Upper Limb Compartment Syndrome—An Extremely Rare Life-Threatening Complication of Cutaneous Anthrax

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

I appreciate the opportunity to review the study "Upper Limb Compartment Syndrome - An Extremely Rare Life-Threatening Complication of Cutaneous Anthrax. Case Series and Systematic Literature Review" by Pertea et al., which highlights cutaneous anthrax, a disease caused by the Gram-positive bacterium Bacillus anthracis, representing 95% of anthrax cases with a mortality rate between 10-40% if untreated.

The study demonstrates the importance of early recognition of characteristic cutaneous lesions and compartment syndrome, along with the early initiation of antibiotic treatment and urgent surgical intervention, as the lifesaving solution.

Below are some considerations:

- In the methodology, was any scale used to assess the quality of the articles included in the review? If so, please indicate this in section 2.2, Data Collected and Method Systematic Review.

- Improve the resolution of Figure 14: The flowchart of articles selected (n=number) summarizes the flowchart of articles selected for the review.

- Tables 3 and 4 could be better represented using a more aesthetically pleasing standard, as it will facilitate reading.

In summary, the review shows that the topic is relevant, especially in the field of medicine, specifically in the subfields of infectious diseases, dermatology, and emergency surgery.

Therefore, I recommend publishing this study after minor revisions.

Thank you once again for the opportunity to contribute to such a valuable study.

Author Response

Dear Reviewer 1,

 

 

Thank you for your appreciation and recommendations!

 

According to your recommendations, I made the following improvements:

• Unfortunately, I did not use any scale to evaluate the quality of the articles included in the review
• Only the inclusion and exclusion criteria mentioned in the text were used
• I improved the resolution of figure 14 – line 324
• Tables 3 and 4 were made according to the standards in the instructions for the author (I hope more aesthetically facilitate reading)
• I modified Tables 1,2,3,4, in Tables I,II,III,IV

 

 

Thank you very much!

 

Best regards,

 

 

Mihaela Pertea MD PhD Assoc Prof

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, I red with interest your article relative to upper limb compartment syndrome linked to anthrax. Most of the article was clear and informative. A clear definition of compartment syndrome would be helpful for non-clinicians. Also, I'm a bit surprised for not finding the article from Thouret et al. 2020, relative to a case of injection anthrax, also published in microorganisms. I believe it's also a kind of compartment syndrome. I would like also to rise some questions for improving clarity.

Line 55: contagiosity is not really true for Ba.

Line 71: the mortality rate seems to me overestimated, and not indicated in the mentioned reference.

Line 84: compartment syndrome - to be defined

Line 91: unwanted biological war - need clarification

Line 122 : add "and both" - coherence with table 1

Line 203: figure 6 is not clearly correlated with text. 

Line 209: picture not defined enough, and not providing information relative to the sentence where it is mentioned.

line 271: picture 12 not showing bacilli arranged in short strains

Line 279: rationale for reverting treatment from amoxicillin to penicillin

Line 305: most Bacillus anthracis strains are naturally resistant to ceftazidim. Such drug is not among the recommended ones according to EMA nor CDC guidelines.Rationale for prescribing such drug?

Line 362: there are no cases since 2014. The formulation lets think that it's still active.

Comments on the Quality of English Language

Line 56: Virgil

Line 63: italic for bacterial name. Many times in the text

Line 80: surinfected instead of superinfected

Line 408: IOT not defined

Author Response

Dear Reviewer 2,

 

Thank you for your appreciation and recommendations!

First of all, I will make a mention in relation to the article by Thouret et al from 2020: the article describes a case of injection anthrax that presented significant edema for which an aponeurotomy was needed, but the presence of compartment syndrome in this case is not mentioned. The surgery was performed in order to prevent compartment syndrome (,,An anterior fasciotomy of the entire right upper limb was performed to prevent any compartment syndrome,,). This is the reason why we did not include the article in the systematic review.

According to your recommendations, I made the following improvements:

• Kamal et al. in 2011 describes anthrax as ,, It is potentially fatal and highly contagious disease,,.
• Tuncali et al in 2020 reported ,,cutaneous anthrax is a fatal disease 20-30% if not treated appropriately,,.
• I defined the compartment syndrome in the introduction – line 85-88
• ,,Unwanted biological war,, – it is not desirable to repeat the use of BA in bioterrorism as it was in the USA in 2001 and mentioned by Klietmann and Ruoff
• I added ,, and both,, - line 127
• I correlated with the text Figure 6 – line 207
• I defined the picture
• I revised the correlation of the text with figure 12 – line 277
• It was the infectious disease specialist's recommendation
• It was the infectious disease specialist's recommendation
• Linia 362 – I modified – ,,2008-2023,, - line 327
• I corrected – ,,Virgil,, - line 56
• I changed the bacterial name in italic everywhere in the text
• I corrected - surinfected – line 80
• I defined and I corrected IOT – oro-tracheal intubation (OTI) – line 416
• I modified Table 1,2,3,4 in Table I, II, III, IV

 

Thank you very much,

 

Best regards,

 

Mihaela Pertea MD PhD Assoc Prof

Author Response File: Author Response.pdf