Fannyhessea vaginae causing bacteraemia and vertebral osteomyelitis: first report of invasive disease in a male
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Introduction. Fannyhessea vaginae (formerly Atopobium vaginae ) is an anaerobic organism commonly associated with female genital flora, with rare cases of invasive disease reported in females.
Case report. We discuss the case of an 81-year-old male who presented with an acute history of back pain and signs of urinary tract infection in the context of intermittent self-urinary catheterisation. Multiple blood cultures grew Fannyhessea vaginae with a later finding of lumbar vertebral osteomyelitis as the cause of back pain. Treatment was commenced with ampicillin, later switched to ceftriaxone, with improvement of acute signs of infection.
Conclusion. Gram-positive anaerobic organisms including Fannyhessea vaginae are possibly under-recognised causes of urinary tract particularly in older males. These bacteria may prove challenging to grow in standard protocols for urine culture; anaerobic or extended incubation could be considered particularly in complicated cases of urinary tract infection without an identifiable pathogen.
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The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community.
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This is a study that would be of interest to the field and community. The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
Major Comments: this case report is interesting, informative and presents infection by a rare pathogen F vaginae, hitherto not previously described as occurring in a male (here, an elderly man with significant underlying health issues.) Line 74-75: The authors may consider reviewing the term anaplastic astrocytoma, as some on-line literature suggests that this was renamed 'grade 3 astrocytoma' in 2021. As possible key word search targets, both terms should possibly be included, such as with "grade 3 astrocytoma (anaplastic astrocytoma)" Minor Comments: -the authors provide a nice history of different infections attributed to A. vaginae / F. vaginae. They may consider reviewing then citing a relatively new paper : Liu P, Wang L, Li R and Chen X (2023) A rare bacteremia caused by Fannyhessea …
Comments to Author
Major Comments: this case report is interesting, informative and presents infection by a rare pathogen F vaginae, hitherto not previously described as occurring in a male (here, an elderly man with significant underlying health issues.) Line 74-75: The authors may consider reviewing the term anaplastic astrocytoma, as some on-line literature suggests that this was renamed 'grade 3 astrocytoma' in 2021. As possible key word search targets, both terms should possibly be included, such as with "grade 3 astrocytoma (anaplastic astrocytoma)" Minor Comments: -the authors provide a nice history of different infections attributed to A. vaginae / F. vaginae. They may consider reviewing then citing a relatively new paper : Liu P, Wang L, Li R and Chen X (2023) A rare bacteremia caused by Fannyhessea vaginae in a pregnant woman: case report and literature review. Front.Cell.Infect.Microbiol.13:1278921.doi:10.3389/fcimb.2023.1278921 The discussion of this manuscript could possibly be slightly shortened if prior cases involving F. vaginae currently cited here were otherwise all mentioned in this review. None of those involved a male patient. - line 98-99. The List of Prokaryote Names with Standing in Nomenclature (LPSN www.bacterio.net) was reviewed; Fannyhessea is indeed assigned to the family Atopobiaceae but appears to be in the order Coriobacteriales, Class Coriobacteriia. This should be corrected.
Please rate the quality of the presentation and structure of the manuscript
Very 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 topic of the manuscript is of potential diagnostic and therapeutic interest since anaerobic cocci can cause urinary tract and other infections in both women and men and require specific isolation, identification, susceptibility testing and treatment. One of the main concerns in the present study is that Mueller-Hinton blood agar is not the medium recommended for susceptibility testing of anaerobes. As a whole, the methods were not well described if at all. Other corrections and additions are also needed as mentioned below. 1. In the Abstract (line 21) and the text (line 98) the authors correctly stated that Fannyhessea vaginae (formerly Atopobium vaginae) is an anaerobic microorganism. However, they should correct the error made in the Introduction (line 38) stating that F. vaginae is "a …
Comments to Author
The topic of the manuscript is of potential diagnostic and therapeutic interest since anaerobic cocci can cause urinary tract and other infections in both women and men and require specific isolation, identification, susceptibility testing and treatment. One of the main concerns in the present study is that Mueller-Hinton blood agar is not the medium recommended for susceptibility testing of anaerobes. As a whole, the methods were not well described if at all. Other corrections and additions are also needed as mentioned below. 1. In the Abstract (line 21) and the text (line 98) the authors correctly stated that Fannyhessea vaginae (formerly Atopobium vaginae) is an anaerobic microorganism. However, they should correct the error made in the Introduction (line 38) stating that F. vaginae is "a facultative anaerobic Gram-positive coccus". Case presentation 2. Line 49: what did the authors mean by "six standard drinks daily"? 3. Line 56: The authors should mention the name, provider and type (aerobic or anaerobic) of the blood cultures. 4. Line 57: The condition of incubation should be described in detail (atmosphere, apparatus, providers, temperature etc.) 5. Line 57: The authors stated: "confidently identified by MALDI Biotyper" What was the score? 6. Lines 59-60: The authors stated: "Susceptibility testing was performed by E-test® (bioMerieux, USA) on Mueller-Hinton blood agar in anaerobic conditions". Importantly, Mueller-Hinton blood agar is not the medium recommended for susceptibility testing of anaerobes. This should also be stated as a drawback (limitation) of the case report. However, I can recommend the authors to repeat the susceptibility testing using a medium appropriate for anaerobes. Discussion 7. Line 98: the names of the bacterial families should also be in italics. 8. Line 99: "Coriobacteria" should be written in italics as well. However, the correct name of the order is Coriobacteriales. 9. Line 129-130: The authors stated: "We hypothesised that our patient probably acquired Fannyhessea from sexual intercourse". Was sexual activity of the patient stated in the anamnesis? 10. Lines 139-142: The authors stated: "In our laboratory, the primary culture plate is incubated for up to 48 hours in aerobic conditions, and if there is significant pyuria without growth after this interval, repeat incubation should occur in both CO2-enriched and anaerobic conditions for 48 hours." It is not an appropriate algorithm to isolate anaerobic bacteria. The culture plates appropriate for anaerobes and anaerobic incubation in parallel with the aerobic one should have been performed. 11. The limitations of the study should be stated.
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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