Mycobacterium interjectum causing submandibular lymphadenitis in a child
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Nontuberculous mycobacteria (NTM) commonly manifest as cervical lymphadenitis in immunocompetent children. Only a few species, such as Mycobacterium avium complex (MAC), cause infection in children. With recent advances in gene sequencing, Mycobacterium interjectum has been identified as a rare cause of adenitis in children, with at least ten cases reported since 1993. Curative treatment for NTM lymphadenitis, particularly when caused by MAC, usually involves complete surgical excision of the affected lymph nodes. This case report highlights successful treatment of submandibular lymphadenitis caused by M. interjectum in a paediatric patient, despite multi-drug resistance in vitro .
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This is a study that would be of interest to the field and community. The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
1. Description of the case(s) This case report ACMI-D-22-00216 by Sallie Lina et al, entitled "Antibiotic Susceptibilities for Mycobacterium interjectum" highlighted the successful treatment of submandibular lymphadenitis caused by M. interjectum in a pediatric patient, despite multi-drug resistance in vitro. The authors addressed an interesting case within the scope of the ACMI journal, with minor corrections. The title of this case report is not fully aligned with what the case report is highlighting, as the highlight of this report is a successful treatment of submandibular lymphadenitis caused by M. interjectum in a pediatric patient, despite multi-drug resistance in vitro and therefore should be revisited and updated. 2. Presentation of results Results in this case report are well presented, …
Comments to Author
1. Description of the case(s) This case report ACMI-D-22-00216 by Sallie Lina et al, entitled "Antibiotic Susceptibilities for Mycobacterium interjectum" highlighted the successful treatment of submandibular lymphadenitis caused by M. interjectum in a pediatric patient, despite multi-drug resistance in vitro. The authors addressed an interesting case within the scope of the ACMI journal, with minor corrections. The title of this case report is not fully aligned with what the case report is highlighting, as the highlight of this report is a successful treatment of submandibular lymphadenitis caused by M. interjectum in a pediatric patient, despite multi-drug resistance in vitro and therefore should be revisited and updated. 2. Presentation of results Results in this case report are well presented, with a few recommendations: Line 48: Bordetella henselae "serologies", this should be "serology tests" were… Line 55: Labwork was obtained- shouldn't it be laboratory work? Also was there a need to repeat the Bordetella henselae "serologies" statement? Authors should avoid repition. Line 69: Cultures do not grow acid fast bacilli but rather colonies, acid fast bacilli are confirmed under the microscope, also, authors need to specify in which media did they cultured the I & D. Line 70: Authors need to specify how the M. interjectum was identified in this report. 3. How the style and organization of the paper communicates and represents key findings The style and organization of the paper communicates and represents key findings in this case report 4. Literature analysis or discussion Line 39: ….mycobacterium "species." Line 82: What do authors mean in Mycobacterium interjectum is named for the phylogenetic position….? Line 85: What are the contaminated objects that the authors are talking about here? 5. Any other relevant comments None
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly 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
The authors present a case report on a 22-month-old female that presented to the hospital for persistent right submandibular swelling for 3 weeks with no significant past medical history. Failure of amoxicillin-clavulanate and trimethoprim-sulfamethoxazole courses led to clinical differentials that identified the Mycobacterium interjectum infection that presented as cervical lymphadenitis. Nontuberculous mycobacteria (NTM) commonly manifest as cervical lymphadenitis in immunocompetent children. Mycobacterium interjectum infections have been identified recently and only a handful of cases have been documented. This case report highlights the successful treatment of submandibular lymphadenitis caused by M. interjectum in a pediatric patient, despite multi-drug resistance in vitro. Major comments: 1. …
Comments to Author
The authors present a case report on a 22-month-old female that presented to the hospital for persistent right submandibular swelling for 3 weeks with no significant past medical history. Failure of amoxicillin-clavulanate and trimethoprim-sulfamethoxazole courses led to clinical differentials that identified the Mycobacterium interjectum infection that presented as cervical lymphadenitis. Nontuberculous mycobacteria (NTM) commonly manifest as cervical lymphadenitis in immunocompetent children. Mycobacterium interjectum infections have been identified recently and only a handful of cases have been documented. This case report highlights the successful treatment of submandibular lymphadenitis caused by M. interjectum in a pediatric patient, despite multi-drug resistance in vitro. Major comments: 1. While the information on this disease is limited, it might be good to include a bit more introductory information that is available in the literature and sources the authors stated. What is the known natural history of the disease? Is this a true pathogen or an opportunistic pathogen? Where is M. interjectum naturally found? Does it have a known reservoir? What is the prevalence of NTM infections in the pediatric population in the US? Etc. 2. For the at least ten cases reported, what countries or regions were the other reported cases from? This might be helpful to further study the etiology of the disease. 3. M. interjectum also has presented as other systemic infections, e.g. bacteremia, hepatic and pulmonary involvement associated with a long-term catheter infection in adults (Case Rep Infect Dis. 2017;2017:6958204. doi: 10.1155/2017/6958204.) It might be beneficial to state other clinical presentations of M. interjectum that are reported. 4. Authors that M. interjectum is positioned between rapidly and slow-growing mycobacteria with a detection or growth time of 3 to 4 weeks. Is this accurate? M. tuberculosis has a growth time of 4 to 6 weeks and is a slow-growing mycobacterium. M. avian has a growth time of 2 to 3 weeks and still is a slower or intermediate-growing mycobacterium. Please verify this statement on growth time and how it compares to other pathogenic mycobacteria. 5. Table 1 Why were only two other studies compared? 12 previous reports were mentioned. The authors do mention that only a few cases report the susceptibilities. But two seems too little. It would be more informative to include some other case reports and reported data or susceptibilities in Table 1. 6. Line 90 states: "Advancements in sequencing, particularly 16S rRNA, have made accurate identification of M. interjectum possible". How was M. interjectum detected in this case study? If it was through sequencing this information also may be useful for readers of this manuscript. This could help clinicians also. 7. No figures or images were provided. To enhance this case report, I would suggest including an image of the gross pathology of the surgically excised lymph nodes, if available, and a histopathological image of these lymph nodes. Minor comments: 1. Line 33: "Mycobacterium interjectum, a newer species of mycobacteria". Might not be clear as it could mean a recently created/mutated species. It might be more appropriate to state this as "Mycobacterium interjectum, a recently identified species of mycobacteria. 2. Several states thought the manuscript seemed repetitive. This may not be needed. Example 1: Line 106 "Current recommendation for treatment involves complete surgical resection. Consistent with this recommendation, curative treatment was achieved in this case with complete surgical excision of affected lymph nodes." Example 2: cervical lymphadenitis in Lines 32 and 34. 3. Lines 27 to 33 are all from the same reference. It may be okay to include the reference for all these sentences at the end of the last sentence. 4. The conclusion is repetitive with information mentioned in the discussion. Please review these two sections and perhaps make the conclusion concise to include a summary statement and a recommendation to clinicians.
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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