Raoultella Bacteremia Presenting as an Acute Self-Limited Il
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Raoultella species belong to the family Enterobacteriaceae and are known to inhabit water, soil, and plants. In humans, they have generally been considered harmless organisms of low virulence that occasionally colonize the gastrointestinal tract and upper respiratory tract, but rarely cause symptoms or infection even in oncologic or immunocompromised patients.

A 20-year-old female at 27-week gestation, with a past medical history significant for hypothyroidism and preterm delivery of a 20-week twin gestation, presented with threatened preterm delivery in the setting of known cervical shortening and new-onset uterine contractions. Cervical examination showed a 1 cm dilated cervix at 80% effacement and a fetal station of -2. Given ongoing contractions, the patient was admitted to the antepartum service. Tocolytics, corticosteroids, and magnesium for fetal neuroprotection were provided. Throughout her admission, fetal testing remained reassuring. Gestational diabetes was diagnosed during routine screening.

Due to continued intermittent contractions, progressive cervical shortening, and previous history of preterm labor, the patient remained in inpatient monitoring. Thirteen days following her initial presentation, the patient reported feeling general malaise as well as a presyncopal episode. The patient was placed on a fetal heart rate monitor revealing both maternal and fetal tachycardia which was unresponsive to an intravenous fluid bolus. Several hours later, she developed fevers, chills, and diffuse myalgias. At that point in time, she was febrile to 38.4°C. Marked tachycardia at 146 beats per minute and tachypnea and fetal tachycardia of 190 beats per minute were also noted. Physical exam was only significant for an infiltrated intravenous catheter in place for magnesium sulfate and fluid boluses as needed. Laboratory evaluation was significant for leukocytosis of 17.9 with a left shift and an elevated C-reactive protein of 37.2. A chest X-ray, urinalysis, and respiratory virus panel yielded no abnormalities.

Shortly following the onset of febrile illness, the patient reported a sense of impending doom. New-onset right lower quadrant abdominal pain was identified on physical examination, sparking concern for appendicitis. An abdominal ultrasound was nondiagnostic; magnetic resonance imaging was negative for acute appendicitis. A diagnostic amniocentesis confirmed the absence of chorioamnionitis, showing no organisms on gram stain or culture.

Initial gram staining on blood cultures revealed a gram-negative bacteremia . Empiric treatment with vancomycin and piperacillin-tazobactam was initiated. By that time however, less than 24 hours from initial symptom onset, all symptoms had resolved. The white blood cell count normalized, and the patient remained afebrile throughout the duration of her hospitalization.

Three days later, ampicillin/amoxicillin-resistant Raoultella was speciated from the blood cultures. Antibiotics were deescalated to ceftriaxone for seven days, with a total of ten days of antimicrobial therapy. Symptoms never returned, and the patient underwent a preterm delivery of a viable infant with weighing 1.695 kilograms via low transverse caesarean section four days following the acute illness. Placental pathology showed no acute inflammation as well as chorionic villi showing maturation consistent with gestational age.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025035/
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