Primary peritonitis caused by Raoultella ornithinolytica in a 53‐year‐old man

Abstract

Introduction: Raoultella ornithinolytica is a Gram-negative bacillus. This bacillus was until recently often confused with Klebsiella spp. It is known primarily for causing histamine fish poisoning or scombroid syndrome, and rarely causes human infections. This case report discusses a patient who presented with generalized primary peritonitis due to R. ornithinolytica.Case presentation: A 53-year-old Scandinavian man resident in Botswana, sub-Saharan Africa, presented to the emergency department shortly after onset of lower abdominal pain and dysuria. He was treated for urinary tract infection and discharged. He came back after 16 h with more severe, generalized abdominal pain and a fever of 38 6C. Abdominal sonography was unremarkable. Examination confirmed peritonitis, particularly marked in the right iliac fossa. He had mild leukocytosis 13.1610 9 l 21 , a C-reactive protein level of 372.7 mg l 21 and his serum albumin level was 31 g l 21 . He was admitted for parenteral antibiotics, laparoscopic peritoneal lavage and appendectomy. He had 500 ml of free pus in the abdomen with no evident focal source. A pus swab grew R. ornithinolytica. The pathology showed mild early acute appendicitis with severe periappendicitis and suppurative peritonitis. He was discharged home after 7 days of parenteral antibiotics.Conclusion: R. ornithinolytica infections are rare in humans, but they can be life-threatening.

Emerging role of Raoultella ornithinolytica in human infections: a series of cases and review of the literature

“…This series of human infections caused by R. ornithinolytica managed at four university hospital centres in France over the last 12 years is the largest reported to date. A literature search identified 86 reported cases of R. ornithinolytica (formerly Klebsiella ornithinolytica), [3][4][5][6][7][8][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and half of these cases were reported in 2015. 10,12,[24][25][26] A high rate of hospital-acquired infection was observed in the present study (49%), which may be explained by the high proportion of patients who had undergone invasive procedures (48%) involving, for example, urinary catheters, mechanical ventilation, and port catheters.…”

“…21 Among the 86 isolates reported in the literature, 80% were resistant to amoxicillin, 17% to amoxicillin-clavulanic acid, 10% to third-generation cephalosporins, 12% to quinolones, 13% to co-trimoxazole, 15% to piperacillin-tazobactam, 7% to aminosides, and 7% to carbapenems. [3][4][5][6][7][8][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Few of these studies reported cases of R. ornithinolytica infection with isolates resistant to multiple antibiotics, including KPC 14 and NDM-1 strains. 27 In this study, the proportions of isolates resistant to ceftriaxone, quinolones, and aminosides were a little bit lower than reported in the literature (4%, 6%, and 1%, respectively).…”

“…Among the 69 reported cases, the mortality rate of human infections caused by R. ornithinolytica was relatively high (20%). [3][4][5][6]8,[14][15][16][17][18][19][20][22][23][24][25][26] This rate was particularly high in cases of bacteraemia (34-44%). 4,8,14,22,23,25,28 In the study cases, the mortality rate was lower (9%) and included three patients (3%) who died of cancer and six patients (6%) who died of septic shock related to pneumonia (three cases), pleural effusion (one case), skin infection (one case), and cholangitis (one case).…”

“…Many cases of biliary tract infection, urinary infection, and bacteraemia caused by R. ornithinolytica have been reported. [3][4][5][6][7][8] However, the clinical features, antimicrobial susceptibility, and clinical outcomes of R. ornithinolytica infection have not yet been well elucidated.…”

Raoultella ornithinolytica Isolation in Cloacal Microbiota of Tinamus solitarius: Preliminary Data

“…R. ornithinolytica is known as one of the bacteria in charge for scombroid poisoning, a toxic condition due to the ingestion of fish with high levels of histamine (Masashi et al, 2002); however, in the last decade it was considered as an emerging pathogen in humans (Seng et al, 2016) involved in urinary tract infection (García-Lozano et al, 2013;Nakasone et al, 2015), septicemia (Kaya et al, 2014;Sueifan et al, 2016), bacteremia (Mau & Ross, 2010;Hadano et al, 2012;Haruki et al, 2014;Sekowska et al, 2015), peritonitis (Sibanda, 2014), enteric fever (Morais et al, 2009), biliary infection (Cleveland et al, 2014;de Jong et al, 2014), infected "diabetic foot" (Solak et al, 2011;Kabbara & Zgheib, 2015) and artritis (Venus et al,2016). However, cases of infection were always related to some factor of primary malignancy or immune deficiency (Chun et al, 2015;Boattini et al, 2016).…”