- Case report
- Open Access
Bacteremic cholangitis due to Raoultella planticola complicating intrahepatic bile duct stricture 5 years post-laparoscopic cholecystectomy: a case report
Journal of Medical Case Reports volume 15, Article number: 152 (2021)
Raoultella Planticola is a facultative anaerobic, gram-negative, water- and soil-dwelling rod bacterium rarely reported as a cause of human disease. However, the number of reported R. planticola infections is growing, without a concomitant increase in research on the microbe or its pathogenesis. Previous genomic studies demonstrating genetic similarities between R. planticola and Klebsiella pneumoniae suggest that capsule biosynthesis, mucoid phenotype, biofilm production, and lipopolysaccharide (endotoxin) synthesis may all be potential virulence factors of R. planticola. We present a unique case of R. planticola infection of the biliary tract 5 years after biliary surgery in a patient with no previously documented risk factors. We also use in silico techniques to predict virulence factors of R. planticola.
This case report is the first to discuss a R. planticola infection in the biliary tract of late onset post-surgery (5 years) in a Caucasian patient with no previously documented risk factors.
An in-depth search of the current literature did not yield other similar cases of R. planticola infections. Moreover, to the best of our knowledge, our case is the first case of R. planticola isolated from post-endoscopic retrograde cholangiopancreatography (ERCP) as part of biliary sepsis not associated with gastroenteritis. The late onset of the infection in our patient and the results of the in silico analysis suggest that R. planticola may have survived exposure to the host immune system through the creation of an intracellular biofilm or in a non-culturable but viable state (NCBV) for the 5-year period. The in silico analysis also suggests that biofilms, enterobactin, and mucoid phenotype may play a role in the pathogenesis of R. planticola. However, further research is needed to illuminate the significance of pili, capsule biosynthesis, and lipopolysaccharide (LPS) in the virulence of R. planticola. Lastly, as our patient did not have any risk factors previously associated with R. planticola, we suggest that biliary tract stricture, cholecystitis, and prior surgery may be possible novel risk factors.
The Raoultella genus comprises gram-negative, oxidase-negative, facultative anaerobic bacteria within the Enterobacteriaceae family. R. planticola, earlier known as Klebsiella planticola and Klebsiella trevisanii, is a gram-negative, rod-like bacterium first described by Ferragut  from aquatic and soil isolates and later differentiated from Klebsiella after phylogenetic analysis by Drancourt and associates . Matrix-assisted laser desorption/ionization–time of flight (MALDI-TOF) mass spectrometry is the current method used to identify and differentiate R. planticola .
R. planticola is an emerging pathogen which has been linked to fatal infections. Only 33 cases of R. planticola were reported prior to the middle of 2015 . There have been 19 novel cases reported since that time. Pediatric cases, although extremely rare, have also been reported . Further, R. planticola may cause bacteremia, pneumonia, intra-abdominal infections, urinary tract infections, soft tissue infections, and conjunctivitis [6,7,8]. To our knowledge, there have been no reports of R. planticola biliary tract infections or a thorough investigation of microbial virulence or immune escape. Herein, we report a case of R. planticola biliary tract infection as a long-term postsurgical complication in a 31-year-old woman who initially presented with acute cholecystitis. We also discuss the results of a genome-based comparison between R. planticola and K. pneumoniae in order to examine possible virulence factors of R. planticola.
A 31-year-old Caucasian woman presented to the emergency department with sudden onset of abdominal pain, fever, chills, and malaise. She had a history of laparoscopic cholecystectomy in 2008 complicated by bile leak requiring biliary stents. In 2011, she developed hepatic cysts, which were surgically extirpated in 2011 and 2012. She remained afebrile and mostly asymptomatic, with only occasional mild right upper quadrant pain until the current presentation which caused her to seek medical attention at the emergency department. Importantly, she denied any history of solid organ transplants, hematologic malignancy, chemotherapy, transplantation neutropenia, cirrhosis, seafood ingestion, or proton pump inhibitor (PPI) use.
