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Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola.

Kim SH, Roh KH, Yoon YK, Kang DO, Lee DW, Kim MJ, Sohn JW - BMC Infect. Dis. (2012)

Bottom Line: Raoultella planticola was originally considered to be a member of environmental Klebsiella.The clinical significance of R. planticola is still not well known.The identity of the organism was confirmed using 16S rRNA sequencing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Korea University Medical College, Seoul, Korea.

ABSTRACT

Background: Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known.

Case presentation: We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement.

Conclusions: R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.

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Related in: MedlinePlus

CT scans of the chest (a) and abdomen (b) show soft tissue edema, subcutaneous fat infiltrations extending along the fascial plane, and muscular thickening with gas in the right anterolateral aspect of the chest and abdominal wall (arrowheads).
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Figure 1: CT scans of the chest (a) and abdomen (b) show soft tissue edema, subcutaneous fat infiltrations extending along the fascial plane, and muscular thickening with gas in the right anterolateral aspect of the chest and abdominal wall (arrowheads).

Mentions: On admission, the patient's mental status was alert. His vital signs were stable except for his temperature, which was 37.7°C. Physical examination revealed intense pain on palpation, crepitus, swelling, and bruising over the right side of the abdominal wall, extending into the shoulder. No traces of the original wound remained. There were no other abnormal findings on physical examination. Laboratory tests revealed the following: white blood cell count, 8,000/mm3 with 74% neutrophils (normal, 4,500-11,000/mm3 with 40-75% neutrophils); hematocrit, 52.5% (normal, 38-52%); hemoglobin, 18.1 g/dL (normal, 13-17 g/dL); platelet count, 125,000/mm3 (normal, 150,000-400,000/mm3); and C-reactive protein, 256.43 mg/L (normal, 0-3 mg/L). Computed tomography scans of the chest and abdomen revealed soft tissue edema and stranding with gas in the chest and abdominal wall (Figure 1). They did not show any abscesses in any other organs. After cultures of two blood draws and a sample obtained by direct needle aspiration were performed, treatment with cefazolin (2 g every 8 h, intravenously [i.v.]) and clindamycin (300 mg every 6 h, i.v.) was started. On hospital day 2, clindamycin was discontinued and cefazolin was changed to ceftriaxone (2 g every 24 h, i.v.) with the preliminary report of Gram-negative bacilli in the culture of the aspirated specimen. Because the patient did not show signs of systemic toxicity, elective operative drainage and debridement was performed on hospital day 3. Intraoperative findings included a foul-smelling brownish-gray exudate and subcutaneous emphysema tracking along the superficial and deep fascia from the right shoulder to the groin. On hospital day 5, the initial blood cultures were negative. The aerobic and anaerobic cultures of the needle-aspiration specimen and the necrotic tissue obtained during the operation were positive only for R. planticola, on hospital day 3 and 5 respectively, as determined biochemically by using the Vitek2 automated identification system (bioMérieux, Marcy l'Etoile, France; 95% probability). It demonstrated mucoid colony in both blood agar and MacConkey agar. The identity of the isolate was further confirmed using 16S rRNA sequencing [4]. Comparative sequence analysis showed a 100% identity with the sequence corresponding to the 16S rRNA gene of R. planticola ATCC 33531. Antibiotic susceptibility results were obtained using a Vitek2 AST-131 kit (bioMérieux) according to Clinical Laboratory Standards Institute methods. The isolate was found to be intermediate only to ampicillin and susceptible to the following antibiotics: amikacin, amoxicillin/clavulanic acid, aztreonam, cefepime, cefotaxime, cefoxitin, ceftazidime, cephalothin, gentamicin, imipenem, meropenem, piperacillin/tazobactam, tobramycin, levofloxacin, trimethoprim/sulfamethoxazole, and tigecycline. The isolates did not reveal extended-spectrum β-lactamase production.


Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola.

Kim SH, Roh KH, Yoon YK, Kang DO, Lee DW, Kim MJ, Sohn JW - BMC Infect. Dis. (2012)

CT scans of the chest (a) and abdomen (b) show soft tissue edema, subcutaneous fat infiltrations extending along the fascial plane, and muscular thickening with gas in the right anterolateral aspect of the chest and abdominal wall (arrowheads).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3362755&req=5

Figure 1: CT scans of the chest (a) and abdomen (b) show soft tissue edema, subcutaneous fat infiltrations extending along the fascial plane, and muscular thickening with gas in the right anterolateral aspect of the chest and abdominal wall (arrowheads).
Mentions: On admission, the patient's mental status was alert. His vital signs were stable except for his temperature, which was 37.7°C. Physical examination revealed intense pain on palpation, crepitus, swelling, and bruising over the right side of the abdominal wall, extending into the shoulder. No traces of the original wound remained. There were no other abnormal findings on physical examination. Laboratory tests revealed the following: white blood cell count, 8,000/mm3 with 74% neutrophils (normal, 4,500-11,000/mm3 with 40-75% neutrophils); hematocrit, 52.5% (normal, 38-52%); hemoglobin, 18.1 g/dL (normal, 13-17 g/dL); platelet count, 125,000/mm3 (normal, 150,000-400,000/mm3); and C-reactive protein, 256.43 mg/L (normal, 0-3 mg/L). Computed tomography scans of the chest and abdomen revealed soft tissue edema and stranding with gas in the chest and abdominal wall (Figure 1). They did not show any abscesses in any other organs. After cultures of two blood draws and a sample obtained by direct needle aspiration were performed, treatment with cefazolin (2 g every 8 h, intravenously [i.v.]) and clindamycin (300 mg every 6 h, i.v.) was started. On hospital day 2, clindamycin was discontinued and cefazolin was changed to ceftriaxone (2 g every 24 h, i.v.) with the preliminary report of Gram-negative bacilli in the culture of the aspirated specimen. Because the patient did not show signs of systemic toxicity, elective operative drainage and debridement was performed on hospital day 3. Intraoperative findings included a foul-smelling brownish-gray exudate and subcutaneous emphysema tracking along the superficial and deep fascia from the right shoulder to the groin. On hospital day 5, the initial blood cultures were negative. The aerobic and anaerobic cultures of the needle-aspiration specimen and the necrotic tissue obtained during the operation were positive only for R. planticola, on hospital day 3 and 5 respectively, as determined biochemically by using the Vitek2 automated identification system (bioMérieux, Marcy l'Etoile, France; 95% probability). It demonstrated mucoid colony in both blood agar and MacConkey agar. The identity of the isolate was further confirmed using 16S rRNA sequencing [4]. Comparative sequence analysis showed a 100% identity with the sequence corresponding to the 16S rRNA gene of R. planticola ATCC 33531. Antibiotic susceptibility results were obtained using a Vitek2 AST-131 kit (bioMérieux) according to Clinical Laboratory Standards Institute methods. The isolate was found to be intermediate only to ampicillin and susceptible to the following antibiotics: amikacin, amoxicillin/clavulanic acid, aztreonam, cefepime, cefotaxime, cefoxitin, ceftazidime, cephalothin, gentamicin, imipenem, meropenem, piperacillin/tazobactam, tobramycin, levofloxacin, trimethoprim/sulfamethoxazole, and tigecycline. The isolates did not reveal extended-spectrum β-lactamase production.

Bottom Line: Raoultella planticola was originally considered to be a member of environmental Klebsiella.The clinical significance of R. planticola is still not well known.The identity of the organism was confirmed using 16S rRNA sequencing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Korea University Medical College, Seoul, Korea.

ABSTRACT

Background: Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known.

Case presentation: We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement.

Conclusions: R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.

Show MeSH
Related in: MedlinePlus