Leclercia Adecarboxylata Cellulitis in a Child with Acute Lymphoblastic Leukemia

Abstract

Leclercia adecarboxylata is a rare, gram-negative rod that has been infrequently reported in the literature. The organism has been documented to cause solitary infections in immunocompromised hosts and polymicrobial wound infections in the immunocompetent. We present a case of an 8-year-old boy with significant past medical history of acute lymphoblastic leukemia who developed cellulitis due to local infection by L. adecarboxylata. This case is presented to raise awareness of this rare organism's ability to cause common cutaneous disease, especially in the immunocompromised.

Catheter-Related Bacteremia Caused by Multidrug-Resistant Leclercia adecarboxylata in a Patient with Breast Cancer

“…This bacterium has been isolated from environmental samples, including water and soil (23). Although it is rarely isolated clinically in humans, there are many reported cases of L. adecarboxylata infection in immunocompromised patients suffering from primary diseases such as cancer, leukemia, hepatoma, and renal failure (6,11,14,20). In such patients, this pathogen can cause bacteremia, sepsis, peritonitis, cellulitis, endocarditis, and cholecystitis (6,9,11,14,16,20).…”

“…Its pathogenesis, specifically its entry and spread into humans, remains unclear. When considering the previous cases, bacteremia due to L. adecarboxylata may be closely associated with destruction of the skin barrier, such as through trauma and burn wounds, change of normal flora by antibiotic treatments, and peritoneal dialysis (2,8,16,(18)(19)(20). Additionally, some cases have implicated catheters as important reservoirs for bacteremia by L. adecarboxylata.…”

Is Leclercia adecarboxylata a New and Unfamiliar Marine Pathogen?

“…These organisms have been described as rare pathogens in endocarditis (7), catheter-related bacteremia (8), bacteremia and cellulitis in children suffering from leukemia (9,10), and spontaneous bacterial peritonitis (11).…”

Late-onset Leclercia adecarboxylata sepsis in a premature neonate

“…2 L. adecarboxylata is typically sensitive to treatment with a wide variety of antibiotics including most beta-lactams, aminoglycosides and the quinolones. 10 However, two resistant isolates have recently been reported, one from a man with a chemical burn 9 and another from a man with acute myelogenous leukemia. 11 Both isolates exhibited characteristics of extended-spectrum betalactamase-producing strains with resistance to ceftazidime, cefotaxime, aztreonam and cefepime, as well as several aminoglycosides, penicillin, piperacillin and other agents.…”

“…There have been five cases of L. adecarboxylata infection reported in pediatric patients (Table 1). 10,[12][13][14][15] All five cases involved patients with serious underlying medical problems, many of which were chronic and involved some degree of immunosuppression, and were due to pansensitive isolates of L. adecarboxylata. The previously reported pediatric cases were all treated successfully with resolution of symptoms and clearance of bacteria from infected sites.…”