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Raoultella planticola was previously considered an environmental organism in soil, water, and plants. However, several cases of human infection have recently been reported in association with R. planticola, some of which have been life-threatening. Most cases were in adults with reduced immunity, with few cases in children. To our knowledge, there have only been two reported cases of urinary tract infection (UTI) caused by R. planticola in children, including one case of cystitis. Here, we present the first case of UTI caused by R. planticola with congenital anomalies of kidney and urinary tract (CAKUT) in a 4-month-old male infant. The patient presented to the emergency department with fever and was diagnosed with UTI.We started third-generation cephalosporins empirically for gram-negative bacteria in the urine, presuming infection with Escherichia coli. On day 1, the patient's fever resolved immediately. On day 2, urine culture was positive for a rare pathogen, R. planticola, and we narrowed antibiotics to first-generation cephalosporins.The patient's fever did not return and he was discharged on day 7. The patient was seen in the clinic 1 week after discharge, with complete resolution of symptoms. Magnetic resonance urography and dynamic renal scintigraphy performed 2 months after discharge revealed severe bilateral hydronephroureter and obstruction of urine flow in the right kidney. As of 6 months after UTI onset, we have continued low-dose cephalexin (10 mg/kg) to prevent the recurrence of UTI and there has been no recurrence. As in this case, children with UTI caused by R. planticola may be associated with CAKUT; therefore, we should actively screen to detect CAKUT. Patients with CAKUT are at high risk of UTI recurrence, so long-term use of unnecessary broad-spectrum antibiotics should be avoided to prevent antimicrobial resistance. However, R. planticola infection is sometimes life-threatening. Hence, it is also important to use sufficiently strong antibiotics for an appropriate period. Although the optimal management of R. planticola infection in children has not been clearly established, we suggest that we can treat UTI caused by R. planticola mainly using first-generation cephalosporins.

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Fig. 1 Photographs of the patient. (a) Onset of left facial nerve palsy. (b-d) Six months after onset of facial nerve palsy. (b) Although the paralysis resolved, the left eyelid closed involuntarily when she opened her mouth, such as when (c) eating or (d) brushing her teeth.

The group A rotavirus (RVA) G3P[9] is a rare genotype isolated in humans and cats. We isolated only one G3P[9] strain RVA/Human-wt/JPN/R11-035/2014/G3P[9] among 487 stool samples in our rotavirus surveillance of children with gastroenteritis in Japan, during 2014–2015. The R11-035 strain was isolated from a 2 year old girl presenting with vomiting and diarrhea who had daily contact with cats. She had type A histo-blood group antigen, which is reported to be related to rare human P[9] rotavirus infection. Full genome sequencing revealed that the R11-035 strain had AU-1-like constellations, except for the NSP3 (T) gene, G3-P[9]-I3-R3-C3-M3-A3-N3-T1-E3-H6. Phylogenetic analysis of all genome segments, except for the NSP3 gene, showed that the R11-035 strain formed distinct clusters and had high nucleotide sequence identity with human/feline-like strains. We postulate that the R11-035 strain was directly transmitted from a cat to the patient. Interestingly, the NSP3 gene of R11-035 was found to cluster closely with Taiwanese porcine strains. Since the remaining genes of R11-035 were closely related to those of human/feline-like human strains, it is likely that R11-035 acquired its NSP3 gene through intergenotype reassortment events with porcine strains before being transmitted to humans. The CAU14-1-262 strain, isolated from a 2 year old girl in South Korea in 2014, is the only reported strain having the same genome constellations as R11-035. These two strains had extremely high nucleotide sequence identity in all 11 gene segments (99.3–99.9%). It is therefore likely that strains with these genome sequences are circulating in East Asia.