Dear Dr. NDOUR,

Thank you very much for submitting your manuscript "Fungal mycetoma and pregnancy: an association with costly and difficult management, about a case" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. In light of the reviews (below this email), we would like to invite the resubmission of a significantly-revised version that takes into account the reviewers' comments.

We cannot make any decision about publication until we have seen the revised manuscript and your response to the reviewers' comments. Your revised manuscript is also likely to be sent to reviewers for further evaluation.

When you are ready to resubmit, please upload the following:

[1] A letter containing a detailed list of your responses to the review comments and a description of the changes you have made in the manuscript. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

Important additional instructions are given below your reviewer comments.

Please prepare and submit your revised manuscript within 60 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email. Please note that revised manuscripts received after the 60-day due date may require evaluation and peer review similar to newly submitted manuscripts.

Thank you again for your submission. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Marcio L Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

***********************

Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: This is a single case

Was the M.mycetomatis identified by culture or by molecular methods ?

Can you be more specific about the surgery ie was this visually complete excision. What doses of voriconazole were used and when was the patient changed to itraconazole

In Table 1 what does thrust mean ? Worsening ??

Reviewer #2: The microbiologic identification of M. mycetomatis is not included

The authors do not explained the reason to stop antifungal therapy and changing to antibiotics

--------------------

Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: "The patient had to develop several previous pregnancies on this site of mycetoma, the outcome of which was favourable"

Does this mean that the patient had been pregnant several times before in the presence of the same mycetoma but had not developed any complications ? If so this isn’t what is said in the discussion where it is implied that the patients’ mycetoma was aggravated in all pregnancies

Chain Reactive Protein – C-reactive Protein

"Only a few cases have been reported in the literature concerning this association". I would be more careful here as you haven’t carried out a full literature review and there are more cases. So this is a real and significant association. I would change this to ….Cases have been reported in the literature concerning this association. You again say this is a rare occurrence in the discussion – I would rephrase this to say Although reported by several authors this is not a very common occurrence

This author believes - there are 9 authors !

Voriconazole, first injected. Presumably this was by standard iv infusion rather than direct infiltration of the lesion

Table 2

Is there a missing drug in the first column ? Also some of the data is repeated

Reviewer #2: Table 1 is not necessary and should be substituted by a time lining

Table 3 is not necessary

--------------------

Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: Conclusion. You might point out that this drug cost problem is a very real one in many countries where the best management of Skin NTDs is compromised by the high cost of medications - in this case antifungals

Reviewer #2: The authors should focus their discussion in the clinical and radiological outcome and especially the use of Antifungal drugs during pregnancy.

In my opinion, advocacy related to therapy costs is non relevant.

--------------------

Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

--------------------

Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: Overall the use of English should be checked and changed were necessary

Reviewer #2: The authors should change the focus of their manuscript.

They should discuss the antingungal drugs during pregnancy

The costs of antifungals and or the therapy in African countries is not scientifically interessante, but they could resume this issues in a single sentence

--------------------

PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Flavio Queiroz-Telles

Figure Files:

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. Additionally, PLOS ONE offers an option to publish peer-reviewed clinical study protocols. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

Attachments

Attachment

Submitted filename: PNTD-D-23-00553.docx

Dear Dr. NDOUR,

Thank you very much for submitting your manuscript "Fungal mycetoma and pregnancy: an association with costly and difficult management, about a case" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. In light of the reviews (below this email), we would like to invite the resubmission of a significantly-revised version that takes into account the reviewers' comments.

I must admit that your manuscript revision differed from what I had anticipated. Although you addressed some of the comments from reviewer 2 on a surface level, you chose to fully disregard the other comments made by this reviewer, as well as all the comments put forth by reviewer 1 (please see these comments below).

Despite a valid foundation for rejection, we are extending an opportunity to you to provide responses to the previously unattended comments, along with more comprehensive explanations for the comments you initially tackled. Furthermore, kindly incorporate a more recent and widely accepted definition of mycetoma in your manuscript. Please take note that we expect your manuscript to undergo comprehensive adjustments that align entirely with your responses to the reviewers.

Reviewer 1

This is a single case

Was the M.mycetomatis identified by culture or by molecular methods ?

Can you be more specific about the surgery ie was this visually complete excision. What doses of voriconazole were used and when was the patient changed to itraconazole

In Table 1 what does thrust mean ? Worsening ??

