Rhabdomyolysis Due to Bacteremia from Enterobacter Cowanii Caused by a Rose Thorn Prick
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Kobe University Repository : Kernel タイトル Rhabdomyolysis due to bacteremia from Enterobacter cowanii caused Title by a rose thorn prick 著者 Washio, Ken / Yamamoto, Go / Ikemachi, Mami / Fujii, Shotaro / Author(s) Ohnuma, Kenichiro / Masaki, Taro 掲載誌・巻号・ページ JOURNAL OF DERMATOLOGY,45(11):e313-e314 Citation 刊行日 2018-11 Issue date 資源タイプ Journal Article / 学術雑誌論文 Resource Type 版区分 author Resource Version 権利 Rights DOI 10.1111/1346-8138.14341 JaLCDOI URL http://www.lib.kobe-u.ac.jp/handle_kernel/90006665 PDF issue: 2021-10-04 1 1 Rhabdomyolysis due to bacteremia from Enterobacter cowanii caused by a rose 2 thorn prick 3 4 Running head 5 Rhabdomyolysis by Enterobacter cowanii 6 7 Ken Washio1, Go Yamamoto2, Mami Ikemachi2, Shotaro Fujii1, Kenichiro Ohnuma3, and 8 Taro Masaki1 9 10 1) Department of Dermatology, Kobe City Nishi-Kobe Medical Center, Japan. 11 2) Department of Clinical Laboratory, Kobe City Nishi-Kobe Medical Center, Japan. 12 3) Department of Clinical Laboratory, Kobe University Hospital, Japan. 13 14 Correspondence: 15 Ken Washio, M.D., Ph.D., Department of Dermatology, Kobe City Nishi-Kobe Medical 16 Center, Japan. 17 5-7-1, Koji-Dai, Nishi-ku, Kobe, 651-2273 Japan. 18 E-mail: [email protected] 19 Tel: +81-78-997-2200 20 Fax: +81-78-993-3728 21 22 2 23 Manuscript word, table, and figure counts 24 Words: 489 25 Tables: 0 26 Figures: 1 27 References: 5 28 Supplemental Figures: 1 29 Supplemental Tables: 3 30 3 31 Dear Editor, 32 Rose bush thorns can be dangerous to human health. Fungal diseases, such as 33 sporotrichosis,1 are well-known complications following rose thorn prick; though 34 bacterial infections are rare. Here, we describe a rare case of rhabdomyolysis due to 35 bacteremia from Enterobacter cowanii preceded by a rose thorn prick. To our 36 knowledge, this is the first report of E. cowanii-induced rhabdomyolysis. 37 A 52-year-old man, apparently healthy except for obesity and fatty liver, 38 visited our emergency room. His heel was pricked by a rose thorn while gardening at 39 home (day 0), and the next day (day 1) he had a high fever (39.3 °C) and painful foot. 40 He was diagnosed with cellulitis and prescribed oral cephalexin (250 mg per 6 h). He 41 visited our hospital again for severe foot pain (day 2). Blood cultures were taken, and 42 he was prescribed further oral cephalexin. However, on day 3, he was no longer able to 43 walk unassisted due to severe general myalgia, so visited our dermatology department. 44 His CRP and CK serum levels were elevated to 12.0 mg/dl and 1359 U/l, respectively. 45 His urinary occult blood test was positive. Despite the inflammatory reactions detected 46 via serum analysis, the focal swelling of the calf was minimal, with a sting on the heel 47 (Figure 1a–b). For the difficulty in ambulation, he was hospitalized and received 48 hydration therapy and intravenous cephazolin (1 g per 8 h). The blood cultures showed 49 Gram-negative bacteria (2/2 individual sets; Figure 1c). The suspicious bacterium was 50 initially regarded as Pantoea agglomerans (Figure 1d), but was amended as E. cowanii 51 based on the 16S rRNA gene nucleotide sequence (Table S1).2 Matrix-assisted laser 52 desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) using MALDI 53 Biotyper™ (Bruker Daltonics, Germany) also identified E. cowanii with a log score of 4 54 2.170, which was considered a reliable identification.3 Two days after hospitalization 55 (day 5), the CK serum levels were further elevated to 3,541 U/l, so we diagnosed 56 rhabdomyolysis. The percentages of the three CK isoenzymes, CK-BB, CK-MB, and 57 CK-MM were 0%, 1%, and 99%, respectively. On day 9, his CRP and CK serum levels 58 decreased to 0.5 mg/dl and 163 U/l, respectively, and he was able to walk, so he was 59 discharged. The clinical course of the case is documented in supplemental Figure S1. 60 E. cowanii, a Gram-negative aerobic bacillus in the family Enterobacteriaceae, 61 was isolated from a group of clinical strains previously identified as P. agglomerans.4 E. 62 cowanii has been detected from plants in most of the previous reports (Table S2). 63 Based on a previous case of P. agglomerans-induced rhabdomyolysis with liver 64 abscess,5 we performed abdominal echography, which was normal except for fatty liver. 65 In our case, the detected E. cowanii showed minimal drug resistance and responded 66 well to intravenous cephazolin (Table S3). In conclusion, we report a case of 67 rhabdomyolysis by E. cowanii probably due to a rose thorn prick in a healthy individual. 68 Clinicians should consider this bacterium in case of plant-associated infectious disease. 69 70 Acknowledgments 71 We thank Dr. Shun Matoba and Dr. Chie Yanagihara (Kobe City Nishi-Kobe Medical 72 Center, Department of Neurology) for their assistance of internal medicine. We thank 73 Katie Oakley, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of 74 this manuscript. 75 76 Conflict of interest 5 77 K.W. has gained grant from Grant-in-Aid for Scientific Research (C) (JSPS KAKENHI grant 78 number 16K19722) from the Ministry of Education, Culture, Sports, Science and 79 Technology, Japan 6 80 References 81 1. Rufino R, Marques BL, Costa CH. Rose Gardener's disease. Thorax 2013; 68: 602. 82 2. Brady CL, Venter SN, Cleenwerck I et al. Isolation of Enterobacter cowanii from 83 Eucalyptus showing symptoms of bacterial blight and dieback in Uruguay. Lett Appl 84 Microbiol 2009; 49: 461–465. 85 3. Justesen US, Holm A, Knudsen E et al. Species identification of clinical isolates of 86 anaerobic bacteria: a comparison of two matrix-assisted laser desorption 87 ionization-time of flight mass spectrometry systems. J Clin Microbiol 2011; 49: 88 4314–4318. 89 4. Inoue K, Sugiyama K, Kosako Y, Sakazaki R, Yamai S. Enterobacter cowanii sp. nov., 90 a new species of the family Enterobacteriaceae. Curr Microbiol 2000; 41: 417–420. 91 5. Fullerton DG, Lwin AA, Lal S. Pantoea agglomerans liver abscess presenting with a 92 painful thigh. Eur J Gastroenterol Hepatol 2007; 19: 433–435. 93 94 Figure legends 95 Figure 1. Clinical manifestations of the patient (day 3). (a) The prick wound on the heel. 96 (b) Mild swelling of the calf despite high fever. (c) Strain of Gram-negative rods from 97 blood culture. (d) Blood culture growth. Left (red): blood agar; right (blue): Drigalski 98 lactose agar. 99 100 Table S1. DNA sequences of the 16S rRNA gene of the isolate from the blood of the patient 1 E.cowanii AIMST 8.Hr.10 TGC-AGTCGA ACGGTAACAG GAAGCAGCTT GCTGCTTTGC TGACGAGTGG CGGACGGGTG