Leclercia adecarboxylata invasive infection in a patient with Hirschsprung disease: A case report

Abstract

Introduction Leclercia adecarboxylata is a ubiquitous aerobic, motile, gram-negative bacilli. The human gastro-intestinal tract is known to harbor this rarely opportunistic microorganism. We describe a rare case of invasive infection with a gastrointestinal starting point due to L. adecarboxylata in a patient with Hirschsprung disease. Case report It is about a newborn female who was admitted on the 3rd day of life to the neonatal intensive care unit for intestinal obstruction. On the 9th day of life, while managing the neonatal obstruction, the patient developed febrile peaks. Cytobacteriological examination of cerebrospinal fluid, blood cultures and culture of umbilical vein catheter allowed the exclusive isolation of Leclercia adecarboxylata . It was producing extended spectrum beta-lactamase and was treated with intravenous imipenem . After favourable evolution, the patient was transferred to the pediatric surgery department. There, she was diagnosed with Hirschsprung disease. Discussion Knowledge of the route of transmission of L. adecarboxylata is limited and the possible source of the infection is unclear. However, the authors describe three hypotheses of contamination of our propositus. In our patient, one or more of these routes of contamination would be possible. Indeed, bacteremia could occur as a result of a bacterial translocation across the mucosal barrier of the colon altered by Hirschsprung disease, antibiotic use and feeding practices. Conclusion Infection with L. adecarboxylata revealed a wide range of infection. It has only recently been acknowledged as an emerging pathogen. Further studies of the pathogenesis and risk factors are required.

First case of VIM-1-producing Leclercia adecarboxylata in Oman: A case report and literature review

“…To date, only ve cases reported in the literature will be used to evaluate the certainty of the previously stated route of transmission. A recent study reported bacteraemia by translocation of L. adecarboxylata into the gastrointestinal tract in a competent patient with Hirschsprung disease [39]. Three other cases reported bacteraemia with no history or current record of undergoing invasive medical interventions [24,[40][41].…”

“…In another study, the frequency of L. adecarboxylata in clinical specimens is estimated to be 0 to 5. However, the absolute frequency of infections caused by L. adecarboxylata is still to be determined, as it has been underreported for many decades since its rst emergence [39].…”

“…L. adecarboxylata resistant species producing ESBL were reported in the literature [39,45,50], which complicates therapeutic decisions leading to the use of broad-spectrum antibiotics such as carbapenems. More terrifying are the cases of Carbapnemase-Producing strains (CPE).…”

Leclercia adecarboxylata infective endocarditis in a man with mitral stenosis: A case report and review of the literature

“…L. adecarboxylata is a rare emerging pathogen and immunosuppression is the most significant risk factor for infection with L. adecarboxylata , which often affects immunodeficient patients, including those with immunomodulators and haematological malignancies or receiving chemotherapy[ 70 ], and is the only isolate cultured from blood, sputum, urine, and peritoneal fluid in immunosuppressed individuals[ 71 - 73 ]. There are currently about three reported cases of immunocompetent patients with monomicrobial L. adecarboxylata infection[ 74 - 76 ]. The remaining cases are all immunosuppressed patients[ 70 ].…”

“…In the fourth reported case, the bacterial translocation could have been the result of mucosal alterations due to invasive interventions to the gastrointestinal tract[ 88 ]. It can therefore be hypothesised that the gastrointestinal pathology causing the alteration of the mucosal barrier leads to a higher risk of this L. adecarboxylata bacteraemia[ 76 ]. Our case presented with clinical signs associated with IE following diarrhoea, and we hypothesize that the intestine may have been the entry point for this L. adecarboxylata infection.…”