Purulent pleurisy caused by Salmonella enterica subspecies arizonae: A case report
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Background : Salmonellosis most commonly presents clinically as typhoid fever or gastroenteritis. Pleuropulmonary infections due to Salmonella are still rare even though they have often been described in immunocompromised patients. Case presentation: We report a rare case of a purulent pleurisy caused by Salmonella enterica ssp. arizonae, occuring in a 50-year-old female with breast cancer who is currently treated with chemotherapy and radiotherapy along with chronic renal failure requiring hemodialysis, who presented with acute chest pain, dyspnea and hemodynamic instability. After bacteriological identification of Salmonella enterica ssp. arizonae in pleural fluid, antibiotic susceptibility testing was performed. The patient was then started on a broad-spectrum antibiotic which improved her condition successfully. Conclusion : Our case highlights the implication of Salmonella enterica ssp. arizonae in a purulent pleurisy in an immunocompromised patient. An early diagnosis and a proper antibiotic therapy enabled us to reduce the morbidity and mortality risk in our patient.
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I appreciate that the authors have revised their manuscript in line with the reviewer comments, and I think this has resulted in an improved case report. While providing the numerical value of the API20 is acceptable, I would encourage the authors to also include the image captured in the original submission as a visual representation of the data. The authors have not included a Gram stain as requested by reviewers, and have only described their antimicrobial testing, rather than providing the data in the manuscript. The concentrations of antimicrobials will be required for acceptance and I encourage the authors to include a Gram stain image of their sample.
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The reviewers were supportive of your manuscript, but also highlighted major concerns with the presentation of the report and the conclusions drawn from your case and data. Pleas address these concerns in full. I look forward to receiving your revised manuscript.
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Comments to Author
Corrections: L-57: passive atelectasis. L-61: Gram-negative bacilli. L-84: It would be better if a reference is given. For example: Majowicz, S. E., et al. 2010 or Van Meervenne, E., et al. (2020). L-87: It would be better if a reference is given. For example: Majowicz, S. E., et al. 2010 or Van Meervenne, E., et al. (2020). L-115: agar and interpreted according to the 2024 EUCAST recommendations. Relevant literatüre (2024 EUCAST) should be added to the references. L-224: This reference (Majowicz, S. E., et al. 2010) should be removed. Same as reference 1.
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 …
Comments to Author
Corrections: L-57: passive atelectasis. L-61: Gram-negative bacilli. L-84: It would be better if a reference is given. For example: Majowicz, S. E., et al. 2010 or Van Meervenne, E., et al. (2020). L-87: It would be better if a reference is given. For example: Majowicz, S. E., et al. 2010 or Van Meervenne, E., et al. (2020). L-115: agar and interpreted according to the 2024 EUCAST recommendations. Relevant literatüre (2024 EUCAST) should be added to the references. L-224: This reference (Majowicz, S. E., et al. 2010) should be removed. Same as reference 1.
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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Comments to Author
This case report is very rare and interesting to find out. But the relevant explanation of how this Salmonella choleraesuis ssp. arizonae causes purulent pleuresy could not be found anywhere. Abstracts could be in short form with a brief description. Introduction: There is no citation in the text and no details about Salmonella choleraesuis ssp. arizonae pathogenecity. There should be written the objectives for the study. According to the guidelines of access microbiology, the case presentation should contain a description of the patient's relevant demographic information (without adding any details that could lead to the identification of the patient). According to the guidelines of access microbiology, please organize your Results section with sufficient subheadings to allow readers to gain a clear …
Comments to Author
This case report is very rare and interesting to find out. But the relevant explanation of how this Salmonella choleraesuis ssp. arizonae causes purulent pleuresy could not be found anywhere. Abstracts could be in short form with a brief description. Introduction: There is no citation in the text and no details about Salmonella choleraesuis ssp. arizonae pathogenecity. There should be written the objectives for the study. According to the guidelines of access microbiology, the case presentation should contain a description of the patient's relevant demographic information (without adding any details that could lead to the identification of the patient). According to the guidelines of access microbiology, please organize your Results section with sufficient subheadings to allow readers to gain a clear understanding of the work. This section should include the outcomes of the experiments, any interpretation of the results, and indicate the key questions being addressed. Discussion: The details written here may be suitable for the introduction part. Here should be compared briefly the results with previous findings without revisiting results in full with proper citation in text. Conclusion: Not supported by the case report properly. Author contributions: authorship and contributions should be using the CRediT taxonomy. References: The reference style is Harvard; please rewrite them as Vancouver style as required by the guidelines of access microbiology.
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Not at all
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 authors describe a case of pleurisy caused by Salmonella sp. This is a relatively rare clinical problem and thus the case is interesting. However, the paper needs improving. Taking care of the points given below will considerably improve the value of the paper: - first of all the authors have to use the current nomenclature/taxonomy for Salmonella. Salmonella choleraesuis is no longer a valid name. There are two species of Salmonella, S. enterica and S. bongori. Salmonella enterica has six subspecies. The isolate described here almost certainly belongs to S. enterica subsp. enterica. Authors can look this up anywhere, even on Wikipedia, which gives accurate information. - then, to make the bacteriological investigation complete, the strain has to be serotyped. The authors can send the strain to …
Comments to Author
The authors describe a case of pleurisy caused by Salmonella sp. This is a relatively rare clinical problem and thus the case is interesting. However, the paper needs improving. Taking care of the points given below will considerably improve the value of the paper: - first of all the authors have to use the current nomenclature/taxonomy for Salmonella. Salmonella choleraesuis is no longer a valid name. There are two species of Salmonella, S. enterica and S. bongori. Salmonella enterica has six subspecies. The isolate described here almost certainly belongs to S. enterica subsp. enterica. Authors can look this up anywhere, even on Wikipedia, which gives accurate information. - then, to make the bacteriological investigation complete, the strain has to be serotyped. The authors can send the strain to any reference laboratory; the Institut Pasteur, Paris is the international reference lab (hopefully the authors have kept the strain alive). There are over 2000 serotypes of S. enterica subsp. enterica. - the microbiological results should be better described: no need to give a photo of the API 20E gallery, giving the numeric code 2704552 is entirely sufficient. Gram stain of the blood culture broth should show regular (not polymorphic) Gram -ve rods. - the clinical details should be described in a more focused way: was the pleurisy preexisting (e.g. because of the cancer) and could hematogenous spread of Salmonella have infected it (bacterial gastroenteritis is often accompanied by Salmonella bacteremia). Clinical history of a febrile gastroenteritis preceding the pleural infection would suggest such a course - or could authors think of other ways for Enterobacteriaceae reaching the pleura (most salmonellae are not more virulent than E. coli, except for some serotypes like S. Typhi or S. Paratyphi A) - the authors should make a literature review of pleurisy caused by Salmonella - there are not that many cases reported so far. Have a look on PubMed. - the references are poorly organized: 7 is a duplicate of 1. The reviewer was unable to retrieve Reference 2 - there must be a mistake Please accept my apologies: I was unable to use italics for species names. Please notice that serovar names (e.g. Enteritidis) are not in italics and with a capital first letter
Please rate the quality of the presentation and structure of the manuscript
Poor
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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