Vital signs on presentation were temperature of 98.1 °F, heart rate of 85 beats per minute, respiration of 18 breaths per minute, and blood pressure of 126/83 mmHg. Physical examination revealed an afebrile, anicteric female in moderate, painful distress with slight, diffuse abdominal tenderness on palpation. Laboratory/radiographic tests revealed a white blood cell count of 41.1 cells/μL; elevated liver enzymes (alanine aminotransferase 102 U/L and aspartate aminotransferase 74 U/L); alkaline phosphatase of 318 U/L; and total bilirubin of 2.4 mg/dl. Computed tomography and magnetic resonance cholangiopancreatography (MRCP) were significant for dilated right intrahepatic bile duct with evidence of a surgically absent gall bladder (Figs. 1, 2, 3). During admission in the emergency room, the patient became febrile, and blood cultures (BC) were drawn. In light of the clinical picture and imaging studies, biliary sepsis and bacteremia due to intrahepatic duct stricture were suspected. The patient was admitted to the hospital and empirically started on piperacillin/tazobactam. The BC was positive for gram-negative rods in two of two peripheral BC after 24 hours. R. planticola was reported as the isolate on the third hospital day and was resistant to ampicillin and piperacillin but susceptible to ceftriaxone (microbial resistance and susceptibilities were completed by Quest Diagnostics). Therapy was changed to ceftriaxone 2 g parenterally every 24 hours, and the patient quickly improved clinically, with normalization of liver function within 3 days (hospital day 6). She was discharged on home therapy with referral for subsequent evaluation and treatment of her intrahepatic duct strictures.
Case discussion and methods
Previously reported R. planticola cases
Raoultella planticola is an emerging bacterial pathogen (see Fig. 4) that has previously been associated with nonclinical environments such as aquatic habitats and therefore has been linked to consumption of seafood . However, case studies since 1985 have indicated an increased number of clinical cases  and multiple organ infections . Previously, R. planticola was isolated from patients with comorbid leptospirosis  and found to be a cause of pneumonia . R. planticola was also observed to occur in hematological malignancy when the organism was isolated from the oral ulcers of a patient with chemotherapy-induced oral mucositis . Similarly, other cases have been documented that suggest an increased susceptibility to infection in immunocompromised states . Table 1 summarizes all reported R. planticola infections prior to 2018 found during an in-depth literature search.
Analysis of all the documented patients showed that R. planticola caused bacteremia in 22% of cases, soft tissue infections in 17%, urinary tract infections in 15%, lower respiratory tract infections in 10%, and eye infections in 10%. Sources of isolation correlated with the infected organ system (r2 = 0.72). The annual timeline frequency of documented infections caused by this pathogen potentially indicate a biannual prevalence (see Fig. 4).
Pathogenesis and virulence factors in R. planticola genome
The pathogenesis of R. planticola has not yet been established; however, fimbria, biofilm production, encapsulation, lipopolysaccharide (LPS), and siderophores have been observed to be important virulence factors in the closely related species Klebsiella pneumoniae species [3, 14].
In order to investigate possible virulence factors for R. planticola, in silico analysis was conducted using the National Center for Biotechnology Information (NCBI) Basic Local Alignment Search Tool (BLAST) (NCBI.gov) , Universal Protein Resource (UniProt; uniprot.com) , and Integrated Microbial Genomes (IMG; img.jgi.gov) system . In the analysis, previously documented virulence factor gene sequences, including known K. pneumoniae virulence factor gene sequences, were used to generate queries to blast against the R. planticola genome. Using these databases, gene sequences and accession numbers for virulence factors in K. pneumoniae were found for over 40 genes pertaining to pili components, pili chaperone proteins, biofilm synthesis and initiation, capsule assembly, capsule biosynthesis, capsule initiation, LPS synthesis, outer membrane surface protein chaperones, and expression of mucoid phenotype (genes present, see Tables 2, 3). Using the gene function on IMG , permanent drafts of K. pneumoniae pKP469IL Plasmid (B) [P], K. pneumoniae pKP531IL (B) [P], K. pneumoniae 1162281 (B) [P], and K. pneumoniae 1191100241 (B) [P] were searched for gene sequences and accession numbers for known virulence factors . The genome for R. planticola strain GODA was selected as a target for querying the virulence factors relevant for endotoxins, capsules, fimbria, pili production, and biofilm production using the BLASTn and BLASTp tools available from NCBI.gov . In order to investigate the clinical relevance, the genome of ATCC 33531  was compared against GODA and found to be 99% identical (see Table 4).
