any other relevant comments: please improve the discussion section as very few studies discussing the antibiotic susceptibility and other cases of infections with the same isolate. Please provide reason for not performing broth micro dilution
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
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
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Comments to Author
Dear authors, I read the manuscript in details. Here are some recommendations for improving the manuscript: - Line 26: The bacteria in the genus Nocardia are filamentous. It recommends using the appropriate word because they are not true bacilli. - Line 96: Instead of " A 1% modified ZN… ", show how to do modified acid-fast staining correctly. Take into account that most Nocardia species are partially acid-fast when using modified acid-fast staining like Kinyoun method. - The history of medical interventions, including each immunomodulation, medicine, and any other patient's risk factors, should be provided in the case presentation section. - Since the isolate has already been identified using the accurate MALDI-TOF method, it is not required to describe a non-specific identification method …
Comments to Author
Dear authors, I read the manuscript in details. Here are some recommendations for improving the manuscript: - Line 26: The bacteria in the genus Nocardia are filamentous. It recommends using the appropriate word because they are not true bacilli. - Line 96: Instead of " A 1% modified ZN… ", show how to do modified acid-fast staining correctly. Take into account that most Nocardia species are partially acid-fast when using modified acid-fast staining like Kinyoun method. - The history of medical interventions, including each immunomodulation, medicine, and any other patient's risk factors, should be provided in the case presentation section. - Since the isolate has already been identified using the accurate MALDI-TOF method, it is not required to describe a non-specific identification method like the susceptibility pattern to four antibiotics.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
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
-
Comments to Author
Overall well written manuscript. These rare infections are important in patients with risk factors and timely diagnosis and treatment is necessary for good outcomes. Few minor suggestions to improve the manuscript 1. Case report a. Developed fever instead of 'a fever' b. Exacerbated on supine position instead of supination c. Can remove - As a part of evaluation CXR, USG and CT were done. Instead, can write CXR and USG findings. d. Can mention what all sputum and BAL investigations were done and negative (bacterial culture, fungal culture, TB, others) e. How was lung biopsy done ? Open lung biopsy or other method? f. Why was a repeat lung biopsy was done when patient was clinically improving ? g. Was the patient put on prophylaxis for …
Comments to Author
Overall well written manuscript. These rare infections are important in patients with risk factors and timely diagnosis and treatment is necessary for good outcomes. Few minor suggestions to improve the manuscript 1. Case report a. Developed fever instead of 'a fever' b. Exacerbated on supine position instead of supination c. Can remove - As a part of evaluation CXR, USG and CT were done. Instead, can write CXR and USG findings. d. Can mention what all sputum and BAL investigations were done and negative (bacterial culture, fungal culture, TB, others) e. How was lung biopsy done ? Open lung biopsy or other method? f. Why was a repeat lung biopsy was done when patient was clinically improving ? g. Was the patient put on prophylaxis for nocardiosis after clinical recovery/cure? 2. Discussion a. Tacrolimus levels - units in ng/mL 3. Figure 1 - Legend A encircles the largest nodule - it should be consolidation
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
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