Review for 10.1186/s12876-024-03550-y (2024)

Title: Increasing incidence of mycotoxicosis in South-Eastern Germany: A Comprehensive
Analysis of Mushroom Poisonings at a University Medical Center
Version: 1 Date: 13 Aug 2024
Reviewer:  Steven D. Salhanick
Reviewer's report:
General Comments
The authors submit a manuscript describing their experience with mushroom poisonings over
a 17-year period.  They describe incidence of various types of poisoning including amatoxin
containing mushrooms as well as hallucinogenic mushrooms.  They also describe therapy
provided.  Lastly, they comment on effects of climate change on mushroom poisoning.
The manuscript has several significant issues.  The authors are not really clear with regard to
what they are seeking to elucidate.  They do not focus their review of their experience and
therefore it is difficult to glean useful information.  The comments regarding plasmapheresis
need exploration.  The literature seems to be a series of case reports.  The authors should explore
this in the discussion and comment that they have done this with the suggestion of a beneficial
effect.  If there is better data for plasmapheresis this should be noted in the comments as well.
The background is too broad a review of mushroom poisoning and does not focus the reader on
the question being addressed.
Specific comments
Abstract
Background-change “intoxication” to poisoning
Omit “particular”
Methods
Omit institution here
“increasing incidents…” is one of the conclusions of the study looking at trends over time I
would think
Better define types of toxic mushrooms-inedible is a general term which would encompass other
types of mushrooms I would think
In what way did they “closely examine” patients with elevated transaminases.
Last sentence-what do the authors mean by “clinical changes.”
Results
Occurrence over 9 years-comment on the 17-year study period
Omit “in relation to climate change”
Omit sentence starting with “this approach…”-results section is not the place for this comment.
Background
Omit sentence “in China…”  not necessary
Last sentence should be in pp 2 describing sx
First sentence of pp 2 needs to be omitted as it is redundant
Omit first sentence in last pp of this section.  Simply briefly describe mechanism of each
frequently employed therapy.
Does reference 20 specifically describe amatoxin induced liver injury?
Methods
Study design…
Omit “focusing on therapeutic approaches”
Pp2-more clearly describe inclusion criteria.
Was mushroom identification done in all cases?
Sentences in pp2 starting with “the study generally”  should be in discussion
Clinical Data…
Should document specifically what charts were abstracted for and how.
Data acquisition
What does “sourced from” mean exactly?
Results
Seasonal trends
There is no description of climate change investigation in the methods or intro.
New pp for mushroom types and use or include scientific names throughout manuscript
Treatment Modalities
Who is third pt who recovered spont?  This is confusing
Discussion
Omit first sentence “This longitudinal…”
Climate change comments are overstated as this was not formally investigated.
Identifying…
2 challenges seem similar-this is confusing
“Laboratory…” heading does not fall under the topic of identifying mushrooms
Comments on plasmapheresis are overstated.  Observing that patients improved does not mean
that a particular therapy was effective.  Authors might comment that they assumed effectiveness
based on results in other types of liver toxicity.
Conclusions
It would seem that the main conclusions are that the number of annual poisonings has increased
(the causes for which could be the subject of speculation by the authors) and that they too
employed plasmapheresis and suspect benefit.  The current pp does not describe conclusions
of the study.