Shewanella putrefaciens: a rare cause of purulent otorrhea !
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Shewanella putrefaciens is a Gram-negative, non-fermenting, motile and oxidase-positive bacillus. Its incrimination in human pathology is very rare with a resurgence of Shewanella infections in recent years.We report the first case in Morocco of a purulent otorrhea caused by Shewanella putrefaciens, rebel to conventional treatment occurring in a 25-year-old female, afebrile, without deterioration of the general state and with a notion of sea bathing. We also describe the bacteriological characteristics and antibiotic susceptibility results of the isolate.
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Thank you for your submission, i'm happy with the authors responses to the reviewers comments and have changed my decision appropriately to to Accept.
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Please consider the reviewers comments below and address them where possible. Please note, Reviewer 1, comment 6. Access Microbiology is is a sound science platform and as a result novelty is not an essential criteria. We invite and encourage submissions including reproduction studies and those that report, challange or support existing literature. I would suggest including the references highlighted as supporting evidence. Both reviewers encourage an expansion/enrichment of the discussion section. This would be useful at least including the additional references and material the reviewers have suggested. Please feel free to contact me for further information where necessary. Best wishes, John.
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Comments to Author
In this work by Benaissa et al., a case of othorrea caused by Shewanella putrefaciens is reported. The report is concise and addresses an infection case by a relatively rare pathogen, yet for which there is a growing number of reported cases in the literature of recent years. The case itself is not particularly remarkable besides the fact that it is reportedly a first finding in the country and that it occurred as a monomicrobial infection in a young and healthy individual. Minor language and spelling mistakes, including, but not exclusively, the use of capital letters and italics, are common throughout the text. The manuscript would benefit from a revision in this sense. Specific comments: L. 18, 37, 42, 99: "female" instead of "girl". L. 60: "S. algae" instead of "S. alga". L. 80: There is a …
Comments to Author
In this work by Benaissa et al., a case of othorrea caused by Shewanella putrefaciens is reported. The report is concise and addresses an infection case by a relatively rare pathogen, yet for which there is a growing number of reported cases in the literature of recent years. The case itself is not particularly remarkable besides the fact that it is reportedly a first finding in the country and that it occurred as a monomicrobial infection in a young and healthy individual. Minor language and spelling mistakes, including, but not exclusively, the use of capital letters and italics, are common throughout the text. The manuscript would benefit from a revision in this sense. Specific comments: L. 18, 37, 42, 99: "female" instead of "girl". L. 60: "S. algae" instead of "S. alga". L. 80: There is a mistake here. Shewanella putrefaciens is not responsible for 80% of the infections by Shewanella spp. - Shewanella algae is. L. 83: The authors refer to molecular analyses based on 16S rRNA and gyrB sequencing. In this sense, it would be worth bringing up that other Shewanella species besides S. algae and S. putrefaciens have been found to be pathogenic to humans. For example, molecular analyses with these genes/gene loci have identified pathogenic Shewanella chilikensis (PMID: 30339183), Shewanella carasii (PMID: 29205124) or Shewanella xiamenensis (PMID: 21546561). L. 85: The authors propose polymyxin susceptibility as an affordable test to discriminate between S. putrefaciens and S. algae. However, this would not be very economical. These two species are already easily distinguishable by other phenotypical properties such as the ability of S. algae to grow at 42 C and high NaCl concentration (e.g. 6%) in contrast to the inability of S. putrefaciens. L. 89-92: The authors briefly discuss the case series presented by Vignier et al. (2013) and Yousfi et al. (2016). It would be good to discuss comparable cases to the one presented herein, such as the series of ear infections occurred in Denmark in the 1990s (PMID: 11864129) or a case series reported in the Canary Islands, which is geographically close to Morocco (PMID: 29623211). L. 111: The authors refer that there are no specific treatment guidelines for Shewanella infections and that this contributes to the emergence of antibiotic resistance; however, they also argue a few lines above that the resistance and susceptibility patterns of Shewanella spp. are known (L. 103-106). This could be elaborated further. In general, the discussion could be enriched a bit more.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
1. What is the season in which the described case occurred in? Is this in alignment with the usual climate as stated in existing literature? 2. What is the time frame between the exposure to seawater to the development of symptoms? 3. Any documentation on the history of "chronic otitis media" - could it be a recurrence of the same species in the same patient? 4. Co-infection has been commonly described in infections due to Shewanella species. Were any other organisms isolated besides Shewanella putrefaciens? 5. Shewanella infections can be severe when they involve other organ systems (e.g. skin and soft tissue infections, hepatobiliary infections, bactereaemia) and patients may have underlying medical co-morbidities. In cases with ear infections, severe infections are rare and most of them occur …
Comments to Author
1. What is the season in which the described case occurred in? Is this in alignment with the usual climate as stated in existing literature? 2. What is the time frame between the exposure to seawater to the development of symptoms? 3. Any documentation on the history of "chronic otitis media" - could it be a recurrence of the same species in the same patient? 4. Co-infection has been commonly described in infections due to Shewanella species. Were any other organisms isolated besides Shewanella putrefaciens? 5. Shewanella infections can be severe when they involve other organ systems (e.g. skin and soft tissue infections, hepatobiliary infections, bactereaemia) and patients may have underlying medical co-morbidities. In cases with ear infections, severe infections are rare and most of them occur in young and immunocompetent patients, according to a large case series on Shewanella ear infections. (Reference: Holt HM, Søgaard P, Gahrn-Hansen B. Ear infections with Shewanella alga: a bacteriologic, clinical and epidemiologic study of 67 cases. Clin Microbiol Infect. (1997) 3:329-33. doi: 10.1111/j.1469-0691.1997.tb00622.x) Please consider rephrasing your lines 100-102, as Shewanella ear infections are already known to occur in immunocompetent subjects. 6. There are already a number of case reports and case series on Shewanella ear infections in existing literature. What is the innovation of your case report among the existing case reports and case series? Reference: Holt HM, Søgaard P, Gahrn-Hansen B. Ear infections with Shewanella alga: a bacteriologic, clinical and epidemiologic study of 67 cases. Clin Microbiol Infect. (1997) 3:329-33. doi: 10.1111/j.1469-0691.1997.tb00622.x Holt HM, Gahrn-Hansen B, Bruun B. Shewanella algae and shewanella putrefaciens: clinical and microbiological characteristics. Clin Microbiol Infect. (2005) 11:347-52. doi: 10.1111/j.1469-0691.2005.01108.x 7. Consider including the references of existing case series and case reports of Shewanella ear infections and compare your case report with these references. 8. You have mentioned in line 111 that a lack of treatment guidelines contributes to emergence of antibiotic resistance. You then stated in the conclusion that the increasing incidence of Shewanella infections requires us to consider empirical coverage of Shewanella infections with marine exposure. What is your recommendation of antibiotic choice to empirically cover for Shewanella infections without contributing to antibiotic resistance?
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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