"The patient had to develop several previous pregnancies on this site of mycetoma, the outcome of which was favourable"

Does this mean that the patient had been pregnant several times before in the presence of the same mycetoma but had not developed any complications ? If so this isn’t what is said in the discussion where it is implied that the patients’ mycetoma was aggravated in all pregnancies

Chain Reactive Protein – C-reactive Protein

"Only a few cases have been reported in the literature concerning this association". I would be more careful here as you haven’t carried out a full literature review and there are more cases. So this is a real and significant association. I would change this to ….Cases have been reported in the literature concerning this association. You again say this is a rare occurrence in the discussion – I would rephrase this to say Although reported by several authors this is not a very common occurrence

This author believes - there are 9 authors !

Voriconazole, first injected. Presumably this was by standard iv infusion rather than direct infiltration of the lesion

Table 2

Is there a missing drug in the first column ? Also some of the data is repeated

Conclusion. You might point out that this drug cost problem is a very real one in many countries where the best management of Skin NTDs is compromised by the high cost of medications - in this case antifungals

Reviewer 2

The microbiologic identification of M. mycetomatis is not included

The authors do not explained the reason to stop antifungal therapy and changing to antibiotics

Table 1 is not necessary and should be substituted by a time lining

Table 3 is not necessary

The authors should focus their discussion in the clinical and radiological outcome and especially the use of Antifungal drugs during pregnancy.

In my opinion, advocacy related to therapy costs is non relevant.

The authors should change the focus of their manuscript.

They should discuss the antingungal drugs during pregnancy

The costs of antifungals and or the therapy in African countries is not scientifically interessante, but they could resume this issues in a single sentence

We cannot make any decision about publication until we have seen the revised manuscript and your response to the reviewers' comments. Your revised manuscript is also likely to be sent to reviewers for further evaluation.

When you are ready to resubmit, please upload the following:

[1] A letter containing a detailed list of your responses to the review comments and a description of the changes you have made in the manuscript. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

Important additional instructions are given below your reviewer comments.

Please prepare and submit your revised manuscript within 60 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email. Please note that revised manuscripts received after the 60-day due date may require evaluation and peer review similar to newly submitted manuscripts.

Thank you again for your submission. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Marcio L Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

Marcio Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

***********************

I must admit that your manuscript revision differed from what I had anticipated. Although you addressed some of the comments from reviewer 2 on a surface level, you chose to fully disregard the other comments made by this reviewer, as well as all the comments put forth by reviewer 1 (please see these comments below).

Despite a valid foundation for rejection, we are extending an opportunity to you to provide responses to the previously unattended comments, along with more comprehensive explanations for the comments you initially tackled. Furthermore, kindly incorporate a more recent and widely accepted definition of mycetoma in your manuscript. Please take note that we expect your manuscript to undergo comprehensive adjustments that align entirely with your responses to the reviewers.

Reviewer 1

This is a single case

Was the M.mycetomatis identified by culture or by molecular methods ?

Can you be more specific about the surgery ie was this visually complete excision. What doses of voriconazole were used and when was the patient changed to itraconazole

In Table 1 what does thrust mean ? Worsening ??

"The patient had to develop several previous pregnancies on this site of mycetoma, the outcome of which was favourable"

Does this mean that the patient had been pregnant several times before in the presence of the same mycetoma but had not developed any complications ? If so this isn’t what is said in the discussion where it is implied that the patients’ mycetoma was aggravated in all pregnancies

Chain Reactive Protein – C-reactive Protein

"Only a few cases have been reported in the literature concerning this association". I would be more careful here as you haven’t carried out a full literature review and there are more cases. So this is a real and significant association. I would change this to ….Cases have been reported in the literature concerning this association. You again say this is a rare occurrence in the discussion – I would rephrase this to say Although reported by several authors this is not a very common occurrence

This author believes - there are 9 authors !

Voriconazole, first injected. Presumably this was by standard iv infusion rather than direct infiltration of the lesion

Table 2

Is there a missing drug in the first column ? Also some of the data is repeated

Conclusion. You might point out that this drug cost problem is a very real one in many countries where the best management of Skin NTDs is compromised by the high cost of medications - in this case antifungals

Reviewer 2

The microbiologic identification of M. mycetomatis is not included

The authors do not explained the reason to stop antifungal therapy and changing to antibiotics

Table 1 is not necessary and should be substituted by a time lining

Table 3 is not necessary

The authors should focus their discussion in the clinical and radiological outcome and especially the use of Antifungal drugs during pregnancy.

