Review for 10.1186/s12876-021-01619-6 (2021)

Reviewer’s report
Title: 
Parasitic infections in Swiss children – are we overtesting?
Version: 
0 
Date: 
11 Aug 2020
Reviewer's report:
Interesting report from a single-center in Switzerland. Reports on findings from
stool parasite testing among 571 children over a period of 10 years. Several
children had multiple tests. Blastocystis was the most common organism
identified (identified on all positive samples n=24). A second organism was
common and present in 6 of the 24, with E. nana being the most common.
Immigrant status was associated with a positive parasite/organism in stool.
Among the positive cases, a repeated evaluation was common. The investigators
recommend, based on their data, that providers consider at least two parasite
exams when evaluating children with persistent GI complaints. Although an
interesting report, may not be substantive enough to form the basis for guideline
recommendations. Maybe more suitable for publication as a Letter unless
additional data can be presented.
The brief report is consistent with data from other developed countries. But lacks
significant details which would help provide additional context and substance to
support recommendations. The lack of a control group or additional details with
respect to clinical presentations (diarrhea/abdominal pain duration, associated
symptoms, results of other stool testing) would help understand the relevance of
Blastocystis and E. nana in this population - which are the authors state, remain
controversial in terms of relevance as pathogens, especially when associated
with other bacterial or more virulent organisms. Although, as the final diagnoses
listed did not include bacterial pathogens suspect these diagnoses were absent.
That said, details on testing for other stool pathogens would be helpful. With the
advent of film array and other technologies, evaluation of multiple pathogens
may become increasingly available and worth mention in terms of impact to any
guidelines. Don't feel the data presented provides sufficient basis to make
guideline recommendations. 
The authors report that repeated tests should be sought, but did not clearly state if
negative sample subjects also had repeated assessments.
Post-infectious and functional GI disorders are mentioned as common diagnoses
among individuals in this cohort. Prior episodes of infectious diarrhea.
Minor comments: Please revise grammar and spelling errors (e.g.. - "feces"
instead of "faces").
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