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Greetings! I hope you are well.

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Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

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

We have released issues of some journals on February 2013.
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American Journal of Infectious Diseases and Microbiology
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American Journal of Biomedical Research
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

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

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

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A Unique of Rhizobium radiobacter Peritoneal Dialysis Catheter-related Peritonitis from a Cat Bite

Benjamin Bluen*, Lukasz Kiljanek, Larry Krevolin, Kyle Krevolin, Hans P. Schlecht

Drexel University College of Medicine, Division of Infectious Disease and HIV Medicine, Hahnemann University Hospital, Philadelphia PA 19102

Abstract: Peritoneal dialysis catheter-related peritonitis is typically related to catheter insertion or hygiene. Organisms usually manifest as gram positive organisms typically Staphylococci or gram negative bacilli that typically colonize aqueous environments such as Pseudomonas spp. as well as other unusual mycobacterial or fungal pathogens. The authors present a unique case of peritoneal dialysis catheter-related peritonitis manifesting after the patient’s cat bit the proximal aspect of the catheter attachment tubing. After failure to clinically improve after outpatient treatment of Staphylococcus hemolyticus and Staphylococcus capitis catheter related-peritonitis with intraperitoneal Vancomycin and empiric Gentamicin, repeat peritoneal cultures were sent that demonstrated growth of Rhizobium radiobacter. The patient was admitted inpatient and treatment was tailored to intraperitoneal Cefepime with clearance of peritoneal cultures and rapid improvement in peritoneal white blood cell count and the patient’s clinical condition. The patient was subsequently discharged on oral Ciprofloxacin with complete recovery and catheter salvage.

Keywords: peritoneal dialysis, Rhizobium radiobacter, peritonitis, intraperitoneal, sensitivity

Citation: Benjamin Bluen, Lukasz Kiljanek, Larry Krevolin, Kyle Krevolin, Hans P. Schlecht, A Unique of Rhizobium radiobacter Peritoneal Dialysis Catheter-related Peritonitis from a Cat Bite. American Journal of Medical Case Reports, 6 (6). 103-105. January 2018. doi:10.12691/ajmcr-6-6-1

1. Introduction

Rhizobium radiobacter, a formerly reclassified from Agrobacterium class by 16s RNA analysis [1], is an aerobic gram-negative, motile, non-spore forming oxidase positive bacillus. Natural habitats for the bacteria exist in plants and soil [2]. Initially regarded as a contaminant, the organism was first determined in 1980 to cause prosthetic aortic valve endocarditis [3]. Previous case series have demonstrated the bacteria to be an opportunistic pathogen in patients with chronic indwelling catheters and hematologic malignancies. To this date, there are no reported cases of transmission of R. radiobacter via cat exposure. Due to the infrequent incidence of R. radiobacter, large clinical trials assessing its impact and treatment options are lacking.

2. Case Presentation

A 38 year-old female with end-stage renal disease on intermittent nocturnal peritoneal dialysis via Tenkhoff catheter for over two years secondary to type-1 diabetes mellitus presented to Hahnemann University Hospital in Philadelphia, Pennsylvania in October 2016 upon her nephrologist’s request due to positive IP cultures. Her symptoms began several days after her cat bit her peritoneal dialysis (PD) connection tubing just distal to the Tenkhoff catheter attachment (see Figure 1). She subsequently developed nausea, vomiting, and abdominal discomfort that lasted 1-2 days. Outpatient dialysis cultures were initially positive for Staphylococcus hemolyticus and Staphylococcus capitis with white blood cell count demonstrating 90 cells/uL and 27% neutrophils. The patient was subsequently treated with three doses of IP Vancomycin and one initial dose of IP Gentamicin over the course of nine days. Two days later, due to persistent fatigue, decreased energy, and decreased appetite, repeat outpatient peritoneal cultures were taken that were positive for gram-negative bacilli. The patient was contacted and referred to the hospital for further evaluation.

