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Referee comments: Referee 5

Posted by PLOS_ONE_Group on 17 Apr 2008 at 15:38 GMT

Referee 5's review:

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N.B. These are the comments made by the referee when reviewing an earlier version of this paper. Prior to publication the manuscript has been revised in light of these comments and to address other editorial requirements.
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The is a straightforwrd analysis of the clinical-neuroimaging features in patients with cryptococcal meningoencephalitis in the post-HAART era. The type of abnormalities found on the brain images, the much greater sensitivity of the MRI over CT scan in detecting the lesions, and the correlation of the brain abnormalities to the higher burden of the fungal antigen in the serum and to a lesser extent in the CSF have been clearly documented and reinforce prior experience of prior knowledge. The detection of parenchymal abnormalities by MRI in the brain in the absence of clinical signs was noted but not surprising. However it is not clear if this finding should lead to more and prolonged treatment is unproven. I do not see much new ground in this paper but still a a good and finely studied reconfirmation of the value of neuroimaging in this context. It provides a solid contribution to the literature re the variety of neuroimaging appearances of cryptococcal meningoencephalitis. Editorially i recommend the expression "neurological abnormalities" to "abnormal neurology" as neurology is the study of neurology. I would have liked to see more clearly how the neuro-imaging of the brain correlated with neurological severity and outcomes.

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