Peribacillus simplex and Klebsiella pneumoniae Responsible for Pyonephrosis with Secondary Psoas Abscess: A Case Report

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Abstract

Bacterial urinary tract infections (UTIs) are common, ranging from benign cystitis to complicated pyelonephritis, which can lead to severe complications such as pyonephrosis and sepsis. Pyonephrosis, characterized by the presence of pus in the renal cavities, often requires urgent urological intervention. We report a unique case of pyonephrosis with a psoas abscess caused by Klebsiella pneumoniae (K. pneumoniae) and Peribacillus simplex (P. simplex) in a 64-year-old diabetic female patient. This is the first case of pyonephrosis caused by P. simplex. The patient presented with acute right lumbar pain, fever, and altered consciousness. Imaging revealed severe right hydronephrosis, pyonephrosis, and a perirenal phlegmon infiltrating the psoas with abscesses. Surgical drainage and nephrectomy were performed. Microbiological and proteomic analysis identified K. pneumoniae and P. simplex.This case highlights the importance of considering environmental bacteria like P. simplex in severe infections and ensuring rigorous protocols to avoid contamination. Successful management of pyonephrosis relies on prompt surgical drainage and appropriate antibiotic therapy based on culture results.

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  1. Comments to Author

    Manuscript Number: ACMI-D-24-00186 Title: Peribacillus simplex and Klebsiella pneumoniae Responsible for Pyonephrosis with Secondary Psoas Abscess: A Case Report Dear Editor, I have reviewed mentioned case report with great interest, and I believe it contributes valuable insights into the clinical management and microbiological understanding of pyonephrosis and secondary psoas abscess. 1. *Clinical Relevance*: Your report highlights a rare and clinically important case that broadens our understanding of infections caused by Peribacillus simplex and Klebsiella pneumoniae. This is particularly valuable for clinicians and microbiologists dealing with similar infections. 2. *Microbiological Insight*: The detailed microbiological analysis and the identification of the pathogens provide a robust framework for the case. The inclusion of specific antimicrobial susceptibilities adds practical value for treatment considerations. 3. *Diagnostic Approach*: The diagnostic methods and imaging studies employed in identifying and managing the infection are well presented and demonstrate a thorough clinical approach. *Areas for Improvement:* While the novelty of the article as a case report is valuable, the discussion and conclusion sections are not as robust as the other parts of the paper and need to be revised to include more comprehensive discussion ideas. I suggest the following enhancements: 1. *Discussion*: Expand on the pathophysiological mechanisms by which Peribacillus simplex and Klebsiella pneumoniae lead to pyonephrosis and subsequent psoas abscess. Compare and contrast this case with other reported cases in the literature to highlight unique aspects and commonalities. 2. *Clinical Implications*: Discuss the broader clinical implications of this case for the management of similar infections, including any specific diagnostic or therapeutic challenges encountered. 3. *Conclusion*: Strengthen the conclusion by summarizing the key findings and their significance clearly. Emphasize the lessons learned and potential areas for further research in this field. Overall, this case report offers valuable clinical and microbiological information. However, strengthening the discussion and conclusion sections will significantly enhance the manuscript's impact. Best Regards,

    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

  2. Comments to Author

    The manuscript presents a well-conducted and clearly written study. The quality of the research is commendable, and the clarity of the manuscript enhances the readability and understanding of the findings. However, I have a few suggestions that could further improve the overall presentation of the data. 1. Antibiotic Resistance Profile Figure: It would be highly beneficial to include a figure that visually represents the antibiotic resistance profile of P. simplex and K. pneumoniae to the tested antibiotics. This will aid readers in quickly interpreting the resistance patterns and enhance the visual appeal of the manuscript. 2. Environmental Prevalence of P. simplex: The presence of P. simplex in this case of pyonephrosis raises an important question about the environmental prevalence of this bacterium in the subject's surroundings. Do you have any information on the environmental or geographical distribution of P. simplex that could shed light on its occurrence in this case? Including such information would provide a broader context to the findings. 3. Colonization Pathway of P. simplex: It would be useful to include a brief discussion or a statement on the potential route of exposure or colonization mechanism of P. simplex in the affected area. This would enhance the understanding of how the bacterium could have reached and established itself in the site of infection. These additions would further strengthen the manuscript by providing additional insights into the findings. Overall, the study is well-executed, and I commend the authors for their work.

    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