After admission, the patient initially underwent treatment with IP vancomycin and gentamicin (Dianeal PD-2 Intraperitoneal dialysis solution with 2L of 1.5% dextrose, 8meQ KCl additive, 4mg gentamicin and 40mg vancomycin) for 3 days and intravenous cefepime dosed at 2g q48 hours for 3 days. IP infusion dwell-time was set to 2.5 hours on a q3 hour basis. Initial inpatient peritoneal fluid analysis indicated WBC count of 274 cells/uL, 49% neutrophils, confirming the diagnosis of peritoneal catheter-related peritonitis. Peritoneal culture repeated while inpatient on 5% sheep’s blood revealed gram-negative bacilli. Speciation by Vitek 2 (BioMérieux, Inc., Durham, NC) demonstrated Rhizobium radiobacter (see Figure 2, Figure 3). Subsequent peritoneal fluid analysis the next day revealed a WBC count of 9 cells/uL with 5% neutrophils with no demonstrated culture growth (see Table 1). Sensitivity analysis confirmed susceptibility to cefepime, ciprofloxacin, and piperacillin-tazobactam (see Table 2) and the patient’s antibiotics were changed via infectious disease consult to IP cefepime 125mg/L (Dianeal PD-2 Intraperitoneal dialysis solution with 2L of 1.5% dextrose, 8meQ KCl additive). The patient’s symptoms gradually improved with this regimen and was discharged on oral ciprofloxacin 500mg daily for a 3 week treatment course with PD catheter retention.

Figure 1. Peritoneal dialysis catheter demonstrating bite site (A). PD attachment site (B) and tubing connector (C) are noted

Figure 2. Colonies of R. radiobacter on blood agar

Table 1. Results of peritoneal fluid and culture

Figure 3. R. radiobacter growth on chocolate agar

Table 2. MIC sensitivities of R. radiobacter isolate

3. Discussion

Rhizobium radiobacter is an infrequent cause of opportunistic infection largely of indwelling catheters and foreign material. The largest case-series involved 13 Taiwanese patients with R. radiobacter infection, of which the majority had chronic indwelling catheters. All isolates were susceptible to cefepime, ciprofloxacin, piperacillin-tazobactam, and carbapenems [4]. Although treatment frequently required foreign device removal [5], recent reports indicate that early and appropriate antibiotic therapy may allow catheter salvage in catheter-related R. radiobacter peritonitis [6]. R. radiobacter isolates should be evaluated in the appropriate clinical context as pseudo-outbreaks have been reported due to nonsterile processing equipment and/or handling of laboratory specimens [7]. As two separate laboratories confirmed R. radiobacter by culture and reactive peritoneal cell counts in our patient, true infection was confirmed.

This case documents the first reported transmission of R. radiobacter via cat exposure. The patient’s cat may have been colonized with R. radiobacter while being near plants and soil at or nearby the patient’s home. Infections transmitted by cat bites tend to be polymicrobial, including Staphylococci, Streptococci, Corynebacterium, Capnocytophagia, Pasteurella, and anaerobic flora [8]. A 1997-2013 literature review by Poliquin et al. found 30 cases of PD catheter-related peritonitis resulting from Pasteurella with cats being the most common source animal. Appropriate treatment and catheter retention was generally obtained with two weeks of amoxicillin-clavulinate or IP cefazolin [9].

The revised 2016 International Society of Peritoneal Dialysis lists pets as a modifiable risk factor for PD catheter-related peritonitis [10]. As zoonotic injuries constitute approximately 1% of emergency department visits and $30 million US dollars yearly, clinicians and patients alike should be aware of potential complications of pet-related interactions with indwelling medical devices [11].

4. Conclusion

Although uncommon, R. radiobacter should be considered in the differential diagnosis of potential pathogens in zoonotic peritoneal catheter-related peritonitis. The importance of patient pet owner education in taking measures to prevent zoonotic infections cannot be overstated.

Acknowledgements

The authors would like to thank the department of nephrology for the dedicated work of the peritoneal dialysis nursing staff. We would also like to acknowledge the contributions of the members of the microbiology laboratory whose efforts to identify pathogens is vital to daily patient care. The authors declare that they did not receive funding for this report.

References

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[2]   | Edmond MB, Riddler SA, Baxter CM, Wicklund BM, Pasculle AW. Agrobacterium radiobacter: A Recently Recognized Opportunistic Pathogen. Clin Infect Dis. (1993) 16 (3): 388-391.
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[9]   | Poliquin PG, Lagace-Wiens P, Verrelli M, Allen DW, Embil JM. Pasteurella species peritoneal dialysis-associated peritonitis: Household pets as a risk factor. Can J Infect Dis Med Microbiol. 2015 Jan-Feb; 26(1): 52-55.
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