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American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

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Raoultella Planticola in a Soft Tissue Infection! An Emerging Pathogen

Luqman Salahudeen*, Paulisa Ward, Rekha Kumari, Efemena Diejomaoh, Vel Sivapalan, Simona Bratu

Division of Infectious Disease Department of Medicine, Harlem Hospital Center in Affiliation with Columbia University College of Physicians and Surgeons, New York, United States

Abstract: Raoultella planticola is a gram-negative aerobic bacillus commonly found in water, plant and soil. Few cases have been reported of this organism affecting humans. We present the case of 68-year-old woman with a five-day history of inability to move right hand. Physical examination revealed an erythematous fluctuant swelling which was incised and drained. Drainage specimen was cultured and grew Raoultella planticola susceptible to augmented penicillin’s. Patient achieved significant clinical improvement following treatment with ampicillin-sublactam. Clinicians should be aware of this emerging pathogen as a cause of soft tissue infection in humans.

Keywords: Raoultella planticola, gram-negative, soft tissue, infection, humans

Citation: Luqman Salahudeen, Paulisa Ward, Rekha Kumari, Efemena Diejomaoh, Vel Sivapalan, Simona Bratu, Raoultella Planticola in a Soft Tissue Infection! An Emerging Pathogen. American Journal of Medical Case Reports, 5 (7). 179-180. January 2017. doi:10.12691/ajmcr-5-7-3

1. Introduction

Raoultella planticola is a gram-negative, aerobic bacillus belonging to the Enterobacteriaceae family. It is commonly found in water, soil, plant and has been implicated in histamine fish poisoning associated with consumption of scombroid fish due to its ability to decarboxylate histidine to histamine [1,2]. Raoultella planticola was previously called Klebsiella planticola and Klebsiella trevisanii until 2001 when the new genus was created based on 16S rRNA and rpoB genetic sequences and named after Didier Raoult [3]. Due to its close relation to Klebsiella species, it can be misidentified as Klebsiella pneumonia or Klebsiella oxytoca [4]. Raoultella planticola is a rare cause of human infections, but in recent times it has been isolated in the hospital environment in patients with a history of cancer, immune-suppression and recent exposure to traumatic or invasive medical procedures [9,10]. The organism’s definitive pathogenic mechanism is still largely unknown.

2. Case Presentation

We present the case of a 68-year-old woman with no comorbidities who presented to our institution with a five-day history of pain, swelling and inability to move right hand. There was no history of abrasion or trauma to the hand. Vital signs were within normal limits. Physical examination revealed erythematous fluctuant local swelling in right hypothenar eminence with no obvious skin breakdown. Laboratory tests was remarkable except for peripheral white blood cell count (WBC) count of 5,500/cmm³.

Incision and drainage performed yielded copious amount of brownish purulent fluid which was sent for gram stain and culture. Identification done with VITEK 2 automated system revealed Raoultella planticola susceptible to augmented penicillin’s, cephalosporins, carbapenems, monobactams, aminoglycosides and fluoroquinolones. Patient achieved significant clinical improvement at fourth day of hospitalization following treatment with ampicillin-sublactam.

3. Discussion

Raoultella planticola is a gram-negative aerobic bacteria predominantly found in the environment and was previously identified as a specie of genus Klebsiella. Pathogenicity of this organism is similar as Klebsiella species and is determined by production of adhesins, siderophores, hemagglutinins, capsular polysaccharides, cell surface lipopolysaccharides, type 1 fimbriae and toxins. Additional virulence factors include histamine, bacteriocin and colonization factor antigens (CFA/I and CFA/III) [11]. The literature is growing on number of cases reported on Raoultella planticola affecting humans. Since 1984, thirty-four cases have been reported, four of which are soft tissue infection in humans [4,5,6,7,8]. To our knowledge, this is the fifth case of Raoultella planticola causing soft tissue infection.

In this unique case of soft tissue infection, the patient was healthy without history of trauma or overt skin breakdown. The proposed mechanism of infection is possible skin micro-abrasion followed by contamination with this common environmental organism. Infection with Raoultella planticola is on the rise [9] and it is imperative for clinicians to be aware of the emergence of this pathogen in humans.

References

[1]   | Bagley S.T, Seider R.J, Brenner D.J. Klebsiella planticola sp.: A new species of Enterobacteriaceae found primarily in nonclinical environments. Curr Microbiol, vol6 (1981) pp 105-109.
[2]   | Kanki M, Yoda T, Tsukamoto T et al. Klebsiella pneumoniae produces no histamine: Raoultella planticola and Raoultella ornithinolytica strains are histamine producers. Appl Environ Microbiol. 2002:68(7):3462-3466.
[3]   | Gavini F, Izard D, Grimont P et.al. Priority of Klebsiella planticola Bagley, Seidler and Brenner 1982 over Klebsiella trevisanii, Ferragut, Izard, Gavini, Kesters, De Ley and Lecterc 1983. Int Jour of Systemic Bact, July 1986, p 486-488 vol 36 No 3.
[4]   | Castanheira M, Deshpande LM, Di Persio JR, Kang J, Weinstein MP, Jones RN. First descriptions of blaKPC in Raoultella spp. (R. planticola and R. ornithinolytica): report from the SENTRY Antimicrobial Surveillance Program. J Clin Microbiol 2009; 47(December (12)):4129-30.
[5]   | Kim SH, Roh KH, Yoon YK, Kang DO, Lee DW, Kim MJ, et al. Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola. BMC Infect Dis 2012;17(March (12)):59.
[6]   | Wolcott R, Dowd S. Molecular diagnosis of Raoultella planticola infection of a surgical site. J Wound Care 2010.19 (August (8):329-32.
[7]   | Skelton W, Taylor Z, Hsu J. A rare case of Raoultella planticola urinary tract infection in an immunocompromised patient with multiple myeloma. ID Cases 8 (2017) 9-11.
[8]   | O’Connel K, Kelly J, NiRiain. A rare case of soft tissue infection caused by Raoultella planticola. Case reports in Medicine Vol 2010 (2010):134086.
[9]   | Boattini M, Almeida A, Cardosa C, et al. Infections on the rise: Raoultella spp, clinical and microbiological findings from a retrospective study, 2010-2014. Scand Journal of Infec Dis vol 48, 2016 – Issue 1.
[10]   | Yoon. J H, Ahn YH, Chun JI et.al. Acute Raoultella planticola cystitis in a child with rhabdomyosarcoma of the bladder neck. Pediatr Int 2015:57 (5), 985-987.
[11]   | Podschun R, Fischer A, Ullman U. Expression of putative virulence factors by clinical isolates of Klebsiella planticola. J. Med Microbiol 2000:49, 115-119.