Fatal Leclercia Adecarboxylata Infection in an Immunocompetent Child: A Case Report and Literature Review
Eric M Barker, Leon A Metlay. University of Rochester, Rochester, NY
Background: Leclercia adecarboxylata is a motile Gram negative rod initially described by Leclerc in 1962 as Escherichia adecarboxylata. It is a member of the Enterobacteriacae and is also formerly known as enteric group 41. The organism has been isolated from human stool, is considered a natural part of enteric flora, and occurs in the environment. Cases of infection by L. adecarboxylata are rare but usually occur in patients with immunocompromise or significant medical comorbidities and typically occur in a polymicrobial infection. In a review of the literature, only one other case of a fatality from L. adecarboxylata infection was found.
Design: We present the fatal case of a 5 year old boy with chronic colonic dysmotility who died from complications of L. adecarboxylata sepsis. We then present a synopsis of current available literature regarding L. adecarboxylata infections.
Results: The patient was a five year old boy who suffered from a chronic colonic dysmotility syndrome which caused severe constipation. For this condition he had undergone ileostomy two years prior, leaving the colon in place as a blind loop. A central catheter for parenteral nutrition was also in place. While at home in his usual state of health the boy developed several days of low grade fever and then suffered a seizure. He was taken to the hospital and found to have had an intracerebral hemorrhage secondary to disseminated intravascular coagulation caused by sepsis. The patient died before emergency surgery could be performed. L. adecarboxylata was grown in pure culture from a central line blood sample. The same organism grew from a blood sample collected at autopsy. Culture of the central catheter tip was negative. Although there are reports of some drug resistant strains of L. adecarboxylata, the organism isolated in this case was susceptible to all antibiotics tested. Possible routes of organism entry in this case include the central catheter and the blind loop of colon (which was found to contain stool at autopsy).
Review of the literature revealed 29 reported cases of infection by L. adecarboxylata with only one fatality. That patient was a 71 year old man with comorbidities of hepatocellular carcinoma and liver cirrhosis due to hepatitis C viral infection.
Conclusions: L. adecarboxylata is a rare but clinically significant organism that may cause fatal infection in humans. When isolated, the organism is often pan-susceptible to the antibiotic panels tested. Routes of entry may include central lines and entry through the gut.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 256, Wednesday Afternoon