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Clinical Infection & Immunity

Case Report

Volume 1, Number 2, December 2016, pages 50-51

Bacteremia Caused by Raoultella planticola: A Case Report

Raoultella planticola is an encapsulated, gram-negative, aerobic, non-motile bacillus commonly found in water, soil and plants [1, 2]. This organism is typically non-pathogenic in the human host. The first reported human infection with this organism was a patient with sepsis in 1984 [3]. Since that time, there have been less than 50 documented of R. planticola worldwide.

Generally, these organisms are associated with undercooked seafood consumption, biliary tract disease, immunodeficiency states, trauma and nosocomial infection [4, 5]. R. planticola bacteremia risk factors include recent chemotherapy and underlying malignancy, especially gastrointestinal malignancies. In those individuals who do develop sepsis from bacteremia, the mortality rate is 10-20%.

R. planticola is an emerging human pathogenic microorganism. The isolation of this bacterium from a wound, blood or urine should prompt further investigation for an occult gastrointestinal malignancy.

A 68-year-old Caucasian female presented to our rural hospital emergency department with a 1-day history of shaking chills and abdominal cramping. These symptoms began 3 - 4 h after eating undercooked blue crab that was caught locally. On initial evaluation, the patient was tachycardic (heart rate 140 bpm), febrile (oral temperature 103.2 °F), normotensive (BP 146/75) and mildly diaphoretic. She also complained of the new onset of a mild non-productive cough.

Initial laboratory values were a WBC count of 11,600/μL with 91 % neutrophils, and no bandemia was present. Lactic acid was 2.2 mmol/L, alkaline phosphatase was 183 IU/L, SGOT/AST was 136 IU/L, SGPT/ALT was 194 IU/L, and total bilirubin was 0.5 mg/dL. Hepatitis A IgM, hepatitis B surface antigen, hepatitis B core IgM and hepatitis C antibody were all non-reactive. Within 24 h, two sets of blood cultures revealed R. planticola.

At the time of admission, this patient was placed on Levaquin 750 mg IV q24h and Merrem 1 g IV q6h. Urine culture was negative. Blood cultures and sensitivity report showed uniform sensitivity to quinolones and cephalosporins with ampicillin resistance. The patient’s hospital course was unremarkable. She improved clinically rapidly. She was discharged home after 48 h on Levaquin 750 mg PO daily for 7 days.

Outpatient follow-up showed persistently elevated liver enzymes. Further evaluation led to the discovery of a T2N0 invasive adenocarcinoma of the duodenum. This was successfully resected and the patient has been symptom free for over 1 year.

The incidence of infections caused by Raoultella spp. has increased over the past 30 years. R. planticola infections are associated with the consumption of raw or undercooked contaminated seafood, biliary tract disease especially gastrointestinal malignancies, trauma in a contaminated environment, immunodeficiency states and nosocomial infections. Mortality rates in bacteremic patients can be significant [2, 6, 7].

It is important for the clinician to recognize the meaning of the isolation of this microorganism. This generally signals an underlying immunodeficiency condition, frequently a gastrointestinal malignancy. Further gastrointestinal evaluation is warranted if this bacterium is isolated.

Normally, R. planticola is a non-pathogenic, gram-negative, non-motile, encapsulated bacterium found in soil, water and aquatic environments. Under certain conditions, this organism can become pathogenic with a significant mortality rate.

Conflicts of Interest

The author declares he has no conflicts of interest.

Consent

Written informed consent for the publication of any materials associated with any individual who may be a participant in this manuscript has been verified.

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