Lab Med Online.  2022 Jan;12(1):74-78. 10.47429/lmo.2022.12.1.74.

A Case of Bacteremia Caused by Pantoea ananatis in a Patient Receiving Home Parenteral Nutrition

Affiliations
  • 1Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
  • 2Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 3Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Korea

Abstract

Pantoea ananatis is a Gram-negative, rod-shaped, non-spore-forming, motile bacterium that belongs to the family Erwiniaceae of the order Enterobacterales. In this study, we report the first Korean case of bacteremia caused by P. ananatis isolated from a 17-year-old female hospitalized due to fever. She had undergone total colectomy and massive intestinal resection due to intestinal pseudo-obstruction. Subsequently, the patient received home parenteral nutrition with a central venous catheter (CVC) for ten years and was hospitalized several times for central line-associated bloodstream infections. Gram-negative rods were isolated from two pairs of CVC blood cultures collected at admission. The isolate was identified as Pantoea spp. (95.0%) by GN ID card of the VITEK 2 system (bioMérieux, USA). It was identified as P. ananatis (score: 2.328) by matrix-assisted laser desorption ionization time-of-flight mass spectrometry using MALDI Biotyper (Bruker Daltonics, Germany). We used universal primers to perform 16S rRNA gene sequence analysis. The sequence was searched in the GenBank database and showed 99.32% identity with P. allii and 99.18% identity with P. ananatis. Since the result was not species-specific, additional cpn60 gene sequencing was performed. The sequence revealed 99.91% identity with P. ananatis and 94.00% identity with P. allii. Consequently, the isolate was confirmed as P. ananatis. To accurately identify Pantoea spp., cpn60 was more reliable than the 16S rRNA gene. This is the first confirmed case of bacteremia caused by P. ananatis in Korea.

Keyword

Pantoea ananatis; Bacteremia; MALDI-TOF MS; 16S rRNA; cpn60

Figure

  • Fig. 1 Microscopic image and colony morphology of Pantoea ananatis. (A) Gram-negative non-spore-forming rods (Gram stain, ×1,000). (B) Round, convex, and pale-yellow colonies on a blood agar plate.


