{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:03:41Z","timestamp":1784621021243,"version":"3.55.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>We report a rare survival case of anthrax meningoencephalitis in a 56-year-old male from a low-incidence region. The patient presented with nasal discharge, fever, headache, and rapid onset of coma following the slaughter of a diseased cow. Physical examination revealed a characteristic ulcerative eschar on the right index finger, while laboratory investigations showed significant leukocytosis and hemorrhagic cerebrospinal fluid (CSF) characterized by elevated protein and decreased glucose levels. Although initial microscopy misidentified the pathogen as Bacillus cereus, metagenomic next\u2212generation sequencing (mNGS) of the CSF confirmed Bacillus anthracis within 48 hours. This rapid molecular diagnosis enabled a timely switch to a CDC\u2212recommended combination regimen, initially with quadruple therapy (penicillin G, ciprofloxacin, amikacin, and linezolid) followed by optimization to triple therapy (penicillin G, levofloxacin, and linezolid) during the ICU stay, ultimately leading to the patient\u2019s full neurological recovery. This case underscores that the synergistic use of rapid mNGS\u2212based diagnosis and appropriate combination therapy is critical for achieving survival in anthrax meningoencephalitis.<\/jats:p>","DOI":"10.3389\/fcimb.2026.1792720","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:26:18Z","timestamp":1784618778000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["First reported survival of anthrax meningoencephalitis in a low-incidence region: successful management with mNGS-guided combination therapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Qiushuo","family":"Geng","sequence":"first","affiliation":[{"name":"School of Medical Device, Shenyang Pharmaceutical University","place":["Benxi, China"]},{"name":"School of Biomedical Engineering, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, People\u2019s Hospital of Liaoning Province","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihao","family":"Fan","sequence":"additional","affiliation":[{"name":"School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, People\u2019s Hospital of Liaoning Province","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Zhao","sequence":"additional","affiliation":[{"name":"School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7206a1","article-title":"CDC guidelines for the prevention and treatment of anthrax 2023","volume":"72","author":"Bower","year":"2023","journal-title":"Mmwr Recommendations Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1093\/cid\/ciae093","article-title":"Central nervous system antimicrobial exposure and proposed dosing for anthrax meningitis","volume":"78","author":"Bradley","year":"2024","journal-title":"Clin. 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