For functional gene annotation, greater than 60% query coverage, 70% nucleotide identity, and Expect (E)-value below 0.001 were used as the minimum similarity criteria between functionally documented genes of K. pneumoniae and unknown R. planticola genes (see Tables 2, 3). Novel queries identified by BLASTn analysis of R. planticola GODA against K. pneumoniae are shown in Table 2, and previously functionally annotated queries are shown in Table 3.
Results and discussion
The results of blasting for capsule and mucoid production genes are shown in Tables 2 and 3.
Wzze  and O-acetyltransferase , genes known to be involved in the synthesis of LPS, showed 93% and 82% identity in 67% and 71% of the gene fragments, respectively (see Table 2). This indicates that those mechanisms might be shared between R. planticola and K. pneumoniae and that R. planticola may produce LPS endotoxin, which could explain how it causes a bacteremia, avoids immune response, or causes sepsis.
Capsule and mucoid production
We observed the following virulence factor relationships between the target genomes: Wzi (99% identity in 94% of the gene fragments); rcsA (69% identity in 100% of the gene fragments); rcsB (82% identity of 100% of the gene fragments); KpsS (99% identity in 5% of the gene fragments) suggesting a shared prosthetic group; uncharacterized protein (99% identity in 1% of the gene fragments) suggesting a shared prosthetic group. The presence of such genetic similarities indicates that R. planticola has the potential to synthesize, regulate, and assemble a capsule and express a mucoid phenotype that could help it escape the host immune system [22,23,24,25,26]. Mucoid phenotype regulators rmpA and rmpA2 did not show significant matching, indicating that capsular mucoid composition in R. planticola may be expressed through a different mechanism from that in K. pneumoniae. The results of blasting for capsule and mucoid production genes are shown in Tables 2 and 3.
Adhesins, pili, and fimbria
Skp and SurfA queries were found to be 92% and 87% identical, respectively, between R. planticola and K. pneumoniae, suggesting that R. planticola codes for periplasmic chaperoning of outer membrane protein assembly [27, 28]. Type 1 fimbria regulatory proteins FimB and FimE and fimbria FimD queries have previously been documented in R. planticola (see Table 3). No other similarities for different fimbrial components were found. This variability that R. planticola possesses in its fimbria may contribute to its host cell attachment and opsonization prevention in ways that differ from those mechanisms in K. pneumoniae.
Raoultella planticola was found to possess genes similar to K. pneumoniae that have previously been shown to cause infection via biofilm production, upregulation of motility factors, outcompeting host cells for iron, and mucous production (see Table 3).
Whole genome blasting analysis between host-associated ATCC 33531 and GODA was conducted to identity chromosomal cassettes. We observed identity of 99% in 93% of gene fragments, suggesting high gene density that could allow efficient regulation of gene expression in mechanisms of antibiotic resistance, host immune system evasion, host cell attachment and invasion, and intracellular survivability (see Table 4) . R. planticola may contain pathogenicity islands, a potential result of transduction that would also be involved in bacterial adaption, but further research is needed to confirm this.
Organ systems affected, virulence factors, and potential latent infection in our case
An in-depth search of the current literature did not yield other case studies with a similar isolation of R. planticola. We were also unable to identify another case of R. planticola isolated after endoscopic retrograde cholangiopancreatography (ERCP) as part of biliary sepsis not associated with gastroenteritis. Further, a detailed history and chart review of our patient did not show any of the previously reported risk factors associated with R. planticola including bacteremia/sepsis of the gastrointestinal tract (GI), biliary malignancy, chemotherapy, transplantation, neutropenia, cirrhosis, seafood ingestion, or PPI usage. It is possible that our patient had recently become infected with R. planticola rather than during the time of her laparoscopic procedure; however, as discussed above, an extensive attempt to document any previously associated risk factors failed to illuminate any. It has been reported that patients with chronic biliary strictures are at increased risk of cholangitis, possibly due to static biliary fluid in the stenotic biliary system or because of abnormal anatomic morphology that facilitates bacterial adhesion and colonization [30,31,32].
Therefore, we speculate that our patient’s bacteremia, which developed 5 years postoperatively, may be due to possible latency of the pathogen. The in silico results might also indicate that this organism survived exposure to the host immune system through the employment of an intracellular biofilm or in a non-culturable but viable (NCBV) state for the 5-year period [33, 34]. Our results also suggest that biofilms, enterobactin, and mucoid phenotype are likely virulence factors in the pathogenesis of R. planticola’s ability to cause infection. Additionally, we identified a conservation of genes involved in pili synthesis regulation, fimbrial protein chaperoning, capsule biosynthesis, and endotoxin production; however, the genetic variation of genes coding for pili, fimbria, and capsule polysaccharide composition may indicate that these genes are subject to antigenic variation or reductive evolution in an attempt to avoid the host immune system. Multiple genomes of newly isolated clinical P. planticola should be sequenced in order to evaluate its level of evolutionary conservation of the extracellular and surface glycoproteins.