Reference

1. Adeolu M, Alnajar S, Naushad S, Gupta RS. 2016; Genome-based phylogeny and taxonomy of the 'Enterobacteriales': proposal for Enterobacterales ord. nov. divided into the families Enterobacteriaceae, Erwiniaceae fam. nov., Pectobacteriaceae fam. nov., Yersiniaceae fam. nov., Hafniaceae fam. nov., Morganellaceae fam. nov., and Budviciaceae fam. nov. Int J Syst Evol Microbiol. 66:5575–99. DOI: 10.1099/ijsem.0.001485. PMID: 27620848.
2. Weller-Stuart T, De Maayer P, Coutinho T. 2017; Pantoea ananatis: genomic insights into a versatile pathogen. Mol Plant Pathol. 18:1191–8. DOI: 10.1111/mpp.12517. PMID: 27880983. PMCID: PMC6638271.
3. Walterson AM, Stavrinides J. 2015; Pantoea: insights into a highly versatile and diverse genus within the Enterobacteriaceae. FEMS Microbiol Rev. 39:968–84. DOI: 10.1093/femsre/fuv027. PMID: 26109597.
4. Asai N, Koizumi Y, Yamada A, Sakanashi D, Watanabe H, Kato H, et al. 2019; Pantoea dispersa bacteremia in an immunocompetent patient: a case report and review of the literature. J Med Case Rep. 13:33. DOI: 10.1186/s13256-019-1969-z. PMID: 30755259. PMCID: PMC6373044.
Article
5. Kaur IP, Inkollu S, Prakash A, Gandhi H, Mughal MS, Du D. 2020; Pantoea agglomerans bacteremia: Is it dangerous? Case Rep Infect Dis. 2020:7890305. DOI: 10.1155/2020/7890305. PMID: 32313708. PMCID: PMC7160720.
6. Dutkiewicz J, Mackiewicz B, Kinga Lemieszek M, Golec M, Milanowski J. 2016; Pantoea agglomerans: a mysterious bacterium of evil and good. Part III. Deleterious effects: infections of humans, animals and plants. Ann Agric Environ Med. 23:197–205. DOI: 10.5604/12321966.1203878. PMID: 27294620.
7. De Baere T, Verhelst R, Labit C, Verschraegen G, Wauters G, Claeys G, et al. 2004; Bacteremic infection with Pantoea ananatis. J Clin Microbiol. 42:4393–5. DOI: 10.1128/JCM.42.9.4393-4395.2004. PMID: 15365053. PMCID: PMC516322.
8. Manoharan G, Lalitha P, Jeganathan LP, Dsilva SS, Prajna NV. 2012; Pantoea ananatis as a cause of corneal infiltrate after rice husk injury. J Clin Microbiol. 50:2163–4. DOI: 10.1128/JCM.06743-11. PMID: 22461671. PMCID: PMC3372121.
9. Clinical, Laboratory Standards Institute. 2018. Interpretive criteria for identification of bacteria and fungi by targeted DNA sequencing. 2nd ed. CLSI guideline MM18. Wayne, PA: Clinical and Laboratory Standards Institute.
10. Soutar CD, Stavrinides J. 2019; Molecular validation of clinical Pantoea isolates identified by MALDI-TOF. PLoS One. 14:e0224731. DOI: 10.1371/journal.pone.0224731. PMID: 31682625. PMCID: PMC6827907.
11. Clinical, Laboratory Standards Institute. 2020. Performance standards for antimicrobial susceptibility testing. 30th ed. CLSI document M100. Wayne, PA: Clinical and Laboratory Standards Institute.
12. Jiang L, Wang D, Kim JS, Lee JH, Kim DH, Kim SW, et al. 2020; Reclassification of genus Izhakiella into the family Erwiniaceae based on phylogenetic and genomic analyses. Int J Syst Evol Microbiol. 70:3541–6. DOI: 10.1099/ijsem.0.004192. PMID: 32369001.
13. Kim HO, Lee HJ, Kim DW, Cho HS, Lim MH, Chang S-H, et al. 2008; A case of peritonitis caused by Pantoea agglomerans in a patient undergoing continuous ambulatory peritoneal dialysis. Korean J Med. 74:426–9.
14. Seok S, Jang YJ, Lee SW, Kim HC, Ha GY. 2010; A case of bilateral endogenous Pantoea agglomerans endophthalmitis with interstitial lung disease. Korean J Ophthalmol. 24:249–51. DOI: 10.3341/kjo.2010.24.4.249. PMID: 20714391. PMCID: PMC2916109.
15. Im JH, Yeo JY, Park SW, Yang DH, Kim MS, Kim JJ, et al. 2012; A case of Pantoea species cholangitis with bacteremia. Soonchunhyang Med Sci. 18:148–50. DOI: 10.15746/sms.12.032.
16. Ross VM, Guenter P, Corrigan ML, Kovacevich D, Winkler MF, Resnick HE, et al. 2016; Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care. Am J Infect Control. 44:1462–8. DOI: 10.1016/j.ajic.2016.06.028. PMID: 27908433.
Article
17. Bond A, Chadwick P, Smith TR, Nightingale JMD, Lal S. 2020; Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition. Frontline Gastroenterol. 11:48–54. DOI: 10.1136/flgastro-2018-101094. PMID: 31885840. PMCID: PMC6914297.
Article
18. Brady C, Cleenwerck I, Venter S, Vancanneyt M, Swings J, Coutinho T. 2008; Phylogeny and identification of Pantoea species associated with plants, humans and the natural environment based on multilocus sequence analysis (MLSA). Syst Appl Microbiol. 31:447–60. DOI: 10.1016/j.syapm.2008.09.004. PMID: 19008066.
19. Vancuren SJ, Hill JE. 2019; Update on cpnDB: a reference database of chaperonin sequences. Database (Oxford). 2019:baz033. DOI: 10.1093/database/baz033. PMID: 30820575. PMCID: PMC6395794.
Article
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