Successful Management of Anaerobic Meningitis Caused by Propionibacterium acnes: A Case Report
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Meningitis due to Propionibacterium acnes is very rare in the absence of neurosurgical intervention. This article reports the treatment and prognosis of a case of meningitis caused by Propionibacterium acnes. Pathogenic bacteria can be detected by mNGS, and the application of appropriate antibacterial treatment can obtain a good prognosis.
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Comments to Author
1. Description of the case: The case report provides a clear and detailed description of a rare instance of anaerobic meningitis caused by Propionibacterium acnes in a 23-year-old male patient. The clinical presentation, diagnostic process, and therapeutic interventions are thoroughly documented. The use of cerebrospinal fluid (CSF) analysis and metagenomic sequencing (mNGS) for pathogen identification is well-explained, highlighting the clinical course and management strategies effectively. 2. Presentation of results: The results are presented clearly, demonstrating the identification of Propionibacterium acnes using mNGS and the subsequent successful treatment. The report includes relevant clinical data, such as vital signs, CSF analysis results, and imaging studies, which support the diagnosis …
Comments to Author
1. Description of the case: The case report provides a clear and detailed description of a rare instance of anaerobic meningitis caused by Propionibacterium acnes in a 23-year-old male patient. The clinical presentation, diagnostic process, and therapeutic interventions are thoroughly documented. The use of cerebrospinal fluid (CSF) analysis and metagenomic sequencing (mNGS) for pathogen identification is well-explained, highlighting the clinical course and management strategies effectively. 2. Presentation of results: The results are presented clearly, demonstrating the identification of Propionibacterium acnes using mNGS and the subsequent successful treatment. The report includes relevant clinical data, such as vital signs, CSF analysis results, and imaging studies, which support the diagnosis and treatment decisions. The outcome of the case, with the patient's recovery following appropriate antibacterial therapy, is also well-documented. 3. How the style and organization of the paper communicate and represent key findings: The paper is well-organized and follows a logical structure, making it easy to follow the progression from case presentation to diagnosis and treatment. The key findings are clearly communicated, with each section building on the previous one to provide a comprehensive understanding of the case. The use of headings and subheadings helps in navigating through the different aspects of the report. 4. Literature analysis or discussion: The discussion section effectively places the case within the context of existing literature. It highlights the rarity of anaerobic meningitis caused by Propionibacterium acnes and the diagnostic challenges associated with it. The authors discuss the advantages of mNGS over traditional culture methods in identifying anaerobic pathogens, supporting their findings with relevant literature. The potential limitations of the study, such as the specificity of mNGS and the single-case nature of the report, are acknowledged. 5. Any other relevant comments: The case report provides valuable insights into the diagnosis and management of a rare type of meningitis. It emphasizes the importance of advanced diagnostic techniques like mNGS in detecting uncommon pathogens. The successful outcome of the case demonstrates the efficacy of targeted antibacterial therapy based on precise pathogen identification. The report could benefit from a brief summary of the patient's follow-up to provide a complete picture of the long-term outcomes. Here are specific lines, headings, or content needing clarification or revision from a reviewer's perspective. Abstract: Line 15: "Pathogenic bacteria can be detected by mNGS, and the application of appropriate antibacterial treatment can obtain a good prognosis." Suggestion: Clarify the exact role of mNGS (metagenomic next-generation sequencing) and how it aids in the detection of pathogens. Introduction: Line 24: "Meningitis attributed to Propionibacterium acnes in the absence of prior neurosurgical interventions is exceedingly rare." Suggestion: Include a citation to support the rarity of such cases. Line 27: "Conventional cerebrospinal fluid (CSF) bacterial culture methods often prove insufficient for detecting bacterial pathogens in non-neurosurgical patients." Suggestion: Provide more context or data on the insufficiency of conventional methods and mention the sensitivity and specificity of these methods compared to mNGS. Case Report: Line 33-34: "Three hours prior to admission, the patient experienced convulsive seizures characterized by limb stiffness, frothing at the mouth, vomiting with gastric contents, loss of consciousness, head tilt to one side, tongue biting, and incontinence." Suggestion: The details of the seizure could be summarized more concisely to maintain focus on key clinical features. Line 42: "A lumbar puncture was performed on the day of admission, revealing a slight elevation in the total number of cerebrospinal fluid cells and glucose levels." Suggestion: Include the exact values or ranges for a more precise clinical picture. Line 44-45: "Pre-antibiotic blood culture results indicated the presence of Clostridium necrosis, as depicted in Figure 1." Suggestion: Clarify the relationship between Clostridium necrosis and the Propionibacterium acnes findings later, or explain if this is a misidentification. Results Table (Table 1): Line 67-69: Ensure that all the laboratory results and cerebrospinal fluid examination values are clearly labeled and that units are consistent and properly formatted for easier understanding. Figure 1: Line 71: "Blood cultures are positive for Clostridium necrosis (10×10)" Suggestion: Verify and clarify the depiction in Figure 1, ensuring it aligns with the text narrative. Discussion: Line 75: "Given the inconsistency between the cerebrospinal fluid examination and the patient's clinical manifestations compared to other common forms of meningitis..." Suggestion: Detail specific inconsistencies and how they led to the suspicion of anaerobic bacterial involvement. Line 79: "The diagnosis of meningitis caused by Propionibacterium acnes was considered based on the pathogen species sequences returned by metagenomic sequencing (mNGS) and positive blood cultures for anaerobic bacteria." Suggestion: Explain the diagnostic criteria more thoroughly, including how mNGS sequences align with Propionibacterium acnes. Line 91: "...it possesses limitations, including poor specificity and inability to distinguish active pathogens from background bacteria." Suggestion: Provide a reference for this limitation and suggest ways to mitigate this issue. Conclusion: Line 101-102: "This case underscores the importance of early diagnosis and tailored antibiotic management in such cases." Suggestion: Reinforce the clinical relevance and possible implications for practice and future research.ease include comments to the Editor here. Comments here will be kept confidential and will not be posted publicly.NLY put comments for the Author(s) in here
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
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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Thank you for submitting your paper to Access Microbiology. It has now been reviewed and I would like you to revise the paper in line with the reviewers' reports and any Editorial Office requirements below. The reviewer reports can be found at the bottom of the email.
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Comments to Author
Please ONLY put comments for the Author(s) in here The case report is well written .(Line 46)Blood culture grew Clostridium necrosis- is the species name correct ? The CSF findings in the case report are in favour of aseptic meningitis which can also be seen in some cases of anaerobic meningitis. Since the patient does not have any co morbidities and you have 2 bacteria in the (Line 55 ) in the metagenomic sequencing ,how can you rule out whether it could have been a collected commensal from the skin. A repeat CSF tap with anaerobic bacterial culture or sequencing would have helped in confirming the diagnosis. Did CSF Gram stain reveal presence of any bacteria?
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are …
Comments to Author
Please ONLY put comments for the Author(s) in here The case report is well written .(Line 46)Blood culture grew Clostridium necrosis- is the species name correct ? The CSF findings in the case report are in favour of aseptic meningitis which can also be seen in some cases of anaerobic meningitis. Since the patient does not have any co morbidities and you have 2 bacteria in the (Line 55 ) in the metagenomic sequencing ,how can you rule out whether it could have been a collected commensal from the skin. A repeat CSF tap with anaerobic bacterial culture or sequencing would have helped in confirming the diagnosis. Did CSF Gram stain reveal presence of any bacteria?
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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