This unique case adds to the literature on the GI affinity of R. planticola and, with the results of the in silico analysis, suggests that potential novel risk factors for infection may be biliary tract stricture, cholecystitis, and prior surgery.
Availability of data and materials
No data or samples from the patient will be made available due to patient privacy.
Endoscopic retrograde cholangiopancreatography
Matrix-assisted laser desorption/ionization–time of flight
Magnetic resonance cholangiopancreatography
Non-culturable but viable state
Proton pump inhibitor
Ferragut C, Izard D, Gavini F, Kersters K, De Ley J, Leclerc H. Klebsiella trevisanii: a New Species from Water and Soil. Int J Syst Bacteriol. 1983;33(2):133–42. https://doi.org/10.1099/00207713-33-2-133.
Drancourt M, Bollet C, Carta A, Rousselier P. Phylogenetic analyses of Klebsiella species delineate Klebsiella and Raoultella gen. nov., with description of Raoultella ornithinolytica comb. Nov., Raoultella terrigena comb. Nov.. and Raoultella planticola comb nov. Int J Syst Evol Microbiol. 2001;51(3):925–32. https://doi.org/10.1099/00207713-51-3-925.
Alves MS, da Dias RC, de Castro ACD, Riley LW, Moreira BM. Identification of Clinical Isolates of Indole-Positive and Indole-Negative Klebsiella spp. J Clin Microbiol. 2006;44(10):3640–6.
Ponce-Alonso M, Rodríguez-Rojas L, del Campo R, Cantón R, Morosini M-I. Comparison of different methods for identification of species of the genus Raoultella: report of 11 cases of Raoultella causing bacteraemia and literature review. Clin Microbiol Infect. 2016;22(3):252–7.
Atıcı S, Alp Ünkar Z, Öcal Demir S, Akkoç G, Yakut N, Yılmaz Ş, et al. A rare and emerging pathogen: Raoultella planticola identification based on 16S rRNA in an infant. J Infect Public Health. 2018;11(1):130–2.
Xu M, Xie W, Fu Y, Zhou H, Zhou J. Nosocomial pneumonia caused by carbapenem-resistant Raoultella planticola: a case report and literature review. Infection. 2015;43(2):245–8. https://doi.org/10.1007/s15010-015-0722-9.
Zuberbuhler B, Abedin A, Roudsari A. A novel case of chronic conjunctivitis in a 58-year-old woman caused by Raoultella. Infection. 2014;42(5):927–9. https://doi.org/10.1007/s15010-014-0624-2.
Vassallo J, Vella M, Cassar R, Caruana P. Four cases of Raoultella planticola conjunctivitis. Eye. 2016;30(4):632–4. http://www.nature.com/articles/eye2015260
Pavlovic M, Konrad R, Iwobi AN, Sing A, Busch U, Huber I. A dual approach employing MALDI-TOF MS and real-time PCR for fast species identification within the Enterobacter cloacae complex. FEMS Microbiol Lett. 2012;328(1):46–53. https://doi.org/10.1111/j.1574-6968.2011.02479.x.
Alves S, Ribeiro R, Ventura AS, Bargiela I, Cruz MT. Raoultella planticola infections — A casousist of a rare infection. Eur J Intern Med. 2013;24:e224.
Tang H, Wu A, Song J, Yang L, Chen D, Lin Y. Extensively drug-resistant Raoultella planticola carrying multiple resistance genes including blaNDM-1. JMM Case Reports. 2014;1:3. https://doi.org/10.1099/jmmcr0.000265.
Cho YJ, Jung EJ, Seong JS, Woo YM, Jeong BJ, Kang YM, et al. A case of pneumonia caused by Raoultella planticola. Tuberc Respir Dis (Seoul). 2016;79(1):42. https://doi.org/10.4046/trd.2016.79.1.42.
