Exceptional association of two species of bacteria causing acute appendicitis: Haemophilus influenzae and Enterobacter cloacae
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Appendicitis, typically caused by appendiceal lumen obstruction, is a prevalent abdominal surgical emergency worldwide. While most cases involve Enterobacterales, Haemophilus influenzae , primarily known for upper respiratory infections, is infrequently associated with gastrointestinal infections. This article presents an exceptional case of acute appendicitis caused by both Haemophilus influenza and Enterobacter cloacae in a 15-year-old child, highlighting the significance of recognizing uncommon pathogens in appendicitis and emphasizing the necessity for thorough microbiological investigations to refine diagnostic approaches.
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Comments to Author
Dear authors, The etiopathogenesis of appendicitis is still under debate. It has been hypothesized that luminal obstruction is the main cause of appendicitis. However, obstruction is not found in all patients with appendicitis. There are some studies suggesting that acute appendicitis is a polymicrobial infection. It is difficult to indicate specific bacterial species which are responsible for appendicitis. In this case report, H. influenzae was held accountable for acute appendicitis. However, in aerobic culture, E. cloacae was also grown. Furthermore, anaerobic culture was not performed. Some studies suggest the role of anaerobic bacteria such as Fusobacterium, Bacteroides, Peptostreptococcus and Porphyromonas spp. in the development of acute appendicitis. Some studies used molecular methods …
Comments to Author
Dear authors, The etiopathogenesis of appendicitis is still under debate. It has been hypothesized that luminal obstruction is the main cause of appendicitis. However, obstruction is not found in all patients with appendicitis. There are some studies suggesting that acute appendicitis is a polymicrobial infection. It is difficult to indicate specific bacterial species which are responsible for appendicitis. In this case report, H. influenzae was held accountable for acute appendicitis. However, in aerobic culture, E. cloacae was also grown. Furthermore, anaerobic culture was not performed. Some studies suggest the role of anaerobic bacteria such as Fusobacterium, Bacteroides, Peptostreptococcus and Porphyromonas spp. in the development of acute appendicitis. Some studies used molecular methods (e.g. 16s rRNA sequencing) to identify the microorganisms present in the specimen. In conclusion, the methods used in this study is not enough to accuse only H. influenzae of the development of appendicitis. The presence of H. influenzae in the sample may reflect colonization or infection. Other comments: Lines 27-29: Please re-arrange the sentence; because in the current form Bacteroides, Peptostreptococcus and Pseudomonas may be mistakenly considered as members of Enterobacterales by readers. Line 43: Correct the writing of 'hyperecoic'. Line 53: Write the full information (i.e. brand name, country) about the commercial identification system (API). Line 55: Write 'disk diffusion' instead of 'agar diffusion'. Line 58: Write the names of antibiotics tested for 'antimicrobial susceptibility testing (AST)' of H. influenzae and E. cloacae, individually. Indicate the AST results individually for each species. Also write the medium used and conditions individually for each species during AST.
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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Comments to Author
Interesting case- thanks for sharing. Suspect most labs would not put up a chocolate plate for this type of specimen so we have no idea how common this is. Well written manuscript, methods are satisfactory, all seems fine.
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 …
Comments to Author
Interesting case- thanks for sharing. Suspect most labs would not put up a chocolate plate for this type of specimen so we have no idea how common this is. Well written manuscript, methods are satisfactory, all seems fine.
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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