A case report of disseminated Streptococcus pneumoniae infection complicated by infective endocarditis, septic arthritis and epidural abscess in an immunocompetent patient
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Streptococcus pneumoniae is a highly virulent, vaccine-preventable pathogen which can cause disease on a spectrum from benign to fatal. Apart from pneumonia, it commonly causes septicaemia and meningitis. This case report describes an unusual range of complications in a 53-year-old Caucasian female presenting to a regional hospital, without any risk known factors for severe disease (such as extremes of age, immunodeficiency or co-morbidities). Progressing from an episode of otitis media, her condition rapidly progressed to mastoid sinusitis, septic arthritis, infective endocarditis, epidural abscesses and multiple subcutaneous abscesses. Following quick identification of S. pneumoniae from a positive blood culture, the patient was treated with high-dose benzylpenicillin and ceftriaxone and aggressive source control by surgery, enabling a good clinical recovery.
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The work presented is clear and the arguments well formed. Thank you for your swift resubmission. With the changes made, I'm happy to recommend accepting the manuscript. Thank you for your efforts and please do consider Access Microbiology in the future. Best wishes, John.
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The work presented is clear and the arguments well formed. Thank you for your submission, Please address the reviewers comments, which are fairly minimal as the manuscript is currently at a good quallity. Best wishes, John.
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Comments to Author
Authors present infection of a 53 year old female patient, immunocompetent, with a disseminated pneumococcal disease. Part of the novalty is the uncommon site of infection. Patient made a full recovery following diagnosis and treatment. While part of childhood immunisation schedule, cases present in young and old and non immunised groups in Australia, this being an uncommon case. Authors present observations, patient test results and provide a thorough discussion placing the patients case in context. The manuscript is in a good state, with minor edits and recommendations below. Line 37: Include patients actual age Line 46: gram positive to Gram-postive, generally, Gram is a noun so check throughout Line 86 for exsmplr. Line 85: period after "S" in S. pneumoniae also line 104, check throughout
Comments to Author
Authors present infection of a 53 year old female patient, immunocompetent, with a disseminated pneumococcal disease. Part of the novalty is the uncommon site of infection. Patient made a full recovery following diagnosis and treatment. While part of childhood immunisation schedule, cases present in young and old and non immunised groups in Australia, this being an uncommon case. Authors present observations, patient test results and provide a thorough discussion placing the patients case in context. The manuscript is in a good state, with minor edits and recommendations below. Line 37: Include patients actual age Line 46: gram positive to Gram-postive, generally, Gram is a noun so check throughout Line 86 for exsmplr. Line 85: period after "S" in S. pneumoniae also line 104, check throughout Line 89: remove bracket at end of sentence Line 90: comma positioning move to after MIC General comment and line 90: Check units for measurements and their formatting. Please be consistant with spacing and useage. e.g 0.25 ug not 0.25u g and later 2g instead of 2 g. Lines 121 and lines 127 for example. I would include a brief summary of risk factors in the introduction. While in the discussion, it would be valuable to understand why the patients case is relatively unique earlier. Figure legends: in generally i would encourage expanding these as general rule of thumb, figures should be interpretable in isolation away from the manuscript but appreicate much of the information is self evident.
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
A Case Report of disseminated Streptococcus pneumoniae infection complicated by infective endocarditis, septic arthritis and epidural abscess in an immunocompetent patient In this manuscript the authors presented a case report of a 53-year-old female patient that presented with the bacterium Streptococcus pneumoniae which led to severe disease including mastoid sinusitis, septic arthritis and infective endocarditis abscesses despite displaying no risk factors. 1. Description of the case Line 37: As this is the first time introducing the patients background, I suggest stating their age instead of 'middle-aged'. If staying with the use of middle-aged, remove comma between middle and aged. 2. Presentation of the results Figures clearly represent the findings of the case, no comments. 3. How the …
Comments to Author
A Case Report of disseminated Streptococcus pneumoniae infection complicated by infective endocarditis, septic arthritis and epidural abscess in an immunocompetent patient In this manuscript the authors presented a case report of a 53-year-old female patient that presented with the bacterium Streptococcus pneumoniae which led to severe disease including mastoid sinusitis, septic arthritis and infective endocarditis abscesses despite displaying no risk factors. 1. Description of the case Line 37: As this is the first time introducing the patients background, I suggest stating their age instead of 'middle-aged'. If staying with the use of middle-aged, remove comma between middle and aged. 2. Presentation of the results Figures clearly represent the findings of the case, no comments. 3. How the style and organisation communicates and represents key findings Line 78 and 79: Isolating into a separate paragraph is unhelpful for flow of reading Line 118 and 119: Isolating into a separate paragraph is unhelpful for flow of reading 4. Literature analysis or discussion Line 168: Line states that 232 cases was higher than previous two years, but it is stated there were 251 cases in 2021 Line 171: Typo in the word 'no' Line 204: Remove 'from' between pneumococci and directly Line 210: Typo in the word 'and' Line 248: Remove space between 'there' and 'for' Line 262: Shorten to S. pneumoniae as full name already used within the text 5. Any other relevant comments Throughout text patient is referred to as 'she', suggest replacing to 'the patient' Would be helpful to name the risk factors of IPD earlier in the text, these are not outlined until line 227, yet it is mentioned several times before then that the patient does not meet the common risk factors.
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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