Peri-oral Monkeypox Virus Infection: A Clinical Report with Confirmatory Polymerase Chain Reaction Findings

Round 1

Reviewer 1 Report

This manuscript was well-written and included adequate background for the case studies. However, only two cases were presented. The discussion around lesions and presentation is well-reported in literature, suggesting lack of novel findings in this study. This paper may be presented more appropriately as a review article, or include additional case studies to allow for novel data to be presented. 

Author Response

Dear Reviewer n'1,

first of all thank you very much for your kind suggestions. Unfortunately, we haven't any case to show in this time, but we added some important and useful information to our manuscript to improve the overall quality.

A warm greeting

Reviewer 2 Report

Dear Authors,

Kudus to you for this manuscript. Its results and conclusions have a really good impact on MPXV. However, I do have more comments to give you, which I will discuss briefly here:

In the title: These two words "Monkeypox virus infection" and "(MPXV)" have duplicated faces, which may make the title too wordy. I prefer that you rewrite the title in a more concise way.

In abstract:

- Line 18: delete (or strains).

- Line 20: update the facts in this sentence "as of May 2022, cases of MPXV 20 have been reported in approximately 70 countries".

- Abstract needs to be shortened.

In Introduction:

- lines 40-45: You repeated what you wrote literarily in the abstract "Monkeypox virus (MPXV) is a member of the Orthopoxvirus group, related to smallpox virus, and characterized by the presence of two distinct clades (or strains): the West African strain and the Congo Basin strain" and "Although, historically, human disease was mainly limited to sporadic cases and occasional outbreaks (mainly but not exclusively in Africa) [2], as of May 2022, cases of MPXV have been reported in approximately 70 countries where the disease is not considered endemic". This really makes readers bored. Try to reshape the presentation of your introduction in a more attractive way. Repetition is a sign of weakness. 

- In line 51: clarify "subpopulations."

- Line 51: Regarding the animal-to-human transmission, I prefer if you mention the role and human-to-animal transmission. Please, read this article and try to add a sentence about their conclusion in this assumption. cite it properly Sah, Ranjit, et al. "Recent first report of human-to-dog transmission of Monkeypox virus emphasizes an urgent need of enhancing surveillance and strengthen further explorative research to reveal its real magnitude of reverse zoonosis from other animals including pets as like that happened with SARS-CoV-2/COVID-19 pandemic–Correspondence." International Journal of Surgery (London, England) (2022).‏

- Line 56: You did not describe the dermatological findings of MPXV in detail. This is the hallmark of diagnosis clinically. I prefer if you add some sentences about the nature of a skin rash, its characteristics, its location, and its communicability. Kindly read this article and cite it properly. Alshahrani, Najim Z., et al. "Assessment of knowledge of monkeypox viral infection among the general population in Saudi Arabia." Pathogens 11.8 (2022): 904.‏

- In line 57: The rationale for doing this case report needs to be stated clearly before the aim.

In Case presentation Section:

- line 62: location ("where" and sitting "which place" and when "time" need to be stated. You just mentioned Bari. for readers, we didn't know what is Bari? hospital? City? village?...

Moreover, more past history of this present illness needs to be mentioned.

- line 62: failure of antiviral therapy (Aciclovir 400 mg twice a day)," what does that mean? Who prescribed this? previously diagnosed? 

- Lines 79- 81: duplicated idea. Please delete it.

- Treatment plan needs to be added. 

- Prognosis of this treatment plan needs to be mentioned clearly. How about other findings?

In Discussion:

- The whole discussion needs to be improved. Many studies asked questions about the role of sexual practices and skin findings of MPXV. Making comparisons with other related medical skin rash manifestations needs to be highlighted. Clinical implications need to be added.

In Conclusions:

Need to be shortened in a more concise way. 

In References:

Follow the journal guideline in making the references.

Author Response

Reviewer n’2: Dear Authors,

Kudus to you for this manuscript. Its results and conclusions have a really good impact on MPXV. However, I do have more comments to give you, which I will discuss briefly here:

In the title: These two words "Monkeypox virus infection" and "(MPXV)" have duplicated faces, which may make the title too wordy. I prefer that you rewrite the title in a more concise way.

Answer n’1: Dear Reviewer n’2, thank you very much for this wonderful comment. We proceeded to reformulate the title of our manuscript. We hope that il will be fine.

