Host Immunity and Francisella tularensis: A Review of Tularemia in Immunocompromised Patients
Round 1
Reviewer 1 Report
The review manuscript " Host immunity and Francisella tularensis: A review of Tularemia in immunocompromised patients" is well written and clearly presented. The authors collected data from clinical cases reported in the literature to identify cases of tularemia in immunocompromised patients. Therefore, they related the main clinical aspects of tularemia in immunocompromised patients and the interplay between the therapeutic approach of tularemia in these patients. The work emphasizes the importance of monitoring tularemia in wildlife and the identification of areas with high risks of outbreaks, as well as setting up a relevant strategy for diagnostic for tularemia.
The review covered the topic and can put together and compare the main findings from described clinical cases of tularemia in immunocompromised patients.
Minor corrections are needed, especially in table 1.
Table 1 - a header is missing to explain each column. The table must be standardized, for example, bold text, capital letters (Complete Recovery). Only the references number is necessary. This table must appear before table 2, preferably in a horizontal position.
22 - In conclusion
62 - to improving
64 - immunosuppression
75 - presentations
92 - a large
96 - these cytokines
98 - to kill
109/119/139/156/249/320 - humans
120 - a bone
124 - the production
124 - Nitric Oxide
139 - the diagnosis
151/265/279 - However,
156 - shown
174 - Google Scholar
222 - appropriate
222- the duration
223 - heterogeneous
232 - Prevention
237 - terms
248 - in addition to
291 - after the first
299 - study.
303/320 - e.g.,
306 - suggest
320 - animals
320 - … (or others)
331 - suggests more
Author Response
We thank the reviewer for having considered our manuscript.
Please see the attachement file for a point-by-point response.
Author Response File: 
Author Response.docx
Reviewer 2 Report
End of the abstract. “ patients presenting pulmonary symptoms with unexplained fever “. I wonder of the “with” could be replaced by “or” because both the pulmonary and typhoidal forms were the most predominant in immunocompromised patients.
Introduction,
line 29. Francisella tularensis subsp. novicida is now considered a different species, Francisella novicida. Especially due to significant differences in the genome sequences and organization.
line 31. F. tularensis subsp. Tularensis. The subspecies name must start with a lowercase
line 40. F. tularensis subsp. mediasiatica is mainly restricted to central Asia and south part of Russia
line 43. Other arthropods than ticks can transmit F. tularensis, especially mosquitoes in Sweden and Finland
line 50. The inhalation of Ft may also lead to acute, rapidly fatal pneumonia with type A strains
lines 58-60. “However, the sensibility of these techniques is only reliable on tissue samples and therefore mostly applies to severe cases [7].” No, PCR is also very useful for rapid detection of Ft in skin ulcer, conjunctival or pharyngeal exudates, as well as sputum for pneumonia diagnosis.
- Host immunity against Francisella
line 95. It would be helpful for the reader to specify that the LVS strain is a vaccine strain with an attenuated virulence in humans.
Discussion
line 287. “This predominance of the pneumonic form suggests that contaminations of immunocompromised patients mainly occur through inhalation.” It should be considered here that the pneumonia can also be of hematogenous origin, in a patient with Ft bacteremia whatever the portal of entry.
line 304. The authors could compare the isolation rate of 48% of Ft in the blood in immunocompromised patients with the 10% in immunocompetent ones.
lines 311-312. Antibiotic names must start with a lower case letter
line 327. Same as lines 58-60
Table 2 should be table 1, and table 1 should be table 2.
Author Response
We would like to thank the Reviewer for considering our manuscript.
Please see the attachement for a point by point response.
Author Response File: Author Response.docx
