Review for 10.1186/1471-230X-8-36 (2008)

Reviewer's report
Title:Correlations of CD4 counts, enteric protozoan infestation and seasonal
variations in AIDS patients - An experience of a tertiary care hospital in Varanasi
(India)
Version: 1Date:26 March 2008
Reviewer: Nancy Malla
Reviewer's report:
Comments
Authors have assessed presence of enteric protozoan infestation in AIDS
patients and correlated the results with CD4 counts and different seasons.
However, following points need to be clarified before paper is considered for
publication:
1. Title:
It is mentioned as” Correlation of CD4 count, enteric protozoan
infestation-------Varanasi(India)”.
(a): In the text, both protozoan and helminthic infections are mentioned.
(b): Do authors feel that positivity of intestinal parasites varies with Seasonal
variation in HIV infected patients and not so in HIV uninfected patients?
However, in the text (results section), seasonal variation is detailed out for all the
infected subjects, irrespective of HIV status.
2. Methods:
(a): The Entamoeba parasites cannot be labeled as E.histolytica, on the basis of
microscopy alone, as it resembles morphologically E.dispar, the non-pathogenic
species.
(b): Similarly, A. duodenale cannot be labeled as A. duodenale, only by
microscopic examination, as ova resemble morphologically Necator americanus
ova.
(c): The microsporidia in these samples have been identified on the basis of
calcofluor staining only. Since yeasts also fluoresce by calcofluor staining and
moreover they have the same size, in addition,alternative staining techniques like
Weber’s or other techniques should have been used . Calcofluor is considered
good for screening only, and not for confirmation of microsporidia
3. Results
(a): Page 6: First Line:
It is mentioned that ‘of the 366 patients ------- to the ART’
How the immune restoration and positive response to the ART was assessed. It
is not detailed out in Methods Section.
The CD4 count at different time periods, if assessed, should have been included.
(b): Fig 2 should be deleted. The details should be included in the Text (Methods
and Results Section).
(c). Statistical analysis of various parameters (Table 2 and 3) is lacking.
4. Discussion is not focused, in reference to the objectives of the study. The
discussion should be focused on the Parameters detailed out in Methods and
Results sections of the study.
(a): Page 7 & 8: p values---- Chronic Vs Acute Diarrhoea and Males and Females
Which statistical method was used?
(b): Page 8 – Paragraph 2 ---. It is mentioned that ‘patients showed positive
response to these drugs’. The details of antiparasitic drug treatment are neither
mentioned in the Methods nor in Results Section.
(c): Page 8: Last Paragraph – Last line: It is mentioned that ‘Some of the similar
parasites isolated in both the groups ----------sewage spills.’
These details are not mentioned in Results section.
The similar parasites should be specified both in Results and Discussion. The
water borne parasitic infections with different positive rate in two groups in this
study should also be discussed.
(d): Page 9: First Paragraph:
It is mentioned that ‘Most of the patients -------- habits were isolated’
These observations have not been included in the ‘Results Section’. It is not
mentioned in Methods section.
(e): Page 9: Paragraph 3: It is mentioned that ‘off all the cases examined ------
heterosexual route’. Whether these observations were for Homosexual Men or all
the HIV patients studied?
(f): Few of the parasitic infections are chronic and/or recurrent in an endemic
area.
The relevance of correlation of these infections with seasonal variation should be
discussed. The subjects may have been infected during one season and
symptoms
may appear during the subsequent season due to chronicity of infection.
(g): Limitations of the study should be defined in the Discussion.
5. What is the new information obtained from this study Vs previous report from
the same area (BMC Infectious Diseases 2006, 6:39)?
6. Recent references from India have not been discussed
7. There are many typographical errors.