Bacterial co-infections in mucormycosis in severely ill populations: an overlooked and complex challenge
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Mucormycosis is found in co-infection with bacteria in >50% of the cases. Most of these cases were reported among people with haematological diseases. The two most frequent bacteria found were Pseudomonas aeruginosa and Klebsiella pneumoniae . Almost 40% of the identified bacteria were reported as multidrug resistant.
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Thank you very much for the quick resubmission of this revised manuscript to Access Microbiology. I am pleased to let you know that it has now been accepted for publication. Congratulations!
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Thank you very much for submitting your revised manuscript to Access Microbiology and addressing the reviewer comments. The modifications to the manuscript have certainly strengthened this piece of work. However, there is still a minor correction that still needs revision. L133-137 mentions P. aeruginosa and K. pneumoniae as critical priority pathogens. However, whereas CRE K. pneumoniae is indeed listed in the WHO critical priority pathogen group in the 2024 list revision cited here, P. aeruginosa (CRE or MDR) has been downgraded to the high priority group. I would please ask you to correct this before progressing to acceptance for publication in the platform. Please provide a revised version of the manuscript within 30 days.
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The reviewers make some suggestions for minor amendments that I would like you to include in a revision.
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Comments to Author
This manuscript describes a useful and interesting review of studies reporting mucormycoses that are coinfected with bacteria. The manuscript is generally well written and well presented. The bulk of the methods section describe identification of on the basis of their reporting coinfections per se, with the parts around rates of coinfection appearing as something of an addition. More details are needed about how studies were classified as either just reporting coinfections or reporting the rates of coinfection to be clear about the extent to which the coinfection rates reported show the rates of bacterial infection as a proportion of mucormycoses as a whole. The discussion and conclusions are primarily based around the rate of coinfection of mycoses with bacteria. To make the best of the data …
Comments to Author
This manuscript describes a useful and interesting review of studies reporting mucormycoses that are coinfected with bacteria. The manuscript is generally well written and well presented. The bulk of the methods section describe identification of on the basis of their reporting coinfections per se, with the parts around rates of coinfection appearing as something of an addition. More details are needed about how studies were classified as either just reporting coinfections or reporting the rates of coinfection to be clear about the extent to which the coinfection rates reported show the rates of bacterial infection as a proportion of mucormycoses as a whole. The discussion and conclusions are primarily based around the rate of coinfection of mycoses with bacteria. To make the best of the data they have reviewed in the results section, it would be useful for the Authors to say more in the discussion and conclusions about what insights the study offers into the types of microorganisms occurring in the infections, their drug resistance and clinical outcomes from the cases. Additional minor comments: 1. Lines 125-126. "most bacterial co-infections in mucormycoses are the result of hospital stay." Unless the data indicate a clear causal relationship with hospital stay (which would need some further explanation), "associated with" would be better than "the result of". 2. Lines 154-155. "The disease will progress, and a new diagnostic approach will start." Consider clarifying this to specify that the new diagnostic approach would be the clinicians' response to the progression of the disease. Maybe: "The disease would then progress and typically would result in a new diagnostic approach that would detect the mucormycosis." 3. The issue of undetected or late diagnosed mucormycoses is nicely covered in the discussion. Is it possible that coinfections where it is the bacterial component that goes undiagnosed are also significant?
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Very 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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Comments to Author
Dear Authours This work deals with mucormycosis and its coinfection incidence. Bacterial coinfection in fungal infections is a known story. So the work is not adding any new data to the current knowledge. Being a review work, there is not a complicated or new method to be reported. The work is thin, lacking new information, and not adding anything new. As such I recommend rejection.
Please rate the manuscript for methodological rigour
Very poor
Please rate the quality of the presentation and structure of the manuscript
Very 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
I…
Comments to Author
Dear Authours This work deals with mucormycosis and its coinfection incidence. Bacterial coinfection in fungal infections is a known story. So the work is not adding any new data to the current knowledge. Being a review work, there is not a complicated or new method to be reported. The work is thin, lacking new information, and not adding anything new. As such I recommend rejection.
Please rate the manuscript for methodological rigour
Very poor
Please rate the quality of the presentation and structure of the manuscript
Very 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
Good work
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Very 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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Comments to Author
Many thanks for this short piece which raised an interesting question in a very under developed area. For this reason I think it is a useful question to raise in publication however I would recommend changes before this can be accepted for publication. The title is appropriate and engaging Line 40 - I would change to "In India alone" Line 42 - affects "rhino-cerbral-sinus" Line 46 - "A related phenomenon" Please expand a bit of endosymbiosis - this sounds harmless?Symbiotic rather than parasitic? Line 58 - why nothing before 1998 included? Line 61 - Same niche "as" mucorales Line 62 - were included "using" the same case definition Line 96 - How do you define MDR? Line 97 - again expand on endosymbiosis and why is Burkholderia important in particular? Line 111 - Is Covid associated mucor a co …
Comments to Author
Many thanks for this short piece which raised an interesting question in a very under developed area. For this reason I think it is a useful question to raise in publication however I would recommend changes before this can be accepted for publication. The title is appropriate and engaging Line 40 - I would change to "In India alone" Line 42 - affects "rhino-cerbral-sinus" Line 46 - "A related phenomenon" Please expand a bit of endosymbiosis - this sounds harmless?Symbiotic rather than parasitic? Line 58 - why nothing before 1998 included? Line 61 - Same niche "as" mucorales Line 62 - were included "using" the same case definition Line 96 - How do you define MDR? Line 97 - again expand on endosymbiosis and why is Burkholderia important in particular? Line 111 - Is Covid associated mucor a co infection?Or a precipitant - it usually "preceeds" mucor not coexists Line 118 - This review suggests - I would not say provides evidence Line 128 - Suggested change - triggers the hypothesis "that in hospital settings" Line 141 - I would not say lung mucor is not consiered. it is because it needs biopsy which often is not possible Conclusion - expand on this. Ths is very speculative. How do we know these bacteria are not just colonisign?or passengers?or contaminants?At this stage this is just raising a theory and needs a lot more work. Expand HOW you might take this theory forward - how can you prove these bacteria are in any way relevant.
Please rate the manuscript for methodological rigour
Satisfactory
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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