Bardellini E, Amadori F, Schumacher RF, Foresti I, Majorana A. A new emerging oral infection: Raoultella planticola in a boy with haematological malignancy. Eur Arch Paediatr Dent. 2017;18(3):215–8. https://doi.org/10.1007/s40368-017-0279-7.
Piperaki E-T, Syrogiannopoulos GA, Tzouvelekis LS, Daikos GL. Klebsiella pneumoniae. Pediatr Infect Dis J. 2017;36(10):1002–5. http://insights.ovid.com/crossref?an=00006454-201710000-00022
Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ. Basic local alignment search tool. J Mol Biol. 1990;215(3):403–10.
Wu CH. The Universal Protein Resource (UniProt): an expanding universe of protein information. Nucleic Acids Res. 2006;34(90001):D187-91. https://doi.org/10.1093/nar/gkj161.
Markowitz VM. The integrated microbial genomes (IMG) system. Nucleic Acids Res. 2006;34(90001):D344-8. https://doi.org/10.1093/nar/gkj024.
Highsmith AK, Jarvis WR. Klebsiella pneumoniae: Selected Virulence Factors that Contribute to Pathogenicity. Infect Control. 1985;6(02):75–7. https://www.cambridge.org/core/product/identifier/S0195941700062640/type/journal_article
NCBI. Raoultella planticola ATCC 33531. https://www.ncbi.nlm.nih.gov/genome/11487?genome_assembly_id=204701
NCBI. KPHS_01320 lipopolysaccharide biosynthesis protein WzzE [ Klebsiella pneumoniae subsp. pneumoniae HS11286 ]. 2017. https://www.ncbi.nlm.nih.gov/gene/11845113
NCBI. O-acetyltransferase [Klebsiella pneumoniae subsp. pneumoniae B5055]. 2013. https://www.ncbi.nlm.nih.gov/protein/513501709
UniProtKB. UniProtKB - P42218 (KPSS5_ECOLX). 2018. https://www.uniprot.org/uniprot/P42218
NCBI. NCgl1186 uncharacterized protein related to capsule biosynthesis enzyme [ Corynebacterium glutamicum ATCC 13032 ]. 2018. https://www.ncbi.nlm.nih.gov/gene/1019216
UniProtKB. UniProtKB - W9BB52 (W9BB52_KLEPN). 2018. https://www.uniprot.org/uniprot/W9BB52
Gillespie SH, Hawkey PM, Hart AC. Principles and Practice of Clinical Bacteriology Second Edition. In: 2nd ed. Liverpool: Ltd, Wiley; 2006. p. 379.
Huynh DTN, Kim A-Y, Kim Y-R. Identification of Pathogenic Factors in Klebsiella pneumoniae Using Impedimetric Sensor Equipped with Biomimetic Surfaces. Sensors. 2017;17(6):1406. http://www.mdpi.com/1424-8220/17/6/1406
UniProtKB. UniProtKB - P0AEU9 (SKP_ECO57). 2018. https://www.uniprot.org/uniprot/P0AEU9
IMG JGI. Gene Detail: periplasmic chaperone for outer membrane proteins SurA. 2018. https://img.jgi.doe.gov/cgi-bin/m/main.cgi?section=GeneDetail&page=geneDetail&gene_oid=2546385592
Markowitz VM, Chen I-MA, Palaniappan K, Chu K, Szeto E, Grechkin Y, et al. The integrated microbial genomes system: an expanding comparative analysis resource. Nucleic Acids Res. 2010;38(suppl_1):D382–90. https://academic.oup.com/nar/article-lookup/doi/https://doi.org/10.1093/nar/gkp887
Björnsson ES, Kalaitzakis E. Recent advances in the treatment of primary sclerosing cholangitis. Expert Rev Gastroenterol Hepatol. 2020. https://doi.org/10.1080/17474124.2021.1860751.
Dadhwal US, Kumar V. Benign bile duct strictures. Med J Armed Forces India. 2012;68(3):299–303. https://linkinghub.elsevier.com/retrieve/pii/S037712371200055X
Gupta E, Chakravarti A. Viral infections of the biliary tract. Saudi J Gastroenterol. 2008;14(3):158. http://www.saudijgastro.com/text.asp?2008/14/3/158/41740
Anderson GG, Palermo JJ, Schilling JD, Roth R, Heuser J, Hultgren SJ. Intracellular bacterial biofilm-like pods in urinary tract infections. Science. 2003;301(5629):105–7.
