Leclercia adecarboxylata Causing Spontaneous Bacterial Peritonitis in a Child with Nephrotic Syndrome: A Case Report and Review of Literature

Abstract

Infection is an important complication of childhood nephrotic syndrome (NS) and spontaneous bacterial peritonitis (SBP) is a frequently encountered one. We present a 7-year-old boy with NS who had decreased urine output, generalized body swelling, and abdominal pain. Urine analysis showed proteinuria of 50 mg/m2/d. Ascitic tap showed total leukocyte count of 100 cells/mm3, sugar of 67 mg/dL, and protein of 1.1 g/dL. Gram stain revealed gram-negative bacilli with pus cells and culture grown Leclercia adecarboxylata (LAD). LAD was identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) with an identification score of 2.0. The organism showed good susceptibility to common antibiotics. The boy had no direct contact with livestock and the source of infection remains speculative. Devitalized skin because of massive edema seems to be the most plausible site of entry for the organism. Our patient was started on ceftriaxone and improved. LAD is a rare opportunistic pathogen, which belongs to Enterobacteriaceae and usually causes soft tissue infections. As far as we know, this is the first case where it has caused peritonitis in a child with NS. We also reviewed other pediatric cases.

Leclercia adecarboxylata as Emerging Pathogen in Human Infections: Clinical Features and Antimicrobial Susceptibility Testing

“…In 2019, Spiegelhauer et al reported a literature cases review demonstrating its pathogenicity in 74 patients [5]. The majority of these cases had been reported in immunocompromised patients, unlike our patients where the 5 of 6 were immunocompetent; only one patient was considered as immunocompromised following kidney transplantation, although peritoneal dialysis could explain this infection episode given the high prevalence of infections in these patients [7,[11][12][13][14].…”

“…L. adecarboxylata is implicated in cases which involve endocarditis [15,16], catheterrelated bacteremia [10,17,18], bacteremia and cellulitis [5,6,9,19,20], urinary tract infections [6,21], pneumonia [5,22] and bacterial peritonitis, especially in peritoneal dialysis patient [7,[11][12][13][14], which was the case for the majority of our clinical presentations. L. adecarboxylata was most often found as a monomicrobial infection in immunocompromised patients, and as part of a polymicrobial infection in immunocompetent patients [5,12].…”

“…In this case series of L. adecarboxylata infections, we highlighted the pathogenicity of this aquatic agent in human pathology since the advancements in microbiology of highresolution methods such as MALDI-TOF MS, which led to accurate identification in early diagnosis and distinction of L. adecarboxylata from Escherichia spp. [5][6][7].…”

“…It can also be isolated from clinical specimens including blood, stool, sputum, urines and wound pus. With new identification methods such as matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), which is preferred for precise species identification over conventional methods, it is currently possible to obtain an accurate identification [5][6][7] of this pathogen. L. adecarboxylata is a 'novel' rare human pathogen, mostly affecting immunocompromised individuals or causing polymicrobial infections in immunocompetent patients.…”

Leclercia adecarboxylata infective endocarditis in a man with mitral stenosis: A case report and review of the literature

“…A few cases with diabetes as the only risk factor have L. adecarboxylata infection of the skin and soft tissues[ 81 , 82 ]. L. adecarboxylata has been implicated in endocarditis[ 6 ], catheter-associated bacteremia[ 78 ], bacteremia, sepsis[ 3 , 67 ], septic arthritis, meningitis[ 83 ], cellulitis[ 2 , 84 ], urinary tract infections[ 85 ], pneumonia[ 70 ], and bacterial peritonitis, especially in patients on peritoneal dialysis[ 86 ]. Of these, the most common clinically are catheter-associated male urinary tract infections (translocation through the genitourinary tract), followed by ventilator-associated pneumonia, peritoneal dialysis peritonitis, corneal abscesses, vascular graft infections (entry into the infected host via catheter or wound)[ 87 ], and intestinal translocation (translocation of bacteria through the mucosal barrier of the gastrointestinal tract, presumably gastrointestinal bacteremia)[ 2 , 70 ].…”