Identification of Pantoea agglomerans in a patient with chronic abdominal sinus.

Abstract

Introduction and importance: Pantoea agglomerans, a yellow-pigmented, gram-negative aerobic non-sporing bacillus belonging to the family Enterobacteriaceae, is an opportunistic pathogen often associated with infections in immunocompromised individuals. This report highlights a case of P. agglomerans identified in the peritoneal fluid of a 35-year-old female with a chronic abdominal sinus. The organism was sensitive to most antibiotics, and the patient responded well to empirical treatment with cefoperazone/sulbactum. This case underscores the importance of accurate microbial identification in guiding effective treatment strategies. The patient was well managed at a tertiary care setting in an academic institute.

Clinical presentation: A 35-year-old female with a history of abdominal tuberculosis diagnosed 1.5 years ago and treated with anti-tubercular therapy (ATT) presented to the OPD with persistent lower abdominal pain, high-grade fever, and distension for two months. She later developed an inflammatory umbilical lesion with fever, followed by a discharging sinus in the left lower abdomen. Her medical history is unremarkable, with no significant past surgical interventions, smoking, alcohol use, or comorbidities.

Case discussion: Pantoea agglomerans, an environmental organism commonly found in plants, soil, and water, is a low-virulence pathogen that can cause infections in immunocompromised individuals or after invasive procedures. It has been associated with wound infections, abscesses, pneumonia, urinary tract infections, septic arthritis, and osteomyelitis. In this case, the patient's history of abdominal tuberculosis likely created a favourable environment for secondary infection, potentially facilitated by gastrointestinal translocation. Accurate identification using the VITEK system and successful treatment with cefoperazone/sulbactam highlight the importance of advanced diagnostics and appropriate antibiotic therapy.

Conclusion: This case highlights the importance of considering opportunistic pathogens like Pantoea agglomerans in chronic infections, emphasizing accurate microbial identification and susceptibility testing for effective therapy and optimal outcomes.