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      Pantoea agglomerans Infections in Children: Report of Two Cases

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          Abstract

          Introduction

          Pantoea agglomerans, primarily an environmental and agricultural organism has been reported as both commensal and pathogen of humans. We present two case reports of P. agglomerans infections in children that involved the meninges and bloodstream.

          Case Presentations

          A 6-month-old female baby, diagnosed as congenital hydrocephalus secondary to aqueduct stenosis with ventriculoperitoneal shunt in situ, operated 14 days back was brought to the pediatric emergency with a two-day history of high fever associated with vomiting, irritability, excessive crying, and decreased feeding. Postoperative meningitis was confirmed as cerebrospinal fluid culture revealed P. agglomerans. She responded well with a 14-day intravenous (IV) course of ceftriaxone. Also, we report a case of a 3-year-old male child referred to our center with a provisional diagnosis of UTI with chickenpox for further evaluation. During his 24-hour stay at the local hospital, he had received oral antibiotics and urinary catherization. Urine culture of catheter clamp urine was sterile. P. agglomerans was grown in blood culture. He was treated successfully with IV ceftriaxone and amikacin.

          Conclusion

          P. agglomerans can cause postsurgical meningitis and bloodstream infection in children. The clinical course of infection was mild and timely administration of proper antibiotic resulted in a favorable outcome.

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          Most cited references9

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          Pantoea agglomerans, a plant pathogen causing human disease.

          We present 53 pediatric cases of Pantoea agglomerans infections cultured from normally sterile sites in patients seen at a children's hospital over 6 years. Isolates included 23 from the bloodstream, 14 from abscesses, 10 from joints/bones, 4 from the urinary tract, and 1 each from the peritoneum and the thorax. P. agglomerans was most associated with penetrating trauma by vegetative material and catheter-related bacteremia.
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            Transfer of Enterobacter agglomerans (Beijerinck 1888) Ewing and Fife 1972 to Pantoea gen. nov. as Pantoea agglomerans comb. nov. and Description of Pantoea dispersa sp. nov.

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              An outbreak of Pantoea spp. in a neonatal intensive care unit secondary to contaminated parenteral nutrition.

              Contaminated parenteral nutrition (PN) is an important source of infection in neonates. Many organisms have been reported to cause contamination that results in outbreaks in intensive care units. The objective of this study was to investigate an outbreak caused by Pantoea spp., which contaminates PN, in a neonatal intensive care unit (NICU). This was a descriptive study of an outbreak of sepsis in an NICU of a tertiary teaching hospital in Malaysia. Pantoea spp. infection was detected in eight patients over a three-day period from 24 to 27 January 2004 following the administration of PN. Seven of the eight patients died due to the infection. Extensive environmental samplings for culture were performed. PN solution from the NICU and the pharmacy were also cultured during the outbreak period. Pantoea spp. was isolated from blood cultures of all infected patients, and the unused PN from the pharmacy and the NICU. All the strains of Pantoea spp. had a similar antibiotic susceptibility pattern and biochemical reaction. From the results, we concluded that PN was the source of the outbreak and the contamination may have occurred during its preparation in the pharmacy. A thorough investigation has been carried out and, where possible, corrective measures have been taken to avoid similar outbreaks in the future.
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                Author and article information

                Contributors
                Journal
                Case Rep Pediatr
                Case Rep Pediatr
                CRIPE
                Case Reports in Pediatrics
                Hindawi
                2090-6803
                2090-6811
                2018
                21 January 2018
                : 2018
                : 4158734
                Affiliations
                1Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
                2Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
                Author notes

                Academic Editor: Larry A. Rhodes

                Author information
                http://orcid.org/0000-0002-7375-4810
                Article
                10.1155/2018/4158734
                5828082
                29527373
                e49387cd-9c96-4f78-93ca-7e5f68a19067
                Copyright © 2018 Shraddha Siwakoti et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 September 2017
                : 16 December 2017
                : 3 January 2018
                Categories
                Case Report

                Pediatrics
                Pediatrics

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