Isolated Neisseria meningitidis-associated endophthalmitis in an immunocompetent host: case report and literature review
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Introduction Neisseria meningitidis is a Gram-negative diplococcus with significant infectious sequelae including meningitis and disseminated meningococcal bloodstream infection. Rarely has it been reported in the context of endophthalmitis without central nervous system involvement. We report a clinical case of isolated meningococcal endophthalmitis in an immunocompetent patient and present a literature review on published cases including treatment regimens and clinical outcomes. Case Presentation A 51-year-old male with no significant medical history presented to the emergency department with acute vision loss in the right eye after returning from Mexico. Ophthalmic examination was consistent with endophthalmitis, presumed to be endogenous in the absence of recent ocular trauma or surgery. Vitreous culture was positive for growth of gram-negative diplococci, subsequently identified as Neisseria meningitidis. Blood and cerebrospinal fluid cultures were negative for growth of similar or implicative pathogens. There was no evidence of disseminated meningococcal infection; imaging did not demonstrate any drainable collections or sequelae of extension into the central nervous system. The patient was treated with intravitreal antibiotics as well as topical steroids and antibiotics. In addition, he completed a two-week course of systemic antibiotics. Visual outcome was unfortunately poor. Conclusion This case illustrates a rare case of isolated endophthalmitis secondary to meningococcus, presumably from nasopharyngeal source. In these clinical scenarios, clinicians should perform a thorough evaluation for predisposing immunodeficiencies.
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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
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Comments to Author
In this case report the Authors found a Neisseria meningitidis-associated endophthalmitis case in an immunocompetent adults and reviewed the literature. The paper is interesting in the specific field, but some concerns arose need to be addressed. 1. Line 99, "topical antibiotics (moxifloxacin four times per day)". Please, indicates the treatment duration of topical moxifloxacin. 2. Lines 156-158. "twice-daily ceftriaxone was adjusted to once-daily dosing to complete the 7 day treatment course.". Please, clarify the duration time of treatment, only 1 week? The international guidelines, recommend treatment with intramuscular injections of ceftriaxone, in addition to topical moxifloxacin eye drops for 2 weeks. Please, clarify this point of concern. 3. Line 123. Gram positive cocci were seen with Gram …
Comments to Author
In this case report the Authors found a Neisseria meningitidis-associated endophthalmitis case in an immunocompetent adults and reviewed the literature. The paper is interesting in the specific field, but some concerns arose need to be addressed. 1. Line 99, "topical antibiotics (moxifloxacin four times per day)". Please, indicates the treatment duration of topical moxifloxacin. 2. Lines 156-158. "twice-daily ceftriaxone was adjusted to once-daily dosing to complete the 7 day treatment course.". Please, clarify the duration time of treatment, only 1 week? The international guidelines, recommend treatment with intramuscular injections of ceftriaxone, in addition to topical moxifloxacin eye drops for 2 weeks. Please, clarify this point of concern. 3. Line 123. Gram positive cocci were seen with Gram stain, but not growth was observed. Please, provide an explanation on this discordant results and the approach used. This could be due to failure in the de-coloration step of the Gram stain procedure, difficult-to growth bacterial species, etc… 4. "The isolate was subsequently confirmed by NML to be N meningitidis serogroup Y". This is an interesting finding. N. meningitidis causing another type of ocular infection, primary meningococcal conjunctivitis, have been reported to belong to serogroup B, although the majority of meningococci causing PMC from adults have been found to be of serogroup A. This point need to be included in the discussion to indicate likely dofferences in the epidemiology of N. meningitides strains (add refs 1. Barquet N, Gasser I, Domingo P, Moraga FA, Macaya A, Elcuaz R. Primary meningococcal conjunctivitis: report of 21 patients and review. Rev Infect Dis. 1990;12(5):838-47. 2. Gherardi G, Surico PL, Coassin M, Di Zazzo A, D'Arezzo S, Angeletti S, Fontana C, Petrosillo N. Meningococcal Conjunctivitis in a 54-Year-Old Man: Case Report and Review of the Literature. Chemotherapy. 2023;68(4):228-232.) 5. Even though there is currently no consensus on the management of ocular infections caused by N. meningitidis and their close contacts, please, indicate if and how the contacts were managed. If not, please clarify the reason of no prophylaxis of contacts. 6. Provide information on the written informed consent obtained from the patient for publication of this case report and on the study protocol reviewed and approved by the Ethical Committee. 7. The English language needs to be improved.
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?
No: it is necessary to provide information on the written informed consent obtained from the patient for publication of this case report and on the study protocol reviewed and approved by the Ethical Committee
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Comments to Author
On overall, the manuscript entitled: ''Isolated Neisseria meningitidis-associated endophthalmitis in an immunocompetent host: case report and literature review'' by Calvin Ka-Fung Lo et al., is well presented and well-written and of interest. Some clarifications are needed: Regarding the patients' history and liver and kidney dysfunction on admission: How where explained the elevated liver and kidney parameters by the authors. Was C-reactive protein elevated? Were stool cultures or stool microscopy reported? Although CSF culture proved negative, but lumbar puncture was performed post-administration of empiric antibiotics, was another means of bacterial load-bacterial DNA detection performed (i.e. Polymerase chain reaction)?
Please rate the quality of the presentation and structure of the …
Comments to Author
On overall, the manuscript entitled: ''Isolated Neisseria meningitidis-associated endophthalmitis in an immunocompetent host: case report and literature review'' by Calvin Ka-Fung Lo et al., is well presented and well-written and of interest. Some clarifications are needed: Regarding the patients' history and liver and kidney dysfunction on admission: How where explained the elevated liver and kidney parameters by the authors. Was C-reactive protein elevated? Were stool cultures or stool microscopy reported? Although CSF culture proved negative, but lumbar puncture was performed post-administration of empiric antibiotics, was another means of bacterial load-bacterial DNA detection performed (i.e. Polymerase chain reaction)?
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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