Leclercia Adecarboxylata Causing Necrotizing Fasciitis in an Immunocompetent Athlete Injecting Illicit Testosterone Supplements

Abstract

Leclercia adecarboxylata (L. adecarboxylata) is an uncommon and often misdiagnosed cause of multiple infection types including skin and soft tissue, cholecystitis, and septicemia. It commonly afflicts immunocompromised hosts or individuals who experience trauma in aquatic environments. We present a case where this bacteria causes necrotizing fasciitis as a consequence of injecting street bought testosterone supplements. This patient was treated successfully with excisional debridement of the wound as well as a one week course of Linezolid and Bactrim.

A Case Report of<i> Leclercia adecarboxylata</i> Pyogenic Arthritis

“…Known to cause cellulitis, bacteremia, septic arthritis, and sepsis, the organism was initially named Escherichia adecarboxylata in 1962 but later reclassified as L. adecarboxylata . 6 , 7 Infections with L. adecarboxylat a are more common in immunocompromised adults, with limited documented cases in the pediatric population including preterm infants in neonatal intensive care units (NICU). 8 , 9 …”

Resistance phenotype and virulence potential of Leclercia adecarboxylata strains isolated from different sources

“…It has been reported to cause bloodstream infections, catheter infections, endocarditis, peritonitis, folliculitis, urinary tract infections, and wound infections [3][4][5][6][7][8][9]. Recent reports have recognized L. adecarboxylata as an important emerging pathogen since it has been a cause of primary infections in immunocompetent patients [10,11]. Infections caused by L. adecarboxylata usually respond to first-choice antimicrobial treatments due to its low antimicrobial resistance.…”

“…In that sense, with a Whole Genome Sequencing approach, our working group recently reported the co-occurrence of resistance genes and virulence genes present in important human pathogens within L. adecarboxylata strains, suggesting the need to consider this species as an emerging pathogen [13]. The clinical relevance of L. adecarboxylata has been demonstrated since the isolation of this microorganism as causative agent in monomicrobial infections such as wound, conjunctive, urinary tract infections (UTI), and bloodstream infections in immunocompetent patients [2, 3, 6–11, 14, 15]. Spiegelhauer et al ., discussed the need for co-infection of L. adecarboxylata due to the poor adherence and invasion capacity to HeP-2 cells, however, they considered important the cytotoxic effect of the bacterium on that cell line [16].…”

Monomicrobial Joint Infection by Leclercia adecarboxylata in an Immunocompetent Patient After Knee Arthroscopy

“…L. adecarboxylata is phenotypically similar to Escherichia coli because both of them are facultatively anaerobic, oxidase-negative, mesophilic, peritrichously flagellated bacilli 2 . Owing to these similarities, scientists suspect that many previously reported L. adecarboxylata infections have been misidentified as E. coli , which may explain the recent increase in reported L. adecarboxylata infections 7,8 . We present a case of a monomicrobial infection by L. adecarboxylata localized in the knee joint after right knee arthroscopy.…”