Thornton RB, Rigby PJ, Wiertsema SP, Filion P, Langlands J, Coates HL, et al. Multi-species bacterial biofilm and intracellular infection in otitis media. BMC Pediatr. 2011;11(1):94. https://doi.org/10.1186/1471-2431-11-94.
Freney J, Gavini F, Alexandre H, Madier S, Izard D, Leclerc H, et al. Nosocomial infection and colonization by Klebsiella trevisanii. J Clin Microbiol. 1986;23(5):948–50.
Alves MS, Riley LW, Moreira BM. A case of severe pancreatitis complicated by Raoultella planticola infection. J Med Microbiol. 2007;56(5):696–8. https://doi.org/10.1099/jmm.0.46889-0.
Castanheira M, Deshpande LM, DiPersio JR, Kang J, Weinstein MP, Jones RN. First Descriptions of blaKPC in Raoultella spp. (R. planticola and R. ornithinolytica): Report from the SENTRY Antimicrobial Surveillance Program. J Clin Microbiol. 2009;47(12):4129–30. https://doi.org/10.1128/JCM.01502-09.
O’ Connell K, Kelly J, NiRiain U. A Rare Case of Soft-Tissue Infection Caused by Raoultella planticola. Case Rep Med. 2010;2010:1–2. http://www.hindawi.com/journals/crim/2010/134086/
Wolcott R, Dowd S. Molecular diagnosis of Raoultella planticola infection of a surgical site. J Wound Care. 2010;19(8):329–32. https://doi.org/10.12968/jowc.2010.19.8.77710.
Yokota K, Gomi H, Miura Y, Sugano K, Morisawa Y. Cholangitis with septic shock caused by Raoultella planticola. J Med Microbiol. 2012;61(3):446–9. https://doi.org/10.1099/jmm.0.032946-0.
Kim S-H, Roh KH, Yoon YK, Kang DO, Lee DW, Kim MJ, et al. Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola. BMC Infect Dis. 2012;12(1):59. https://doi.org/10.1186/1471-2334-12-59.
Teo I, Wild J, Ray S, Chadwick D. A Rare Case of Cholecystitis Caused by Raoultella planticola. Case Rep Med. 2012;2012:1–3. http://www.hindawi.com/journals/crim/2012/601641/
Hu AY, Leslie KA, Baskette J, Elsayed S. Raoultella planticola bacteraemia. J Med Microbiol. 2012;61(Pt_10):1488–9. https://doi.org/10.1099/jmm.0.041129-0.
Olson DS, Asare K, Lyons M, Hofinger DM. A novel case of Raoultella planticola urinary tract infection. Infection. 2013;41(1):259–61. https://doi.org/10.1007/s15010-012-0294-x.
Puerta-Fernandez S, Miralles-Linares F, Sanchez-Simonet MV, Bernal-Lopez MR, Gomez-Huelgas R. Raoultella planticola bacteraemia secondary to gastroenteritis. Clin Microbiol Infect. 2013;19(5):E236-7.
Koukoulaki M, Bakalis A, Kalatzis V, Belesiotou E, Papastamopoulos V, Skoutelis A, et al. Acute prostatitis caused by Raoultella planticola in a renal transplant recipient: a novel case. Transpl Infect Dis. 2014;16(3):461–4. https://doi.org/10.1111/tid.12213.
Lam PW, Salit IE. Raoultella planticola Bacteremia Following Consumption of Seafood. Can J Infect Dis Med Microbiol. 2014;25(4):e83–4. http://www.hindawi.com/journals/cjidmm/2014/439598/
Salmaggi C, Ancona F, Olivetti J, Pagliula G, Ramirez GA. Raoultella planticola-associated cholangitis and sepsis: a case report and literature review. QJM. 2014;107(11):911–3. https://doi.org/10.1093/qjmed/hcu087.
Ershadi A, Weiss E, Verduzco E, Chia D, Sadigh M. Emerging pathogen: a case and review of Raoultella planticola. Infection. 2014;42(6):1043–6. https://doi.org/10.1007/s15010-014-0638-9.
González-González L, Álvarez-Otero J, Lamas Ferreiro JL, de la Fuente Aguado J. Cholangitis and bacteraemia caused by Raoultella planticola. Med Clin (Barc). 2015;144(5):231–2.