Isolate TGCAAGTCGA ACGGTAACAG GAAGCAGCTT GCTGCTTTGC TGACGAGTGG CGGACGGGTG 61 E.cowanii AIMST 8.Hr.10 AGTAATGTCT GGGAAACTGC CTGATGGAGG GGGATAACTA CTGGAAACGG TAGCTAATAC Isolate AGTAATGTCT GGGAAACTGC CTGATGGAGG GGGATAACTA CTGGAAACGG TAGCTAATAC 121 E.cowanii AIMST 8.Hr.10 CGCATAACGT CGCAAGACCA AAGAGGGGGA CCTTCGGGCC TCTTGCCATC AGATGTGCCC Isolate CGCATAACGT CGCAAGACCA AAGAGGGGGA CCTTCGGGCC TCTTGCCATC AGATGTGCCC 181 E.cowanii AIMST 8.Hr.10 AGATGGGATT AGCTAGTAGG TGGGGTAACG GCTCACCTAG GCGACGATCC CTAGCTGGTC Isolate AGATGGGATT AGCTAGTAGG TGGGGTAACG GCTCACCTAG GCGACGATCC CTAGCTGGTC 241 E.cowanii AIMST 8.Hr.10 TGAGAGGATG ACCAGCCACA CTGGAACTGA GACACGGTCC AGACTCCTAC GGGAGGCAGC Isolate TGAGAGGATG ACCAGCCACA CTGGAACTGA GACACGGTCC AGACTCCTAC GGGAGGCAGC 301 E.cowanii AIMST 8.Hr.10 AGTGGGGAAT ATTGCACAAT GGGCGCAAGC CTGATGCAGC CATGCCGCGT GTATGAAGAA Isolate AGTGGGGAAT ATTGCACAAT GGGCGCAAGC CTGATGCAGC CATGCCGCGT GTATGAAGAA 361 E.cowanii AIMST 8.Hr.10 GGCCTTCGGG TTGTAAAGTA CTTTCAGCGG GGAGGAAGGC GATGCGGTTA ATAACCGCGT Isolate GGCCTTCGGG TTGTAAAGTA CTTTCAGCGG GGAGGAAGGC GATGCGGTTA ATAACCGCGT 421 E.cowanii AIMST 8.Hr.10 CGATTGACGT TACCCGCAGA AGAAGCACCG GCTAACTCCG TGCCAGCAGC CGCGGTAATA Isolate CGATTGACGT TACCCGCAGA AGAAGCACCG GCTAACTCCG TGCCAGCAGC CGCGGTAATA 481 E.cowanii AIMST 8.Hr.10 CGGAGGGTGC AAGCGTTAAT CGGAATTACT GGGCGTAAAG CGCACGCAGG CGGTCTGTCA Isolate CGGAGGGTGC AAGCGTTAAT CGGAATTACT GGGCGTAAAG CGCACGCAGG CGGTCTGTCA 541 E.cowanii AIMST 8.Hr.10 AGTCGGATGT GAAATCCCCG GGCTCAACCT GGGAACTGCA TCCGAAACTG GCAGGCTTGA Isolate AGTCGGATGT GAAATCCCCG GGCTCAACCT GGGAACTGCA TCCGAAACTG GCAGGCTTGA 601 E.cowanii AIMST 8.Hr.10 GTCTCGTAGA GGGGGGTAGA ATTCCAGGTG TAGCGGTGAA ATGCGTAGAG ATCTGAA-GA Isolate GTCTCGTAGA GGGGGGTAGA ATTCCAGGTG TAGCGGTGAA ATGCGTAGAG ATCTGGAGGA 661 E.cowanii AIMST 8.Hr.10 ATACCGGTGG CGAA-GCGGC CCCCTGGACG AA-ACTGAC Isolate ATACCGGTGG CGAAGGCGGC CCCCTGGACG AAGACTGAC Table S2. Reports of Enterobacter cowanii Year Authors Source Description 2000 Inoue K1) Specimen from human First report of E.cowanii 2006 Götz M et al. 2) Tomato roots An indigenous bacterial community in the rhizosphere 2006 Kariluoto S et al.3) Flour Detected from non-sterlized flour 2007 Yang JE et al.4) Citron peel A limonene-degrading microorganism 2007 Stephan R et al. 5) Fruit powder Four Enterobacteriae including E. cowanii were detected 2009 Brady CL et al. 6) Eucalyptus trees An endophyte in trees making them blight 2010 Wetzel K et al. 7) Edible flowers A microbial flora in flowers 2014 Mardaneh J et al. 8) Powdered infant milk A food contaminant González-Quijano 2014 Vegetables An endophytic bacterial in vegetables GK et al. 9) 2015 Sarkar S et al. 10) Weeds Related to plant wilt 2016 Feng X et al. 11) Coffee bean Produce pectinase 2017 Shi JF et al. 12) Tomato Biocontrol potential against Botrytis cinerea 1) Inoue K, Sugiyama K, Kosako Y, Sakazaki R, Yamai S. Enterobacter cowaniisp. nov., a new species of the family Enterobacteriaceae. Curr Microbiol 2000; 41: 417-420. 2) Götz M, Gomes NC, Dratwinski A, et al. Survival of gfp-tagged antagonistic bacteria in the rhizosphere of tomato plants and their effects on the indigenous bacterial community. FEMS Microbiol Ecol 2006; 56: 207-218. 3) Kariluoto S, Aittamaa M, Korhola M, Salovaara H, Vahteristo L, Piironen V. Effects of yeasts and bacteria on the levels of folates in rye sourdoughs.