The Hospital for Tropical Diseases

The statement that HIV co-infection is common (8 cases) and bacterial co-infection uncommon (7 cases) in this patient population seems not very objective. Please reconsider this statement. We have changed this to “Co-infection with HIV was relatively common but, compared to studies in children, bacteraemia was uncommon” Besides CAM and MSA another internationally established scoring tool (Lambarene-Organ Dysfunction Score; Helbok et al. J Infect Dis.) has been proposed and the manuscript would greatly benefit from inclusion of this score in the analysis. Both the CAM and MSA scoring systems were derived for use in adults, whereas the Lambarene Organ Dysfunction Score was specifically written to assess severity among children in an endemic area. We therefore chose to validate the CAM and MSA scores but do not think it appropriate to use a scoring system designed for children amongst an adult population. The clinical presentation of patients is very well described and highly informative.