Although Neisseria macacae has been recognized as a commensal of macaque oral flora since 1983, its involvement in human disease remains remarkably uncommon. Prior literature documented fewer than a handful of infections, ranging from reddish rash, bacteremia to invasive conditions such as endocarditis and peritonitis. Strikingly, the respiratory system has not been reported as a site of infection. We first reported a case of pneumonia due to N. macacae. A 60-year-old male developed pneumonia during treatment for a cervical spine fracture complicated by spinal cord injury. N. macacae was isolated from sputum culture and identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA gene sequence analysis. The strain exhibited non-susceptible to third-generation cephalosporins but susceptible to carbapenems. Meropenem was administered, leading to a favorable response and significant improvement after one week, resulting in recovery and discharge 14 days later. No recurrence was observed during a follow-up visit one month post-discharge. This case represents the first documented report of N. macacae–associated pneumonia, expanding the known clinical spectrum of this macaque commensal into the human respiratory tract under conditions of impaired clearance. This finding highlights the necessity of enhanced clinical–laboratory collaboration. Furthermore, the strain’s atypical antimicrobial resistance profile underscores the critical importance of comprehensive susceptibility testing to guide targeted therapy and inform empirical treatment strategies in similar clinical scenarios.
Xia et al. (Sat,) studied this question.
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