Identification of Kosakonia cowanii as a rare cause of acute cholecystitis: case report and review of the literature

Abstract

Background: Kosakonia cowanii, formerly known as Enterobacter cowanii, is a Gram-negative bacillus belonging to the order Enterobacterales. The species is usually recognized as a plant pathogen and has only anecdotally been encountered as a human pathogen. Here we describe the rare case of a K. cowanii infection presenting as an acute cholecystitis and provide a review of available literature. Evident difficulties in species identification by biochemical profiling suggests that potentially, K. cowanii might represent an underestimated human pathogen. Case presentation: A 61-year old immunocompromised man presented to the hospital with fever and pain in the upper right abdomen. Sonography revealed an inflamed gall bladder and several gall stones. A cholecystectomy proved diagnosis of an acute cholecystitis with a partial necrosis of the gall bladder. Surgical specimen grew pure cultures of Gram-negative rods unambiguously identified as K. cowanii by MALDI-TOF, 16S-rRNA analysis and whole genome sequencing. Conclusions: Reporting cases of Kosakonia species can shed light on the prevalence and clinical importance of this rare cause of human infection. Our case is the first to describe an infection without prior traumatic inoculation of the pathogen from its usual habitat, a plant, to the patient. This raises the question of the route of infections as well as the pathogen's ability to colonize the human gut.

Usefulness of BioFire FilmArray BCID2 for Blood Culture Processing in Clinical Practice

“…Therefore, at present available rapid phenotypic susceptibility testing assay formats (e.g. Accelerate, EUCAST RAST) offer a broader and thus more reliable approach towards early reporting of resistance phenotypes (27,28).…”

Bacteremia Due to Kosakonia cowanii in a Preterm Neonate

“…In a reported case, rhabdomyolysis due to bacteremia was observed after rose thorn prick. 11 More recently, Berinson et al reported a case of acute cholecystitis in an immunocompromised patient without penetrating trauma, 12 suggesting the origin of the infection may be food contamination. The authors suggested that transient colonization of the gut by K. cowanii may have caused acute cholecystitis in an immunocompromised patient.…”

“…15 Berinson et al suggested that K. cowanii might be an underestimated pathogen in children. 12 Indeed, in a retrospective study about pediatric infections due to P. agglomerans, seven patients out of 53 (13%) had a history of penetrating trauma with a stick, plant thorn, or glass shard. 16 As shown in our case report, K. cowanii may be falsely identified as P. agglomerans using biochemical reactions.…”

Novel Viruses That Lyse Plant and Human Strains of Kosakonia cowanii

“…It was isolated from the intestine of Atlantic codfish ( Gadus morhua ) from the subpolar White Sea [ 9 ] and from nasal aperture of kea parrot ( Nestor notabilis ). In human, several strains of K. cowanii and K. radicincitans species have been isolated from clinical samples, including of blood, urine, bile, and sputum [ 2 , 10 , 11 ].…”

“…It has been reported as a real pathogen of eucalyptus [ 13 ], woody plants [ 14 ], onion [ 15 ], and soybean [ 16 ]. Rare cases of opportunistic human infection have been reported; K. cowanii was identified as causative agent of rhabdomyolysis and bacteremia related to a rose thorn prick [ 17 ] and recently as a cause of acute cholecystitis in human [ 10 ]. On the other hand, co-inoculation of alfalfa plant with nonrhizobial bacteria Klebsiella sp.…”