A hydrocele revealing epididymal tuberculosis
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Abstract: Urogenital tuberculosis is a severe form of extrapulmonary tuberculosis. The organs most commonly affected are the epididymis and the testis. Clinical manifestations may include epididymitis, orchi-epididymitis, hydrocele, associated with leukocyturia, and significant hematuria. We report a case of a patient with a hydrocele that revealed epididymal tuberculosis.
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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
This manuscript covers a rare case of epididymal tuberculosis, which is important for clinicians, especially in TB-endemic areas. However, several key points need further clarification and expansion to improve the manuscript's scientific output. The negative results from the classic diagnostic methods (direct examination and culture on Löwenstein-Jensen media) raise concerns about the confirmation of tuberculosis. Without bacteriological evidence, the diagnosis relies heavily on molecular methods. It would be helpful to address the limitations of relying on these results alone and to explain how this was considered in the diagnostic process. You state that the anatomopathological examination confirmed the bacteriological diagnosis, but this is somewhat misleading. Histopathology alone doesn't confirm …
Comments to Author
This manuscript covers a rare case of epididymal tuberculosis, which is important for clinicians, especially in TB-endemic areas. However, several key points need further clarification and expansion to improve the manuscript's scientific output. The negative results from the classic diagnostic methods (direct examination and culture on Löwenstein-Jensen media) raise concerns about the confirmation of tuberculosis. Without bacteriological evidence, the diagnosis relies heavily on molecular methods. It would be helpful to address the limitations of relying on these results alone and to explain how this was considered in the diagnostic process. You state that the anatomopathological examination confirmed the bacteriological diagnosis, but this is somewhat misleading. Histopathology alone doesn't confirm the presence of Mycobacterium tuberculosis. There's no definitive confirmation of bacilli in the specimen. It might be worth considering another histopathological technique, such as Ziehl-Neelsen staining, or at least discussing why this wasn't performed. This would give the manuscript more credibility in terms of diagnostic accuracy. The differential diagnosis in this case is an area where more detail would be beneficial. Highlighting the other conditions that were considered, and why they were ruled out, would give a clearer understanding of your diagnostic process. You also report leukocyturia and hematuria, which are important findings, but their clinical relevance in the context of the TB diagnosis could be explored further. It would add value to explain how these results correlate with the severity or progression of the patient's condition. The treatment approach seems standard and appropriate, but it would be useful to discuss whether any other treatment options were considered, especially since the case involves an unusual form of TB. The brief mention of rifampicin injections into the testicular region is intriguing, and explaining why this was not chosen could add depth to the treatment discussion. Finally, including more detailed figures, such as ultrasound images or gross lesions, would really strengthen the manuscript.
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
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Comments to Author
Dear author, The case is very interesting and thank you for sharing it. You have responded to all the insightful previous comments of the reviewers. Here, we provide some other comments to improve the quality of the manuscript. Comment 1: Line 19- 20: "The patient was treated conservatively with tuberculosis medication for six months". In this case, the patient was treated with antitubercular treatment and an epididymectomy. Comment 2: The renal tuberculosis is the most common form of genitourinary tuberculosis and not the epididymis and testicles. The epididymis is the most commonly affected site in genital tuberculosis in males. Please correct these information in the abstract, the introduction and the discussion. Comment 3: Please correct this phrase: Line 38- 39: "Ultrasound examination of the …
Comments to Author
Dear author, The case is very interesting and thank you for sharing it. You have responded to all the insightful previous comments of the reviewers. Here, we provide some other comments to improve the quality of the manuscript. Comment 1: Line 19- 20: "The patient was treated conservatively with tuberculosis medication for six months". In this case, the patient was treated with antitubercular treatment and an epididymectomy. Comment 2: The renal tuberculosis is the most common form of genitourinary tuberculosis and not the epididymis and testicles. The epididymis is the most commonly affected site in genital tuberculosis in males. Please correct these information in the abstract, the introduction and the discussion. Comment 3: Please correct this phrase: Line 38- 39: "Ultrasound examination of the scrotum revealed a significant amount of fluid in the left hydrocele and a smaller amount in the right hydrocele". The hydrocele is a collection of fluid in the scrotum. --- Scrotal ultrasonography showed a significant amount of fluid around the left testicles… Comment 4: Please correct this phrase: Line 78 - 79: "The manifestations of genitourinary tuberculosis can vary, with epididymitis or orchid epididymitis"--- " The manifestations of genital tuberculosis in males … ase ONLY put comments for the Author(s) in here
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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Thank you for your submission to Access Microbiology. Having initially reviewed the case presented, this would be a valuable contribution to the literature in a restructured format with greater clarity of clinical details. I would recommend a review of the language provided throughout and to access the journal's guidance. Specific comments: 1. There is limited information to contextualise the current presentation - please provide a more comprehensive overview of TB in Morocco, and urogenital tuberculosis in particular. 2. The case presentation itself requires greater structure and more clinical details: what was the initial presenting complaint, duration etc. Clarify co-morbidities and therapeutics (it is unacceptable to mention 'immunosuppressive therapy' in a TB case without characterisation of the agent, dose, duration of therapy …
Thank you for your submission to Access Microbiology. Having initially reviewed the case presented, this would be a valuable contribution to the literature in a restructured format with greater clarity of clinical details. I would recommend a review of the language provided throughout and to access the journal's guidance. Specific comments: 1. There is limited information to contextualise the current presentation - please provide a more comprehensive overview of TB in Morocco, and urogenital tuberculosis in particular. 2. The case presentation itself requires greater structure and more clinical details: what was the initial presenting complaint, duration etc. Clarify co-morbidities and therapeutics (it is unacceptable to mention 'immunosuppressive therapy' in a TB case without characterisation of the agent, dose, duration of therapy etc). What does 'satsifactory condition' mean? This is not an acceptable clinical descriptor - provide further details. There is no provision of basic investigations such as blood work-up or radiological assessment. 3. Further details required on what microbiological diagnostics were performed - 'no bacterial growth'. On which culture conditions? 4. Provide justification for why a urine TB assay was not performed on a case of urogenital TB. 5. Provide an image/figure of the hiostopathological examination. 6. There reference list is historic and requires an appraisal of more contemporary literature. 7. Provide greater clarity on national guidance for TB therapy - and provide an explanation of the case resolution, duration of treatment, outcome etc. If the authors are able to significantly improve the submitted manuscript in accordance with above recommendations, I would be happy to forward for external peer-review.
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