Bacterial Foodborne Diseases in Central America and the Caribbean: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript is a literature review titled Bacterial foodborne diseases in Central America and the Caribbean: A systematic review. It is a very ambitious study with a lot of relevant references. In Material and Methods the authors postulated: “The literature review was conducted to identify relevant studies on bacterial foodborne diseases”. However, most of the text is dealing with prevalence of different pathogenic bacteria in food products and animal reservoirs and not with diseases. Very, very little is about foodborne cases and outbreaks. I miss the classical account, that is suspected/identified agents, number of outbreaks, number of cases, number of deaths and involved/suspected foods. The only part, seven lines of text, is the Shigella spp. part, which tell a little about cases of shigellosis.  

 

The review also includes papers concerning lack of policy to control food industries, e.g. inadequate surveillance, lack of HACCP and knowledge gaps among staffs. There are a lot of interesting and relevant information in the present review, but the title must be changed and the text must be structured and compressed/shortened. I think that it will be better to merge the parts  ‘‘Results and Discussion’’ to one part.

 

Comments on the Quality of English Language

English is not my mother-tongue

Author Response

We sincerely thank the reviewers for the time and effort they dedicated to reviewing our manuscript. Their comments and suggestions have greatly improved the quality and clarity of the work. We also appreciate their observations, which strengthened the results and discussion presented.

 

Comments 1: Inclusion of clinical cases and specific outbreaks

Response 1: We appreciate the comment regarding the manuscript's focus. Modifications have been made to include more information on clinical cases and specific outbreaks. In the Results section, quantitative data on FBD in the region has been added, including:

• Suspected/identified pathogens
• Number of reported outbreaks
• Number of cases and deaths
• Involved/suspected foods

The discussion on relevant outbreaks of Salmonella spp., Escherichia coli, Campylobacter spp., Listeria monocytogenes, Shigella spp., and Aliarcobacter spp. in various Central American and Caribbean countries has been expanded. The section on diagnosis and treatment has also been strengthened, linking the review's findings with the clinical impacts of these infections.

 

Comments 2:  The reviewer acknowledges the value of the findings regarding deficiencies in food safety policies and epidemiological surveillance but suggests that the title should better reflect the manuscript's content.

 

Response 2: We understand the suggestion regarding the title and have proposed a modification to reflect the study's scope better. The new suggested title is:

"Bacterial contamination and foodborne disease surveillance in Central America and the Caribbean: A systematic review"

This change highlights the article's focus on bacterial contamination and challenges in the epidemiological surveillance of foodborne diseases.

Comments 3: The reviewer suggests merging the Results and Discussion sections to improve the flow of the text and reduce its length.

Response 3 To improve the manuscript's structure, we have consolidated the Results and Discussion sections into one section. This has allowed us to reduce redundancies and present the findings more concisely, directly linking data on pathogen prevalence with outbreaks and epidemiological surveillance in the region.

Reviewer 2 Report

Comments and Suggestions for Authors

The review article entitled “Bacterial Foodborne diseases in Central America and the Caribbean: A systematic review” studies the bacterial pathogens responsible for FBD, their prevalence, challenges in management, and strategies for prevention. It is a well-organized article with valuable information about this point. There are some points need to be considered for improving the final quality of this article as follow:

Methodology: Discuss the limitations of the search process.

Results, 3.3. Foodborne disease caused by bacteria in CAC: Authors write generally about foodborne diseases. They need to be more specific by discussing specific types of foodborne diseases: name of each disease, symptoms under each bacterial species.

Discussion: there is a need for tailored public health strategies for different regions. Explain this statement in more detail to provide the reader with a comprehensive idea about this strategy.

Diagnosis and treatment of foodborne diseases: Write a short paragraph to discuss different methods for diagnosis and treatment of foodborne diseases.

Discuss shortly the impact of foodborne diseases on the economic situation.

Author Response

 

We sincerely thank the reviewers for the time and effort they dedicated to reviewing our manuscript. Their comments and suggestions have greatly improved the quality and clarity of the work. We also appreciate their observations, which strengthened the results and discussion presented.

 

Comments 1:Methodology: Discuss the limitations of the search process.

