Chagas Disease in the Non-Endemic Area of Rome, Italy: Ten Years of Experience and a Brief Overview

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript resumes the general knowledge about Chagas disease in endemic and non-endemic countries, the importance of screening the population, and the clinical outcome of a cohort of patients treated with benznidazole in a hospital in Rome (Italy). This is very interesting since there are scarce reports about Chagas disease in Italy.

However, while reading the manuscript I thought that it was a review because it was difficult to discriminate the new results from previous studies already published by the authors Ref 14,  

DOI: 10.1186/s12879-018-3118-5).

Please modify the title, abstract, and results section to clarify that you report in the manuscript the clinical outcome after treatment with benznidazole of a group of patients.

 

 

Author Response

Comment 1 The manuscript resumes the general knowledge about Chagas disease in endemic and non-endemic countries, the importance of screening the population, and the clinical outcome of a cohort of patients treated with benznidazole in a hospital in Rome (Italy). This is very interesting since there are scarce reports about Chagas disease in Italy.

However, while reading the manuscript I thought that it was a review because it was difficult to discriminate the new results from previous studies already published by the authors Ref 14,  

DOI: 10.1186/s12879-018-3118-5).

Please modify the title, abstract, and results section to clarify that you report in the manuscript the clinical outcome after treatment with benznidazole of a group of patients.

 

Response: Thank you for pointing this out. We agree with this comment. Therefore we have, accordingly, modified the title, abstract and result section.

Title: “Chagas disease in the non-endemic area of Rome, Italy: a ten years experience and a brief overview.” Title, pag. 1, line 2-5.

The abstract has been modified, as suggested. Abstract, pag 1, line 20-28

The result section now contains only the results of our case series and, specifically, in the first part, the results of benznidazole treatment in the 47 patients in our cohort. Results, pag 9, line 319-368

Reviewer 2 Report

Comments and Suggestions for Authors

This is a avery interesting paper dealing with an important subject: Chagas disease in Europe, especially in Italy. First of all, I would like to congratulate the authors for their effort to address this neglected disease because I feel that this is very difficult for people not acquainted with the subject. Their personal experience in handling Chagas disease must be commended. As far as the paper is concerned, I would like to address some questions: 1) The review on Chagas disease has ben shown under the Results section.I strongly suggest to move that to the Introduction section. The results section might start with the Personal experience section; 2) page 2, lines 74 and 76: The sentence is incorrect because the infection with T. cruzi is not th consequence of a insect bite. This must be corrected; 3) page 4, lines 145 to 147; It is necessary to clarify the indeterminate stage: It is mandatory to point out the there is digestive tract disease as detected by X-Ray or endoscopic imaging; page 6, line 228: Kuschnir classification is not the most freequently used classification for patients with chronic Chagas disease. I suggest to replace it by that used by Andrade JP et al. Arquivos Brasileiros de Cardiologia 2011; 96: 434-442.; page 8, line 286; treatment of patients with Benznidazol is debatable even for patients < 50 years of age because there is no support of evidence-based medicine (see, for example: PLOS Neglect Trop Disease 2022; 16: e0010386, https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010386; Lancet Infectious Disease 2024; 24: 333-334, https://www.sciencedirect.com/science/article/abs/pii/S1473309923006874). I think that some comments about this would enrich the paper.    

Author Response

Reviewer 2

This is a a very interesting paper dealing with an important subject: Chagas disease in Europe, especially in Italy. First of all, I would like to congratulate the authors for their effort to address this neglected disease because I feel that this is very difficult for people not acquainted with the subject. Their personal experience in handling Chagas disease must be commended. As far as the paper is concerned, I would like to address some questions:

Comment 1) The review on Chagas disease has been shown under the Results section. I strongly suggest to move that to the Introduction section. The results section might start with the Personal experience section;

 

Response. Following the referee’s suggestion, the review on Chagas disease has been moved to the Introduction section. Introduction, pag.2, line 52-301.

