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Pantoea agglomerans, a Plant Pathogen Causing Human Disease

Pantoea agglomerans, a Plant Pathogen Causing Human Disease,Andrea T. Cruz,Andreea C. Cazacu,Coburn H. Allen

Pantoea agglomerans, a Plant Pathogen Causing Human Disease   (Citations: 20)
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We present 53 pediatric cases of Pantoea agglomerans infections cultured from normally sterile sites in patients seen at a children's hospital over 6 years. Isolates included 23 from the bloodstream, 14 from abscesses, 10 from joints/bones, 4 from the urinary tract, and 1 each from the peritoneum and the thorax. P. agglomerans was most associated with penetrating trauma by vegetative material and catheter-related bacteremia. Pantoea agglomerans (formerly Enterobacter agglomerans )i s a gram-negative aerobic bacillus in the family Enterobacteria- ceae. All species of the genus Pantoea can be isolated from feculent material, plants, and soil (2), where they can be either pathogens or commensals (12). Within the genus, P. agglom- erans is the most commonly isolated species in humans, result- ing in soft tissue or bone/joint infections following penetrating trauma by vegetation (6, 7, 9, 14, 15). P. agglomerans bacter- emia has also been described in association with the contam- ination of intravenous fluid (11), total parenteral nutrition (8), the anesthetic agent propofol (3), and blood products (1). However, spontaneously occurring bacteremia has rarely been reported, especially for children, and the role of P. agglomerans as a pathogen in other circumstances is unclear. Here, we present a large series of P. agglomerans infections in children that involve the bloodstream, soft tissue, and bones/joints.
Published in 2007.
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    • ... United States by the Environmental Protection Agency (EPA) as microbial pesticides http:// www.epa.gov/fedrgstr/EPA-PEST/2006/September/Day- 20/p8005.htm, registration efforts in Europe are hindered by biosafety concerns stemming from clinical reports that identify strains of P. agglomerans as opportunistic human pathogens, and have resulted in the current classification of this species as a biosafety level 2 (BL-2) organism in Europe [ ...
    • ...Confirmed pathogenicity of this species is difficult to ascertain, since clinical reports involving P. agglomerans are typically of polymicrobial nature, often involve patients that are already affected by diseases of other origin, lack Koch's postulate fulfillment or any pathogenicity confirmation, and diagnostic isolates are rarely conserved for confirmatory analysis [24]...

    Fabio Rezzonicoet al. Genotypic comparison of Pantoea agglomerans plant and clinical strains

