Erratum: Prevalence and predictors of psychological distress among Chinese male adults: A cross-sectional study in a large general population - CORRIGENDUM.

Bacillus anthracis, a Gram-positive spore-forming bacterium, causes anthrax, with anthrax meningoencephalitis representing one of the most lethal complications (). This severe neurological infection occurs in fewer than 5% of all anthrax cases but carries a mortality rate of 80%–100% due to rapid toxin-mediated blood-brain barrier disruption, hemorrhagic inflammation, and subsequent neurological deterioration (). The pathogen’s toxins induce endothelial cell apoptosis and inflammatory responses, facilitating bacterial invasion of the central nervous system (). Geographically, anthrax is endemic in livestock-rearing regions, but sporadic cases occur in low-prevalence areas where diagnostic delays are common (). Traditional identification methods face significant challenges: B. anthracis shares morphological and genetic similarities with Bacillus cereus complex species, and culture-based diagnostics require 48–72 hours for results, often leading to misdiagnosis in unfamiliar laboratories (). Genomic studies have documented that certain B. cereus-group lineages can harbor anthrax toxin genes or anthrax-like virulence determinants, and routine phenotypic or limited molecular assays may misclassify such isolates unless plasmid and virulence gene content are specifically examined (; ). In this context, metagenomic next-generation sequencing (mNGS) has emerged as a transformative tool. Systematic reviews show that mNGS applied to cerebrospinal fluid (CSF) increases the breadth of detectable pathogens compared with culture and targeted PCR, with moderate-to-high pooled sensitivity and high specificity; importantly, mNGS often identifies pathogens missed by culture, especially in patients pretreated with antibiotics (; ). While penicillin G remains the first-line treatment for anthrax, combination therapy is recommended for severe cases, and outcomes depend critically on early intervention (). The objective of this report is to demonstrate how rapid mNGS-based diagnosis can guide effective combination therapy for anthrax meningoencephalitis, a condition associated with nearly universal fatality in prior literature. We present a case from a low-incidence region where mNGS enabled timely diagnosis and successful management.