In my opinion, advocacy related to therapy costs is non relevant.

The authors should change the focus of their manuscript.

They should discuss the antingungal drugs during pregnancy

The costs of antifungals and or the therapy in African countries is not scientifically interessante, but they could resume this issues in a single sentence

Figure Files:

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. Additionally, PLOS ONE offers an option to publish peer-reviewed clinical study protocols. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

Dear Dr. NDOUR,

Thank you very much for submitting your manuscript "Fungal mycetoma and pregnancy: an association with costly and difficult management, about a case" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. The reviewers appreciated the attention to an important topic. Based on the reviews, we are likely to accept this manuscript for publication, providing that you modify the manuscript according to the review recommendations.

Thank you for your revision. Overall, I agree with reviewer 1; there have been improvements, but some English language editing is still needed. In Table 1 under "Thrust," we recommend changing it to "Worsening" in the table for clarity. It would also be beneficial to replace "exeresis" with "surgery" for better comprehension. Furthermore, please explicitly mention in the text that voriconazole was administered intravenously as the authors confirmed. This will enhance the clarity of your work.

Please prepare and submit your revised manuscript within 30 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email.

When you are ready to resubmit, please upload the following:

[1] A letter containing a detailed list of your responses to all review comments, and a description of the changes you have made in the manuscript.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

Important additional instructions are given below your reviewer comments.

Thank you again for your submission to our journal. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Marcio L Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

Marcio Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

***********************

Thank you for your revision. Overall, I agree with reviewer 1; there have been improvements, but some English language editing is still needed. In Table 1 under "Thrust," we recommend changing it to "Worsening" in the table for clarity. It would also be beneficial to replace "exeresis" with "surgery" for better comprehension. Furthermore, please explicitly mention in the text that voriconazole was administered intravenously as the authors confirmed. This will enhance the clarity of your work.

Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: In general this is improved. It does need some editing to the English.

I note the authors provided answers to my queries such as in Table 1 Thrust . This does mean Worsening - so it is important to change Thrust to Worsening in the table. I would also change exeresis to surgery

Likewise the authors confirm that the voriconazole was given intravenously - this should be stated in the text

Reviewer #2: (No Response)

--------------------

Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: See above

Reviewer #2: (No Response)

--------------------

Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: Yes

Reviewer #2: (No Response)

--------------------

Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: See above

Reviewer #2: (No Response)

--------------------

Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: See above

Reviewer #2: (No Response)

--------------------

PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Figure Files:

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. Additionally, PLOS ONE offers an option to publish peer-reviewed clinical study protocols. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

References

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article's retracted status in the References list and also include a citation and full reference for the retraction notice.

Dear Dr. NDOUR,

Thank you very much for submitting your manuscript "Fungal mycetoma and pregnancy: an association with costly and difficult management, about a case" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. The reviewers appreciated the attention to an important topic. Based on the reviews, we are likely to accept this manuscript for publication, providing that you modify the manuscript according to the review recommendations.

Thank you for your manuscript's revision. Reviewer 1 still has minor concerns - please address them and return the revised manuscript to us.

Please prepare and submit your revised manuscript within 30 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email.

When you are ready to resubmit, please upload the following:

[1] A letter containing a detailed list of your responses to all review comments, and a description of the changes you have made in the manuscript.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

Important additional instructions are given below your reviewer comments.

Thank you again for your submission to our journal. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Marcio L Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

Marcio Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

***********************

Thank you for your manuscript's revision. Reviewer 1 still has minor concerns - please address them and return the revised manuscript to us.

Figure Files:

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. Additionally, PLOS ONE offers an option to publish peer-reviewed clinical study protocols. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

References

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article's retracted status in the References list and also include a citation and full reference for the retraction notice.

Dear Dr. NDOUR,

We are pleased to inform you that your manuscript 'Fungal mycetoma and pregnancy: an association with costly and difficult management, about a case' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

Should you, your institution's press office or the journal office choose to press release your paper, you will automatically be opted out of early publication. We ask that you notify us now if you or your institution is planning to press release the article. All press must be co-ordinated with PLOS.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Marcio L Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

Marcio Rodrigues

Section Editor

PLOS Neglected Tropical Diseases

***********************************************************