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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. Int J Food Microbiol 2006; 106: 137-143. 4) Yang JE, Park YJ, Chang HC. Cloning of four genes involved in limonene hydroxylation from Enterobacter cowanii 6L. J Microbiol Biotechnol 2007; 17: 1169-1176. 5) Stephan R, Van Trappen S, Cleenwerck I, Vancanneyt M, De Vos P, Lehner A. Enterobacter turicensis sp. nov. and Enterobacter helveticus sp. nov., isolated from fruit powder. Int J Syst Evol Microbiol 2007; 57: 820-826. 6) Brady CL, Venter SN, Cleenwerck I, et al. Isolation of Enterobacter cowanii from Eucalyptus showing symptoms of bacterial blight and dieback in Uruguay. Lett Appl Microbiol 2009; 49: 461-465. 7) Wetzel K, Lee J, Lee CS, Binkley M. Comparison of microbial diversity of edible flowers and basil grown with organic versus conventional methods. Can J Microbiol 2010; 56: 943-951. 8) Madhaiyan M, Poonguzhali S, Lee JS, Saravanan VS, Lee KC, Santhanakrishnan P. Enterobacter arachidis sp. nov., a plant-growth-promoting diazotrophic bacterium isolated from rhizosphere soil of groundnut. Int J Syst Evol Microbiol 2010; 60: 1559-1564. 9) González-Quijano GK, Dorantes-Alvarez L, Hernández-Sánchez H, et al. Halotolerance and survival kinetics of lactic acid bacteria isolated from jalapeño pepper (Capsicum annuum L.) fermentation. J Food Sci 2014; 79: M1545-53. 10) Sarkar S, Chaudhuri S. New report of additional enterobacterial species causing wilt in West Bengal, India. Can J Microbiol 2015; 61: 477-486. 11) Feng X, Dong H, Yang P, et al. Culture-Dependent and -Independent Methods to Investigate the Predominant Microorganisms Associated with Wet Processed Coffee. Curr Microbiol 2016; 73: 190-195. 12) Shi JF, Sun CQ. Isolation, identification, and biocontrol of antagonistic bacterium against Botrytis cinerea after tomato harvest. Braz J Microbiol 2017; 48: 706-714. Table S3. Drug susceptibility tests for detected Enterobactor cowanii Drugs Minimum Adjudication Inhibitory Concentration (MIC, mg/L) Aminobenzyl penicillin >16 Resistant Piperacillin >64 Resistant Aminobenzyl penicillin/ <8 Sensitive Sulbactam Piperacillin/ <16 Sensitive Tazobactam Cefaclor <8 Sensitive Cephazolin <4 Sensitive Cefotiam <8 Sensitive Cefotaxime <1 Sensitive Ceftazidime <4 Sensitive Ceftriaxone <1 Sensitive Cefepime <2 Sensitive Cefcapene <0.25 Sensitive Cefmetazole <8 Sensitive Flomoxef <8 Sensitive Cefoperazone/ <16 Sensitive Sulbactam Meropenem <1 Sensitive Aztreonam <4 Sensitive Amikacin <4 Sensitive Gentamicin <2 Sensitive Minocycline <2 Sensitive Levofloxacin <0.5 Sensitive Fosfomycin >16 Resistant Sulfamethoxazole/ <2 Sensitive Trimethoprim
Supplemental Figure S1. Clinical course of the patient. CK: creatinine kinase, CRP: C-reactive protein, CEX: cephalexin (oral), CEZ: cephazolin (intravenous)