A gram-negative Buttiauxella gaviniae-like organism (LBV449) was isolated from a urine sample of a patient suffering from urine bladder pathology and neurological problems. The isolate was positive for adonitol fermentation and L-arginine dihydrolase and negative for melibiose and L-ornithine decarboxylase. The API 20E code was 3004113. Retrospectively, another isolate (ENT107), from a leg wound, was recovered from our collections and was shown to have similar biochemical characteristics. DNA-DNA hybridization showed 77% similarity between both strains, and strain LBV449 revealed 74% DNA-DNA similarity to the type strain of B. gaviniae. Neither 16S rRNA gene sequencing nor fatty acid analysis were useful for identification. The characteristic tRNA-PCR patterns obtained for these two clinical isolates consisted of fragments with lengths of 102.2, 105.4, 116.6, and 136.9 bp and most resembled the tRNA-PCR pattern obtained for B. gaviniae, but they lacked the B. gaviniae fragments of 88.2 and 239.5 bp. To our knowledge, no clinical cases with Buttiauxella strains have been described thus far.
CASE REPORTIn April 1998, a 31-year-old man was admitted to our hospital with a bifrontal contraction lesion and a D12-L4 fracture. Due to this trauma and neurological syndrome, he developed epileptic attacks, hyperflexion of the lower limbs, and a neurological urinary syndrome, wherefore a suprapubic catheter was placed. During a recent hospitalization the person suffered again from urinary retention and a urine sample was taken for further investigation. Microscopic examination of the urine sediment yielded 121 leukocytes per l (normal count, less than 25 leukocytes per l, as determined with UF100 [TOA Medical Electronics, Kobe, Japan]) and 10 3 bacteria per l. Direct microscopy and culture indicated gram-negative rods at a concentration of 10 6 CFU/ml. All of these results are indicative of a urinary tract infection in a spinal cord patient.The suprapubic catheter was removed and the patient was treated with ofloxacin (200 mg, twice a day) for 2 weeks. Therapy was successful, and no bacteria and no elevation in number of white blood cells were seen in later samples.
Discussion.Culture of the urine sample on tryptic soy agar with 5% sheep blood (Becton Dickinson, Erembodegem, Belgium) and on MacConkey agar (Becton Dickinson) yielded a lactose-negative gram-negative rod, designated LBV449. Identification with API 20E (Biomérieux, Marcy l'Etoile, France) resulted in code 3004113 or 1004113, due to a variable -galactosidase reaction (o-nitrophenyl--D-galactopyranosidase [ONPG] hydrolysis) that was negative in the latter case, which gave a good identification as Escherichia vulneris (96.5%) or a weak identification as E. vulneris (95%), Buttiauxella agrestis (85%), Klebsiella pneumoniae subsp. ozaenae (80%), or Pantoea sp. strain 4 (89%), respectively. Although lactose fermentation was scored negative, macro-testing showed that it was positive after 6 days of incubation. Lactose fermentation was found in this study to be slowl...