R. aquatilis was first described in 1976 by Gavini and colleagues at Institut Pasteur. The name
Rahnella is derived from the name of bacteriologist Otto Rahn, while “
aquatilis” is derived from the Latin term for water [
3]. The first clinical isolate of
R. aquatilis was reported to the Center for Disease Control and Prevention in 1985 [
4]. Most cases of
R. aquatilis infection have been reported in compromised hosts or young children [
5,
6]. A case of iatrogenic inoculation by contaminated intravenous fluid also been reported in a healthy adult [
7]. The history of
R. aquatilis since its discovery is relatively short; only a few pathological manifestations of the organism are understood, and it is confused with
Pantoea agglomerans because of similarity in biochemical characteristics [
8]. However,
Rahnella does have a few characteristic traits and has now been included in commercial databases for easier detection in clinical and environmental samples. Currently, the VITEK, BBL Crystal ID, and API 20E systems include
R. aquatilis in their databases, and identification of the organism is relatively easy [
7]. To our knowledge, there are approximately 20 to 30 case reports of
R. aquatilis infection in humans. Except for a few, most of these cases —including the present case— involve patients with diabetes mellitus, alcoholism, acquired immune deficiency syndrome, or cancer, which indicates that this organism might cause opportunistic infections.
R. aquatilis has been isolated from blood, wound, urine, respiratory tract, and stool samples [
5]. Although the origin of the
R. aquatilis strain isolated from our patient is unclear, catheter related blood stream infection (CRBSI) was suspected clinically because fever and chill were developed in a patient with central venous catheter without any localizing sign [
8]. Unfortunately, we could not get any definitive evidence of CRBSI. One possible reason is that appropriate blood culture – peripheral venous blood collection accompanied with central catheter blood collection – was not performed on febrile day. Another possible reason is that antibiotics was injected via chemoport before blood culture was drawn through a chemoport. Interestingly, the present patient performed farm work during chemotherapy, as a hobby to improve her well-being. Although we did not perform any epidemiological study at her farm, we suspect that fresh water near the farm could be the primary source of infection. Regarding the possibility that this was a nosocomial infection, the present case was the only one of
R. aquatilis being isolated from clinical specimens at our hospital; therefore, we did not consider that this could be an outbreak, as seen in other case [
9]. The present patient was treated with a short-term intravenous antibiotic regimen and a longer duration of oral antibiotic regimen, followed by removal of the chemoport after completion of her scheduled chemotherapy. Generally,
R. aquatilis is known to possess a chromosomally encoded extended-spectrum antimicrobial resistance; for this reason, it is recommended to avoid beta-lactam-based treatment regimens, with the exception of some active agents. However, an
R. aquatilis strain with sensitivity towards beta-lactam antibiotics has been isolated in specimens from a surgical wound [
10]; the isolate in the present case, too, exhibited similar drug sensitivity characteristics.
R. aquatils has also been reported to exhibit sensitivity towards quinolones, carbapenems, and trimethoprim–sulfamethoxazole, which, therefore, appear to be attractive treatment choices [
11]. Although
R. aquatilis is an environmental organism, underestimating the importance its discovery in clinical culture specimens might be dangerous because of its ability to cause diseases and even sepsis [
12-
14]. Since the chances of exposure to
R. aquatilis are relatively high, its significance in public health should not be underestimated [
15]. At the time of this publication, there were no reports of
Rahnella-associated mortality.