Response 1: We appreciate the suggestion to discuss the limitations of the search process. A new section has been added to the Materials and Methods that details the main limitations of the study:

• Availability of information: Although databases like PubMed and Google Scholar were used, documentation on foodborne diseases in Central America and the Caribbean is limited compared to other regions.
• Publication bias: Some older studies may have been excluded if they were unavailable in open access or did not meet inclusion criteria.
• Differences in surveillance systems: Variability in national reports and the lack of a standardized reporting system make comparing data between countries directly difficult.
• Exclusion of other agents: The review focused on bacterial diseases, excluding those caused by viruses, fungi, and parasites, which may limit a broader view of the problem.

Comments 2: Results, 3.3. Foodborne disease caused by bacteria in CAC: Authors write generally about foodborne diseases. They need to be more specific by discussing specific types of foodborne diseases: the name of each disease and symptoms under each bacterial species.

Response 2: To improve the clarity and specificity of the findings, Section 3.3. Foodborne disease caused by bacteria in CAC has been restructured. The pathogens are now presented in more detail, including:

• Salmonellosis (Salmonella spp.): Causes diarrhea, fever, vomiting, and abdominal pain. It can lead to complications such as septicemia in immunocompromised individuals.
• Escherichia coli infections (E. coli) Can cause hemorrhagic colitis and hemolytic uremic syndrome, which can lead to potentially severe kidney damage.
• Campylobacteriosis (Campylobacter spp.): Causes diarrhea (sometimes bloody), fever, abdominal pain, and, in severe cases, Guillain-Barré syndrome.
• Shigellosis (Shigella spp.): Characterized by watery or bloody diarrhea, fever, and abdominal cramps.
• Listeriosis (Listeria monocytogenes): Can cause meningitis, septicemia, and miscarriages in pregnant women.
• Infection by Aliarcobacter spp.: Associated with enteritis and septicemia, with symptoms similar to those of Campylobacter.
• Clostridium difficile enterocolitis: Causes severe diarrhea, fever, and cramps, primarily in hospitalized patients.

Tables summarizing each disease's symptoms and commonly implicated foods have been added.

 

Comments 3: Discussion: there is a need for tailored public health strategies for different regions. Explain this statement in more detail to give the reader a comprehensive idea about this strategy.

Response 3: We have expanded the discussion on the need for region-specific public health strategies. Several key approaches are highlighted:

• Food safety regulation: In countries with a developed food industry (e.g., Costa Rica and Panama), regulations such as HACCP can be strengthened to reduce risks in food production and distribution.
• Training in hygiene and food handling: In rural areas with limited access to sanitary infrastructure, community education on good food and drinking water handling practices is needed.
• Strengthening epidemiological surveillance: Some countries (e.g., the Dominican Republic and Guatemala) have a high burden of foodborne diseases but lack effective monitoring systems. Investment in technologies like genome sequencing is proposed to improve outbreak identification.
• International cooperation: Organizations like PAHO and CDC have implemented regional initiatives to improve outbreak detection and response, but greater coordination between countries is required.

References to previous studies demonstrating the effectiveness of these strategies in other regions of the world have been included.

 

Comments 4: Diagnosis and treatment of foodborne diseases: Write a short paragraph to discuss different methods for diagnosis and treatment of foodborne diseases.

Response 4: A paragraph has been added in the Diagnosis and Treatment section to summarize the most commonly used methods:

• Diagnosis: This includes microbiological cultures, serological tests, PCR, and molecular methods such as whole-genome sequencing. These methods allow for the detection of antibiotic resistance and the tracking of infection sources.
• Treatment: In most cases, hydration and symptomatic management are recommended. However, severe infections (e.g., listeriosis, systemic Salmonella infections) require specific antibiotics, although their use must be controlled to avoid antimicrobial resistance.

The importance of developing rapid tests and improving diagnostic capacity in the region has been emphasized.

 

Comments 5: Discuss shortly the impact of foodborne diseases on the economic situation

Response 5: A brief section on the economic impact of FBD has been added.

Reviewer 3 Report

Comments and Suggestions for Authors

Here are my comments that need to be addressed by the author:

1. It would be helpful if the author could plot a graph showing the number of articles published by year, up to 2025, as mentioned in Figure 1.

2. Table 2: Some countries are missing.

3. The names of bacteria should be italicized in the text as well as in each table (I noticed they are not italicized in the tables).

4. What about data related to fungal pathogens, which are also major contributors to foodborne diseases? The author only discusses bacterial pathogens.

5. In Section 3.5, "Strategies to Prevent and Control FBD in CAC," no strategies are discussed. Several biological, chemical, and physical methods are available to prevent infections. Please provide a detailed discussion of these strategies, including their limitations, and include them in the tables.