 

Comment 2) page 2, lines 74 and 76: The sentence is incorrect because the infection with T. cruzi is not the consequence of a insect bite. This must be corrected;

 

Response. The phrase has been reformulated accondingly to reviewer comment. Pag.2, Introduction, line 62

 

Comment 3) page 4, lines 145 to 147; It is necessary to clarify the indeterminate stage: It is mandatory to point out the there is digestive tract disease as detected by X-Ray or endoscopic imaging;

Response: The sentence has been changed: ”If patients with positive T. cruzi antibodies have no symptoms or signs and no evidence of organic cardiac and intestinal lesions on ECG, chest X ray, and on any other radiological imaging or endoscopic study, the disease is classified as “indeterminate”. Introduction, pag. 4, line 138-141

-page 6, line 228: Kuschnir classification is not the most frequently used classification for patients with chronic Chagas disease. I suggest to replace it by that used by Andrade JP et al. Arquivos Brasileiros de Cardiologia 2011; 96: 434-442.;

Response: The reference has been changed by the suggested one in the text and reference sections. Pag. 6, Introduction, line 222-223

 

- page 8, line 286; treatment of patients with Benznidazol is debatable even for patients < 50 years of age because there is no support of evidence-based medicine (see, for example: PLOS Neglect Trop Disease 2022; 16: e0010386, https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010386; Lancet Infectious Disease 2024; 24: 333-334, https://www.sciencedirect.com/science/article/abs/pii/S1473309923006874). I think that some comments about this would enrich the paper. 

Response: The sentence has changed to “Treatment is generally offered to patients with chronic CD, although the effectiveness of treatment in adults is controversial”, as suggested. Introduction, pag.9, line 281

Futhermore, a sentence was added (“No randomised, placebo-controlled trial on effectiveness of benznidazole for prevention of progression to cardiomyopathy in the indeterminate stage of chronic CD is available.”). Introduction, pag. 9, line 284-286

The references suggested has been added (Bestetti RB, reference n. 39)

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have presented a paper that includes a general review of Chagas disease (CD) followed by a summary of serological studies on CD performed by the authors. CD is a parasitic disease endemic in Latin America but gaining relevance in the world, and in particular in Italy due to population migration.

The manuscript requires some modifications:

- in introduction: include the objective of the study

- abstract: at the beginning of a sentence numbers should be written in letters

- in results: eliminate duplicate information in text and tables

- Check the clarity and resolution of figures

- Include references in some paragraphs

All observations are detailed in the attached file.

Comments for author File: Comments.pdf

Author Response

Reviewers 3

The authors have presented a paper that includes a general review of Chagas disease (CD) followed by a summary of serological studies on CD performed by the authors. CD is a parasitic disease endemic in Latin America but gaining relevance in the world, and in particular in Italy due to population migration.

The manuscript requires some modifications:

 

Comment 1- in introduction: include the objective of the study

Response: The objective of our study was added in the Introduction section, as suggested. Introduction, pag.2, line 46-50

 

Comment 2- abstract: at the beginning of a sentence numbers should be written in letters

Response: The sentence has been delated.

 

Comment 3- in results: eliminate duplicate information in text and tables

Response. Text has been modified to evoid too much repetitions, as suggested. Results, pag.11, line 334-336

 

Comment 4- Check the clarity and resolution of figures

Response. Resolution of Figure 1 and Figure 2 has been improved. Text of Figure 2 has been re-organized

 

Comment 5- Include references in some paragraphs

Response: References have been added, as required

Introduction Pag 3, Line 72, etc

Comment 5. All observations are detailed in the attached file.

-Concentration method called the Strout technique in adults or Microstrout in newborns was added. Introduction, Pag. 5, line 150-151

-As suggested, the sub-title has been changed in: “Personal experience on screening, diagnosis and treatment of CD at Spallanzani Institute”. Results, Pag.10, line 319

- T.cruzi (italic) has been corrected