    • ...To the best of our knowledge, such incidents in neonates have not been reported previously in Kuwait. Due to the paucity of literature related to this organism in neonates, this study reports 5 cases of bloodstream infection (BSI) with P. agglomerans.Case ReportAll 5 cases reported here were from the neonatal intensive care units (NICU1 and NICU2) of Farwaniya and Maternity Hospitals in Kuwait, but were not connected to each other in time.Case 1A 1,500-gram preterm baby, delivered vaginally as a second twin, developed respiratory distress shortly after birth and was managed using nasal continuous positive air pressure (CPAP). Intravenous (i.v.) ampicillin and gentamicin were started empirically after collection of an initial blood sample for culture. I.v. fluids were initiated and the baby was given nothing orally for the first day. He was weaned gradually from CPAP and kept in an oxygen hood. Initial cultures proved negative after 5 days and antibiotic therapy was stopped. The baby then developed jaundice and was treated with phototherapy. At the age of 10 days, he became desaturated and lethargic with skin mottling. Sepsis workup was done. I.v. cefotaxime and amikacin were instituted. Blood gas analysis showed metabolic acidosis and the baby was mechanically ventilated for 1 day. Cerebrospinal fluid and urine cultures showed no growth. However, two blood culture bottles showed the growth of P. agglomerans. The baby showed good response to a 10-day course of antibiotic treatment and was discharged in good general condition. During the episode, the baby did not develop pneumonia or necrotizing enterocolitis.Case 2A preterm baby, admitted directly due to respiratory distress, was intubated and mechanically ventilated. At the age of 7 days, he became well, was extubated and connected to nasal CPAP. However, on day 12, he became lethargic with bradycardia, skin mottling and frequent attacks of desaturation and required reventilation. The baby was kept nil per os. Intravenous meropenem was given for 2 weeks. Blood culture was positive for P. agglomerans. The baby responded well to treatment. There was no evidence of pulmonary infiltrate on chest radiograph.Case 3This preterm baby was delivered by lower segment cesarean section and transferred immediately to the neonatal intensive care unit for ventilatory support. Empiric treatment with ampicillin and amikacin was started. Echocardiogram revealed a small atrial septal defect. The patient developed uncomplicated pre-necrotizing enterocolitis during her first week of life. On day 15, she was accidentally extubated and then connected to nasal CPAP. On day 17, she became inactive, with abdominal distension, temperature instability and had repeated attacks of apnea. A full sepsis workup was done. Blood culture grew P. agglomerans in less than 24 h. The baby was connected to mechanical ventilation and given meropenem i.v. Treatment continued for 2 weeks. The patient showed clinical improvement and was transferred to the special care baby unit.Case 4A preterm neonate was delivered by spontaneous vaginal delivery after 26 weeks of pregnancy. The mother had premature rupture of membranes shortly before delivery. The baby developed severe respiratory distress, so he was intubated and mechanically ventilated. Initial blood cultures were negative but on day 8, the baby became pale, lethargic with evident skin mottling, desaturation and braycardia. Full sepsis workup was initiated and the patient was treated with pipracillin/tazobactam (Tazocin). Blood culture showed the growth of P. agglomerans. Tazocin was continued for 10 days. Following antibiotic therapy, the baby became stable and was in good general condition.Case 5A septic episode was suspected at the age of 11 days in a baby with clinical features similar to case 4. The baby was successfully treated with tazocin for 10 days.DiscussionGenerally, pantoea infection is uncommon in humans. There are few reports of systemic infection with this organism in preterm neonates. Surveillance between January 2005 and December 2006 in neonatal intensive care units of the two governmental teaching hospitals in Kuwait reported 5 sporadic episodes of nosocomial BSI due to P. agglomerans. During that period, 2 of 42,101 and 8 of 13,264 blood culture bottles were positive for the organism in the 2 hospitals, respectively. That is, 1 of 644 patients admitted to NICU1 and 4 of 1,021 patients admitted to NICU2 were infected. The pantoea isolates were not previously isolated from neonates in the preceding years.Neonatal BSIs are commonly caused by coagulase-negative staphylococci, multi-resistant Klebsiella spp. and Candida spp. in central-line-associated infections, and by Pseudomonas spp., multi-resistant Klebsiella spp. and others in non-central-line-associated infections. The high mortality associated with BSI makes it very important to rapidly diagnose and treat these infections.In all cases, 2 pediatric blood culture bottles grew the organism upon incubation in the BacTec System (Becton Dickinson, Sparks, Md., USA) within 24 h. The organism was a Gram-negative, motile bacillus belonging to the family of Enterobacteriaceae. All strains produced a yellow pigment on blood agar. With biochemical testing, it was found to be oxidase- and urease-negative and did not produce H2S on triple sugar iron agar. It also showed a negative reaction with arginine dihydrolase, ornithine decarboxylase and lysine decarboxylase. Microbial identification was done using the Vitek-2 system (bioMérieux, Marcy l’Etoile, France). In the isolate from case 1, the following tests contradicted a typical biopattern: negative reactions to L-lysine arylamidase, phosphatase and D-raffinose. However, retesting of the isolate by API 20E confirmed the identity. The full API profile identified 81.7% of this isolate and more than 90% in the others as P. agglomerans.Antibiotic susceptibility was performed on Vitek-2 using the AST-N020 card. All isolates showed in vitro susceptibility to amikacin, gentamicin, piperacillin/tazobactam and meropenem. However, variable susceptibility to other antibiotics was noticed: isolate 1 was fully sensitive, and isolate 4 was resistant to all cephalosporins. The two isolates (No. 4 and 5) that showed resistance to cephalosporins did not give a positive result with the ESBL E-test with clavulanate.In a recent study at a children’s hospital [...

    Nasser Yehia A. Alyet al. Pantoea agglomerans Bloodstream Infection in Preterm Neonates

    • ...P. agglomerans has been recovered from joint fluids of patients with arthritis, synovitis, or osteomyelitis (7)...
    • ...Infection often occurs after injuries with plant thorns, wood slivers, or wooden splinters (7, 8, 16, 30, 40, 49)...
    • ...Hieng et al. (25) described a case of septicemia due to an Erwinia herbicola strain that was resistant to ampicillin, carbenicillin, and cephalothin (cefalotin) and susceptible to other antibiotics usually active on gram-negative bacilli. Cruz et al. (7) reported similar results...

    Alexis Deletoileet al. Phylogeny and Identification of Pantoea Species and Typing of Pantoea ...

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