Recurrent Campylobacter jejuni Infection in an Immunodeficient Patient Treated with Repeated Faecal Microbiota Transplant (FMT)—A Case Report

Round 1

Reviewer 1 Report

The main error observed in Figure 1:

Figure 1. Be careful with the format. There are some numbers with more spaces, others that don't. There are times that the date appears in number and others that it does not. The tables must also be self-explanatory, JFM…. All directly. What does not detectablex2 mean? Tables and figures must be self-explanatory regardless of the text, then all abbreviations must be explained, as well as the color guides used. What do the numbers mean by the use of antibiotics?

Some minor bugs:

• Use an abbreviation guide throughout the text.
• There are some formatting errors in the text, such as capitalization in figure 1, please check the text.
• Sometimes they use IVIG or IVIg.
• PCR is not defined.
• Extra-parentheses 205, BRACKET.
• HbH is not defined.
• Point one if it ends in point point two does not.
• Please check all formatting errors.

Author Response

Figure 1. Be careful with the format. There are some numbers with more spaces, others that don't. There are times that the date appears in number and others that it does not. The tables must also be self-explanatory, JFM…. All directly. What does not detectablex2 mean? Tables and figures must be self-explanatory regardless of the text, then all abbreviations must be explained, as well as the color guides used. What do the numbers mean by the use of antibiotics?

Please see amended table. All abbreviations are explained in the footnotes to the table. The colour is not necessary so has been removed.

Some minor bugs:

• Use an abbreviation guide throughout the text.
All abbreviations have been expanded at first mention.

• There are some formatting errors in the text, such as capitalization in figure 1, please check the text.
This has been corrected

• Sometimes they use IVIG or IVIg.
We have amended and used IVIg throughout.

• PCR is not defined.
Amended

• Extra-parentheses 205, BRACKET.
Amended

• HbH is not defined.
HbH is abbreviated and defined in eth first paragraph.

• Point one if it ends in point point two does not.
This sentence does not make sense - unclear what the problem is?

• Please check all formatting errors.
Done

Reviewer 2 Report

In the manuscript entitled “Recurrent Campylobacter jejuni infection in an immuno-deficient patient treated with repeated Faecal Microbiota Transplant (FMT)-a case report” the authors discuss the utility of FMT in the context of common variable immunodeficiency (CVID). Below are the suggestions to improve the manuscript.

1. Lines 109-110: ……Campylobacter infection appears to be less common in patients…….
2. What are the expanded forms of DLBCL, CDI? The authors should expand all the abbreviations the first time in the manuscript.
3. Lines 128-129: Where necessary, macrolides are presently the antimicrobials of choice
4. Lines 138-139: also presumed that the organism developed macrolide resistance in vivo, which has previously been reported (8).
5. If the described pattern in the patient mirrors the Campylobacter persistence/relapses hypothesis, why the jejuni was undetectable by PCR? What are the possible mechanisms for this observation? The authors should discuss.
6. Lines 140-141: The development of antimicrobial resistance has led to the use of older agents, such as fosfomycin, and broad-spectrum agents, such as meropenem.
7. Lines 185-186: Emerging data suggest overall bacterial diversity is lower in individuals with CVID compared to healthy controls (5).
8. The authors should have sampled the microbiome specimen kinetically and based their treatment based on microbiome composition leading to a more rational treatment.

Author Response

1. Lines 109-110: ……Campylobacter infection appears to be less common in patients…….
   
   We have itaicised Campylobacter as suggested
2. What are the expanded forms of DLBCL, CDI? The authors should expand all the abbreviations the first time in the manuscript.
   DLBCL is already defined in the first paragraph of page 1. CDI has been defined when first mentioned on page 5.
3. Lines 128-129: Where necessary, macrolides are presently the antimicrobials of choice
   Amended as suggested
4. Lines 138-139: also presumed that the organism developed macrolide resistance in vivo, which has previously been reported (8).
   Amended (italicised) as suggested
5. If the described pattern in the patient mirrors the Campylobacter persistence/relapses hypothesis, why the jejuni was undetectable by PCR? What are the possible mechanisms for this observation? The authors should discuss. 
   The Campylobacter was detected by PCR following the first FMT on 23rd and 31st May 2019, as indicated in Figure 1. This is consistent with persistance of the organism.
6. Lines 140-141: The development of antimicrobial resistance has led to the use of older agents, such as fosfomycin, and broad-spectrum agents, such as meropenem.
   Amended as suggested
7. Lines 185-186: Emerging data suggest overall bacterial diversity is lower in individuals with CVID compared to healthy controls (5).
   Amended as suggested
8. The authors should have sampled the microbiome specimen kinetically and based their treatment based on microbiome composition leading to a more rational treatment.
   We would have liked to have done this but did not. We already state "We did not undertake serial microbiome or other analyses (e.g. metabolomics) in our patient, thus cannot further explore these hypotheses." on page 6

Round 2

Reviewer 1 Report

the authors have made all suggested changes.