 

Author Response

We sincerely thank the reviewers for the time and effort they dedicated to reviewing our manuscript. Their comments and suggestions have greatly improved the quality and clarity of the work. We also appreciate their observations, which strengthened the results and discussion presented.

 

Comments 1: "It would be helpful if the author could plot a graph showing the number of articles published by year, up to 2025, as mentioned in Figure 1."

Response 1: "We appreciate the reviewer's suggestion. We have included Figure 2 (previously not correctly labeled), a bar chart showing the number of papers published annually from 2001 to 2024, in the revised manuscript (see Figure 2). This provides a clearer visualization of the publication trends over the specified period, with a peak in 2016 and noticeable increases in 2020, 2022, and 2023."

Comments 2: "Table 2: Some countries are missing."

Response 2: "Thank you for pointing this out. We acknowledge that Table 2 in the original manuscript was not exhaustive in its coverage of all countries within Central America and the Caribbean. The table has now been updated to reflect a more comprehensive representation of the region based on the data extracted from the included studies. (Table 2)"

 

Comments 3: "The names of bacteria should be italicized in the text as well as in each table (I noticed they are not italicized in the tables)."

Response 3: "We thank the reviewer for noting this inconsistency. We have carefully reviewed the manuscript and italicized all bacterial names throughout the text, including those in the tables, to adhere to standard scientific nomenclature."

 

Comments 4: "What about data related to fungal pathogens, which are also major contributors to foodborne diseases? The author only discusses bacterial pathogens."

Response 4: "We acknowledge the importance of fungal pathogens in foodborne diseases. However, the scope of this review was specifically limited to bacterial foodborne diseases in Central America and the Caribbean. This focus was clearly stated in the Introduction section: '...the scope of the review was FBD caused by bacteria.' While fungal pathogens are relevant, their inclusion would have significantly broadened the scope of this study. We recognize this as a potential limitation and suggest that future research could explore the role of fungal pathogens in FBD within the region."

 

Comments 5: "In Section 3.5, 'Strategies to Prevent and Control FBD in CAC,' no strategies are discussed. Several biological, chemical, and physical methods are available to prevent infections. Please provide a detailed discussion of these strategies, including their limitations, and include them in the tables."

Response 5: "We appreciate the reviewer's feedback that section 3.5 lacked details on specific prevention and control strategies. We have expanded this section to include a more thorough discussion of the biological, chemical, and physical methods to prevent bacterial foodborne diseases. Table 2 summarizes the main strategies for preventing and controlling FBD in CAC. Based on the reviewed literature, this includes information on their mechanisms, applications, and limitations. Examples include:

• • Biological Methods: Bacteriophages, competitive exclusion.
  • Chemical Methods: Disinfectants (chlorine, quaternary ammonium compounds), organic acids.
  • Physical Methods: Pasteurization, irradiation, modified atmosphere packaging."

 

 

 

 

 

 

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thanks for a thorough reworking of the article. One additional point in Table 2: the symptoms you describe belong to the gastrointestinal form of listeriosis. You probably want to refer to the invasive form of listeriosis with septicemia, abortion, meningitis. Check also spelling of ’‘Listeria spp.’’.

Author Response

Comments:  One additional point in Table 2: the symptoms you describe belong to the gastrointestinal form of listeriosis. You probably want to refer to the invasive form of listeriosis with septicemia, abortion, meningitis. Check also spelling of ’‘Listeria spp.’’.

Response to Reviewer:

We greatly appreciate your insightful feedback. We have carefully addressed your comments regarding Table 2 as follows:

The original description of symptoms (fever, diarrhea, headache, vomiting, upset stomach) reflected the gastrointestinal form of the disease. Following your suggestion, we have revised this to emphasize the invasive form of listeriosis. The updated description now reads:
"Septicemia, meningitis, pregnancy complications (miscarriage), and neurological symptoms in vulnerable populations (immunocompromised individuals, the elderly, and neonates)."

The typographical error “Listernia spp.” has been corrected to “Listeria spp.,” with the genus name italicized and properly formatted.

A note has been added to Table 2 to distinguish between the gastrointestinal and invasive forms of listeriosis, highlighting the clinical relevance of the latter in food safety contexts.

Reviewer 3 Report

Comments and Suggestions for Authors

Author responded all raised question

Author Response

Thank you for your positive feedback. We are glad to hear that all the raised questions have been addressed satisfactorily. If there are any additional concerns or points for clarification, please feel free to let us know.