Gangcuangco LMA, Saul ZK. A novel case of Raoultella planticola urinary tract infection in a female: comment on ‘Nosocomial pneumonia caused by carbapenem-resistant Raoultella planticola: a case report and literature review’. Infection. 2015;43(5):621–2. https://doi.org/10.1007/s15010-015-0790-x.
Yoon JH, Ahn YH, Chun JI, Park HJ, Park B-K. Acute Raoultella planticola cystitis in a child with rhabdomyosarcoma of the bladder neck. Pediatr Int. 2015;57(5):985–7. https://doi.org/10.1111/ped.12677.
Kim SW, Kim JE, Hong YA, Ko GJ, Pyo HJ, Kwon YJ. Raoultella planticola peritonitis in a patient on continuous ambulatory peritoneal dialysis. Infection. 2015;43(6):771–5. https://doi.org/10.1007/s15010-015-0788-4.
Gian J, Cunha BA. Raoultella planticola chronic bacterial prostatitis with prostatic calcifications: successful treatment with prolonged fosfomycin therapy. Int J Antimicrob Agents. 2016;47(5):414.
Kruszewski BD, Adhyaru B. Emerging Pathogens: A Case of Raoultella planticola UTI. J Hosp Med. 2017; https://www.shmabstracts.com/abstract/emerging-pathogens-a-case-of-raoultella-planticola-uti/
Adjodah C, D’Ivernois C, Leyssene D, Berneau J-B, Hemery Y. A cardiac implantable device infection by Raoultella planticola in an immunocompromized patient. JMM Case Reports. 2017;4:2. https://doi.org/10.1099/jmmcr.0.005080.
Skelton WP, Taylor Z, Hsu J. A rare case of Raoultella planticola urinary tract infection in an immunocompromised patient with multiple myeloma. IDCases. 2017;8:9–11.
Howell C, Fakhoury J. A case of Raoultella planticola causing a urinary tract infection in a pediatric patient. Transl Pediatr. 2017;6(2):102–3. http://tp.amegroups.com/article/view/14478/14641
Tuğcu M, Ruhi C, Gokce AM, Kara M, Aksaray S. A case of urinary tract infection caused by Raoultella planticola after a urodynamic study. Brazilian J Infect Dis. 2017;21(2):196–8.
Povlow MR, Carrizosa J, Jones A. Raoultella planticola: Bacteremia and Sepsis in a Patient with Cirrhosis. Cureus. 2017. http://www.cureus.com/articles/6413-raoultella-planticola-bacteremia-and-sepsis-in-a-patient-with-cirrhosis
Subedi R, Dean R, Li W, Dhamoon A. A novel case of Raoultella planticola osteomyelitis and epidural abscess. BMJ Case Rep. 2017;bcr-2017-220329. http://casereports.bmj.com/lookup/doi/https://doi.org/10.1136/bcr-2017-220329
Kalaria SS, Elliott K, Combs N, Phillips LG. Raoultella planticola: a rare cause of wound infection. Wounds a Compend Clin Res Pract. 2017;29(11):E103-5.
UniProtKB. UniProtKB - P0AF96 (TABA_ECOLI). 2018. https://www.uniprot.org/uniprot/P0AF96
Domka J, Lee J, Wood TK. YliH (BssR) and YceP (BssS) regulate Escherichia coli K-12 biofilm formation by influencing cell signaling. Appl Environ Microbiol. 2006;72(4):2449–59.
Knight SD, Bouckaert J. Structure, Function, and Assembly of Type 1 Fimbriae. In 2009. p. 67–107. http://link.springer.com/https://doi.org/10.1007/128_2008_13
The authors would like to thank Yatinder Baines, MD (Jersey City Medical Center, New Jersey), Keshav M. Shivashankar, MD (Clara Maass Medical Center, New Jersey), and Susan M. Blihar-Schneider (Wisconsin) for their contributions to the conceptualization of this manuscript.
This case report did not receive any funding.
Ethics approval and consent to participate
Ethical approval was waived for this case report by St George’s University Institutional Review Board.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors report no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Blihar, D., Phuu, P., Kotelnikova, S. et al. Bacteremic cholangitis due to Raoultella planticola complicating intrahepatic bile duct stricture 5 years post-laparoscopic cholecystectomy: a case report. J Med Case Reports 15, 152 (2021). https://doi.org/10.1186/s13256-021-02762-0
- Raoultella planticola
- Intrahepatic bile ducts
- Gall bladder resection