Mycobacterium Avium Complex Genitourinary Infections: Case Report and Literature Review

Round 1

Reviewer 1 Report

This case report and literature review studied a case of Mycobacterium avium-intracellulare complex (MAC)-associated urinary tract infection in a 79-year-old woman patient has been presented in this article. The patient has an extensive urological history and recurrent urinary tract infections. Rajendraprasad et al made a significant contribution to the field of the biology of MAC infection by providing a new case study in addition to proposing a baseline protocol with beneficial effects of using macrolides and aminoglycosides which should be adaptable in every condition and for different patient.

The manuscript is well-written and well-structured for publication. I have only one minor comment to provide to authors: “Could the authors make sure that the abbreviation used in the text comes just before the first group of word to abbreviate. For Rifampin on page 2 does not have an abbreviation. However, the abbreviation come at Page 7.

Author Response

Thank you.  We have placed the abbreviation for rifampin on page 2 rather than page 7.

Reviewer 2 Report

First, a well-written case history and good tabular presentation of prior reports of this rather rare presentation of nontuberculous mycobacterial (NTM) infection.

Just a few suggestions

1. Introduction, Lines 25-26. The description of the Mycobacterium avium complex (MAC) is insufficient. There are currently 7 distinct species and 4 subspecies of M. avium. Of major importance is the exclusion of Mycobacterium chimaera which can be easily misidentified as Mycobacterium intracellulare. I suspect this is due to the age of the references cited. Follow the publications of Enrico Tortoli.
2. Lines 61-62. What company and kit was used for the nucleic acid probe isolation? Gen-Probe? This is important, as the kits may not discriminate between MAC species.
3. Paragraph 3. Nontuberculous Mycobacteria: an overview. Lines 85-96. The history lesson is correct, but the citations incorrect.  Citation [11] should be an article by Ray Corpe describing the virulence of the "Battey" isolate, named after Battey State Hospital in Rome, Georgia where he was a clinician.

Author Response

1.  We have adjusted to include more modern proposed definition, as outlined in DOI: 10.1099/ijsem.0.003026

2.  Thank you.  Our lab uses the AccuProbe series, by Hologic, and manuscript was edited to reflect this.

3. We can't express thanks enough for picking up on this.  As previously written, references were incorrect and reflective of an earlier version.  The manuscript has been updated to not only appropriately reference Corpe's work, but an animal study as well.  doi 10.1378/chest.45.4.380 and doi 10.1378/chest.43.1.26