A case of severe pancreatitis complicated by Raoultella planticola infection

Abstract

A 45-year-old-male presented with severe pancreatitis. Two bacterial isolates obtained from peritoneal fluid and abdominal purulent secretion were identified to the species level by 15 biochemical tests and four supplementary tests as Raoultella planticola. Identification was confirmed by rpoB gene sequencing. R. planticola is difficult to identify in the clinical laboratory, and the clinical significance of this isolation remains uncharacterized. This is the first report of pancreatitis with a primary infection by R. planticola. IntroductionRaoultella planticola was first described as Klebsiella planticola in 1981 (Bagley et al., 1981) and as Klebsiella trevisanii in 1983 (Ferragut et al., 1983). In 1986, the two organisms were placed in the same species because of their extensive DNA sequence similarity (Gavini et al., 1986). In 2001, based on 16S rRNA gene and rpoB sequence analysis, the new genus Raoultella was created, and the name R. planticola was proposed to accommodate K. planticola (Drancourt et al., 2001).R. planticola was initially seen as an aquatic, botanic and soil bacterium. However, in 1984, a human infection caused by this organism was reported: a patient with sepsis, admitted to an intensive care unit in France (Freney et al., 1984). Two other cases were later described: a bloodstream infection after a mitral valve replacement for infective endocarditis and a bacteraemic pneumonia after coronary artery graft surgery (Freney et al., 1986). No other case reports or case series of infections caused by R. planticola have been published, and the clinical spectrum of diseases caused by this organism is unknown. The correct identification of Raoultella is not easily accomplished in most clinical microbiology laboratories, and isolates can be easily misidentified as Klebsiella pneumoniae or Klebsiella oxytoca (Monnet & Freney, 1994). In the present report, we describe a patient with pancreatitis with a primary infection by R. planticola. Case reportOn 2 September 2003, a 45-year-old male patient was admitted to a small (80 beds) public general hospital in Juiz de Fora, Minas Gerais state, Brazil, with abdominal pain, diarrhoea and a 30-year history of alcoholism. After 10 days of treatment for a suspect pneumonia and no invasive procedures, abdominal symptoms persisted and the patient was transferred to Hospital Universitário of Universidade Federal de Juiz de Fora on 12 September 2003. On admission, he had abdominal pain, vomiting, diarrhoea and fever. Chest X-ray and an abdominal CT scan revealed a small left pleural effusion and two abdominal fluid collections. Ciprofloxacin and metronidazole were started. On September 16, the patient underwent an exploratory laparotomy. Pancreatitis with a retroperitoneal abscess was diagnosed, with inflammation of pancreatic body and tail. A Gram-negative bacterial isolate was obtained as pure culture from the peritoneal fluid collected before surgery (isolate K111) and from abdominal pyogenic secretion obtained during surgery (isolate K112). Other clinical spec...

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