Abstract We report the first documented case of Yersinia ruckeri isolated from a wound infection, in a 16-year-old male after hitting a stone while paddling in a river

A De Bel

D Pi Erard

G Wauters

M Janssens

S De Keukeleire

Y Jansen

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Yersinia ruckeri, an unusual
microorganism isolated from a
human wound infection
S. De Keukeleire1,, A. De Bel1, Y. Jansen2, M. Janssens3, G.
Wauters3 and D. Pierard1
1) Department of Microbiology and Infection Control, 2) Department of
Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), and
3) National Reference Centre for Yersinia, Secteur des sciences de la sante –
Pôle de Microbiologie Medicale, Universite Catholique de Louvain, Brussels,
Belgium
Abstract
We report the first documented case of Yersinia ruckeri isolated
from a wound infection, in a 16-year-old male after hitting a stone
while paddling in a river.
Keywords: Human, MALDI-TOF MS, wound infection, Yersinia
ruckeri
Original Submission: 10 February 2014; Revised Submission:
21 May 2014; Accepted: 26 May 2014
Article published online: 19 June 2014
New Microbe and New Infect 2014; 2: 134–135
Corresponding author: S. De Keukeleire, Department of
Microbiology and Infection Control, Universitair Ziekenhuis Brussel,
Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels,
Belgium
E-mail: stevendekeukeleire@hotmail.com
Introduction
An adolescent male consulted his general physician to suture a
deep wound of his left lower leg (day 1) after hitting a stone
while paddling in a river in the Ardennes; a region in the
southeast of Belgium. The next day, he presented at the
Emergency Department for evaluation of the wound (day 0).
The lesion felt warm, painful and was accompanied by cellulitis.
The patient had no fever. Laboratory findings showed a slightly
raised level of C-reactive protein of 14.5 mg/L (reference value
<5 mg/L) and a white blood cell count of 12.9 9 103/mm3
with an absolute neutrophilia of 8.462 9 103/mm3 (reference
value 1.4 9 103 to 6.7 9 103/mm3). No systemic complica-
tions were recorded. A gauze wick soaked in topical antiseptic
solution (povidone-iodine) was placed after the abscess was
opened and intravenous amoxicillin–clavulanic acid (4 9 1 g/
day) was started as empirical antibiotic therapy.
Wound swabs were cultured on MacConkey agar, Trypti-
case Soy Agar-based medium enriched with 5% horse blood
with 20 mg/L haemin (Hem side) or 40 mg/L nalidixic acid (NaI
side) (Hem/Nal agar) and on an anaerobic agar enriched with
5% defibrinated horse blood. Identification took place using
matrix-assisted laser desorption ionization time-of-flight mass
spectrometry (MALDI-TOF MS; Microflex, Bruker Daltonik
GmbH, Bremen, Germany) by direct transfer method and in
combination with database version 3.3.1.0 (Bruker, Daltonik
GmbH) and security relevant (SR) database. 16S rRNA
sequencing was performed at the National Reference Centre
for Yersinia using the method described by O’Neill et al. [1,2].
Phenotypic characteristics were determined using conven-
tional methods [3]. Antibiotic susceptibility was performed on
Mueller–Hinton agar by the EUCAST methodology.
After 24 h of incubation, cultures of the infected wound
yielded a mixed culture. MALDI-TOF MS analysis of each
colony type showed the presence of Aeromonas spp., Lactoba-
cillus spp., Clostridium perfringens and Yersina ruckeri. The latter
showed small (1-mm diameter) non-pigmented circular colo-
nies on MacConkey agar and Hem/Nal agar and flat to convex
colonies on anaerobic agar. Growth was optimal between 25
and 30°C. The MALDI-TOF MS log score was: best match
Y. ruckeri 1.969 and second-best match Yersinia pestis (log score
1.887). Yersinia pseudotuberculosis came out as third species on
the sixth place (log score 1.726). Identification was confirmed
by the National Reference Centre Yersinia. 16S rRNA gene
sequence analysis of the strain revealed the highest similarity
(100%) to Y. ruckeri strain PIC 8 and 99.8% similarity to
Y. ruckeri type strain (ATCC29473).
The strain fitted the conventional phenotypic characteristics
of Enterobacteriaceae spp., e.g. oxidase-negative, cata-
lase-positive fermenting gram-negative rods. Glucose and
mannitol were acidified without gas production, but sucrose,
xylose, rhamnose and melibiose were negative. Urease, esculin
hydrolysis, indole and H2S production and Voges–Proskauer
reaction were negative. Simmons’ citrate was delayed positive.
In contrast to almost all other Yersinia species, lysine decar-
boxylase and gelatine hydrolysis were positive [3–5]. Antimi-
crobial susceptibility testing showed sensitivity to ampicillin,
amoxillin/clavulanic acid, piperacillin/tazobactam, temocillin,
cefazolin, cefuroxime, ceftriaxone, ceftazidime, ceftazidime/
clavulanic acid, cefepime, cefepime/clavulanic acid, merope-
nem, aztreonam, gentamicin, amikacin and ciprofloxacin. At
day +3 the patient could be discharged from the hospital with
daily local wound care and an equivalent oral antibiotic
ª 2014 The Authors. New Microbes and New Infections published by John Wiley & Sons Ltd on behalf of the European Society of Clinical Microbiology and Infectious Disease.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use,
distribution and reproduction in any medium, provided the original work is properly cited.
NEW MICROBES IN HUMANS – NEW RESISTANT MICROBES IN HUMANS 10.1002/nmi2.56
regimen. At follow-up consultations at day +10 no signs of
infection were present, so local treatment was switched to
local wound care and antibiotics were discontinued. At
consultation +20 complete healing of the wound was
observed.
Curiously, Y. ruckeri was first described as the causative
agent of yersinosis or enteric red mouth disease, which affects
mainly salmonid fish [6–11]. Infections due to Y. ruckeri cause
high mortalities in fish aquaculture systems, especially in
rainbow trout (Oncorhynchus mykiss), leading to significant
economic losses in the fish farming industry [9,11,12]. The
bacterium is shed in the faeces of infected fish and the disease
can be transmitted by water. Yersinia ruckeri is able to survive
for long periods of time (more than 4 months), especially after
an outbreak of the disease [10,13]. Yersinia ruckeri remains
infective in an aquatic environment, mainly associated with
poor water quality [11,12]. The strain has the ability to adhere
on solid surfaces and to form biofilms [12,14]. This case report
underlines the high discriminative power of MALDI-TOF MS.
The potential pathogenicity of Y. ruckeri in human wound
infections remains unanswered and further evaluation is
needed. In this case it remains unclear whether Y. ruckeri or
another bacterium (Aeromonas spp., Lactobacillus spp. or
Clostridium perfringens) caused the infection. Nevertheless, to
the best of our knowledge, isolation of Y. ruckeri from human
wounds or biopsies and its possible association with infection
in humans was never previously described.
Acknowledgements
The 16S rRNA fragment of Y. ruckeri was submitted to
GenBank under reference number KJ192333.
Conflict of Interest
None declared.
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ª 2014 The Authors. New Microbes and New Infections published by John Wiley & Sons Ltd on behalf of the European Society of Clinical Microbiology and Infectious Disease., NMNI, 2, 134–135
NMNI De Keukeleire et al. Yersinia ruckeri, an unusual microorganism isolated from a human wound infection 135


Yersinia ruckeri, an unusual microorganism isolated from a human wound infection

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Yersinia ruckeri, an unusual microorganism isolated from a human wound infection

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