European Archives of Paediatric Dentistry

, Volume 18, Issue 3, pp 215–218 | Cite as

A new emerging oral infection: Raoultella planticola in a boy with haematological malignancy

  • E. BardelliniEmail author
  • F. Amadori
  • R. F. Schumacher
  • I. Foresti
  • A. Majorana
Case Report



Oral mucositis is a common complication in pediatric cancer patients, affecting up to 80% of children. Due to neutropenia and disruption of the mucosal barrier, chemotherapy-induced oral mucositis is often complicated by super-infections.

Case report

A 16-years old male with stage 3 Burkitt’s lymphoma developed chemotherapy induced oral mucositis grade 3 (according to WHO scale). Ulcers were quickly growing (reaching a maximum diameter of 3 cm) and became greyish in colour, resulting in dysphagia and pain. A swab of the lesions was taken and microbiological tests were performed. The sample grew for Raoultella planticola, an encapsulated Gram-negative bacterium whose full pathogenic potential still needs to be defined. Treatment: The patient received antibiotic combination therapy with Amikacin and Ceftazidime for 8 days. Complete healing of the lesions and resolution of the symptoms were reached and he completed his antineoplastic therapy without further complications. Follow-up: Twelve months after the infection, he is alive and well, with no oral complaints.


This is the first report of a Raoultella planticola infection in a patient with chemotherapy induced oral mucositis. This type of infection must be added to the list of organisms to be considered when caring for these patients.


Oral ulcer Infection Anti-neoplastic agents 


Compliance with ethical standards

Conflict of interest

The Authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in this study were in accordance with the ethical standards of the Declaration of Helsinki.

Informed consent

Informed consent from the patient’s parents for the publication of the case was taken.


  1. Alves MS, Riley LW, Moreira BM. A case of severe pancreatitis complicated by Raoultella planticola infection. J Med Microbiol. 2007;56:696–8.CrossRefPubMedGoogle Scholar
  2. Bardellini E, Schumacher F, Conti G, et al. Risk factors for oral mucositis in children receiving hematopoietic cell transplantation for primary immunodeficiences: a retrospective study. Pediatr Transpl. 2013;17:492–7.CrossRefGoogle Scholar
  3. Cho YJ, Jung EJ, Seong JS, et al. A case of pneumonia caused by Raoultella planticola. Tuberc Respir Dis (Seoul). 2016;79:42–5.CrossRefGoogle Scholar
  4. 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;51:925–32.CrossRefPubMedGoogle Scholar
  5. Elting LS, Cooksley C, Chambers M, et al. The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer. 2003;98(7):1531–9.CrossRefPubMedGoogle Scholar
  6. Ershadi E, Weiss E, Verduzco D, Chia D, Sadigh M. Emerging pathogen: a case and review of Raoultella planticola. Infection. 2014;42(6):1043–6.CrossRefPubMedGoogle Scholar
  7. Freney J, Fleurette J, Gruer LD, et al. Klebsiella trevisanii colonisation and septicaemia. Lancet. 1984;1:909.CrossRefPubMedGoogle Scholar
  8. Kim SH, Roh KH, Yoon YK, et al. Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola. BMC Infect Dis. 2012;12:59.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Lam PW, Salit IE. Raoultella planticola bacteremia following consumption of seafood. Can J Infect Dis Med Microbiol. 2014;25(4):e83–4.PubMedPubMedCentralGoogle Scholar
  10. Mertens K, Mns K, Loennies S, et al. Antiserum against Raoultella terrigena ATCC 33257 identifies a large number of Raoultella and Klebsiella clinical isolates as serotype O12. Innate Immun. 2010;16(6):366–80.CrossRefPubMedGoogle Scholar
  11. Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH. Manual of clinical microbiology. 8th ed. Washington DC: ASM Press; 2007.Google Scholar
  12. Nesher L, Rolston KV. The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection. 2014;42(1):5–13.CrossRefPubMedGoogle Scholar
  13. O’Connell K, Kelly J, Niriain U. A rare case of soft-tissue infection caused by Raoultella planticola. Case Rep Med. 2010;. doi: 10.1155/2010/134086 (epub 2010 Aug 1).Google Scholar
  14. Olson DS Jr, Asare K, Lyons M, Hofinger DM. A novel case of Raoultella planticola urinary tract infection. Infection. 2013;41(1):259–61.CrossRefPubMedGoogle Scholar
  15. Podschun R, Acktun H, Okpara J, et al. Isolation of Klebsiella planticola from newborns in a neonatal ward. J Clin Microbiol. 1998;36:2331–2.PubMedPubMedCentralGoogle Scholar
  16. 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:E236–7. doi: 10.1111/1469-0691.12102 CrossRefPubMedGoogle Scholar
  17. Sonis ST, Elting LS, Keefe D, et al. Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100:1995–2025.CrossRefPubMedGoogle Scholar
  18. Westbrook GL, O’Hara CM, Roman SB, Miller JM. Incidence and identification of Klebsiella planticola in clinical isolates with emphasis on newborns. J Clin Microbiol. 2000;38:1495–7.PubMedPubMedCentralGoogle Scholar
  19. Yokota K, Gomi H, Miura Y, Sugano K, Morisawa Y. Cholangitis with septic shock caused by Raoultella planticola. J Med Microbiol. 2012;61:446–61.CrossRefPubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2017

Authors and Affiliations

  • E. Bardellini
    • 1
    Email author
  • F. Amadori
    • 1
  • R. F. Schumacher
    • 2
  • I. Foresti
    • 3
  • A. Majorana
    • 1
  1. 1.Department Oral Medicine and Paediatric DentistryDental Clinic, University of BresciaBresciaItaly
  2. 2.Paediatric Haematology-Oncology UnitSpedali Civili di BresciaBresciaItaly
  3. 3.Microbiology DepartmentSpedali Civili di BresciaBresciaItaly

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