Reviewer n’2: In abstract:- Line 18: delete (or strains).- Line 20: update the facts in this sentence "as of May 2022, cases of MPXV 20 have been reported in approximately 70 countries".- Abstract needs to be shortened.

Answer n’2: Done, thank you very much.

Reviewer n’2: In Introduction:- lines 40-45: You repeated what you wrote literarily in the abstract "Monkeypox virus (MPXV) is a member of the Orthopoxvirus group, related to smallpox virus, and characterized by the presence of two distinct clades (or strains): the West African strain and the Congo Basin strain" and "Although, historically, human disease was mainly limited to sporadic cases and occasional outbreaks (mainly but not exclusively in Africa) [2], as of May 2022, cases of MPXV have been reported in approximately 70 countries where the disease is not considered endemic". This really makes readers bored. Try to reshape the presentation of your introduction in a more attractive way. Repetition is a sign of weakness.

Answer n’3: Dear Reviewer n'2, thank you very much for your valuable advice. We have opted to edit a large part of the abstract rather than the introduction, thereby eliminating repetition.

Reviewer n’2: - In line 51: clarify "subpopulations." - Line 51: Regarding the animal-to-human transmission, I prefer if you mention the role and human-to-animal transmission. Please, read this article and try to add a sentence about their conclusion in this assumption. cite it properly Sah, Ranjit, et al. "Recent first report of human-to-dog transmission of Monkeypox virus emphasizes an urgent need of enhancing surveillance and strengthen further explorative research to reveal its real magnitude of reverse zoonosis from other animals including pets as like that happened with SARS-CoV-2/COVID-19 pandemic–Correspondence." International Journal of Surgery (London, England) (2022).

Answer n’4: Done, thank you.

Reviewer n’2: - Line 56: You did not describe the dermatological findings of MPXV in detail. This is the hallmark of diagnosis clinically. I prefer if you add some sentences about the nature of a skin rash, its characteristics, its location, and its communicability. Kindly read this article and cite it properly. Alshahrani, Najim Z., et al. "Assessment of knowledge of monkeypox viral infection among the general population in Saudi Arabia." Pathogens 11.8 (2022): 904. - In line 57: The rationale for doing this case report needs to be stated clearly before the aim

Answer n’5: Dear Reviewer n’2, all done. Thank you!

Reviewer n’2: - line 62: location ("where" and sitting "which place" and when "time" need to be stated. You just mentioned Bari. for readers, we didn't know what is Bari? hospital? City? village?...

Answer n’6: All done. We added all useful and important informations. Thanks a lot.

Reviewer n’2: Moreover, more past history of this present illness needs to be mentioned.- line 62: failure of antiviral therapy (Aciclovir 400 mg twice a day)," what does that mean? Who prescribed this? previously diagnosed? - Lines 79- 81: duplicated idea. Please delete it.- Treatment plan needs to be added. - Prognosis of this treatment plan needs to be mentioned clearly. How about other findings?

Answer n’7: All done. We added all useful and important informations. Thanks a lot.

Reviewer n’2: - The whole discussion needs to be improved. Many studies asked questions about the role of sexual practices and skin findings of MPXV. Making comparisons with other related medical skin rash manifestations needs to be highlighted. Clinical implications need to be added. In Conclusions:

Need to be shortened in a more concise way.

Answer n’8: Done.

Reviewer 3 Report

The authors present a well-described case series of patients with perioral MPOX infections.

Minor suggestions include:

There is now an opportunity for the authors to update disease nomenclature throughout the paper to conform to the recently released WHO MPOX nomenclature.

Line 69: authors may want to clarify if this was an anonymous sexual contact and whether contact tracing had been attempted.

112: Suggest authors clarify that this outbreak was first reported in May 2022

127: it may be more accurate to note that “lesions in patients in non-endemic countries are more localized as compared to lesions reported from patients in endemic area and have a different distribution."

Author Response

Dear Reviewer n'3,

thank you very much!

We addressed all your suggestions. Thanks again.

Round 2

Reviewer 1 Report

Thank you for your revisions. As a note, the WHO has recently renamed monkeypox to mpox. While both versions can be used during this timeframe, it may be appropriate to update the manuscript with this information. 

Author Response

Dear Reviewer n'1,

thank you very much. We have correct with the update nomenclature.

Thank you very much

Reviewer 2 Report

Dear Authors,
Thank you for taking my previous feedback onboard and amend it accordingly

Author Response

Thanks a lot.