Gram Negative Rods of Kluyvera intermedia in Gram Staining of Culture
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An 80- year- old man with painful urination was requested for testing Urine Routine Examination (R/E), Complete Blood Cell (CBC) count, Thyroid stimulating hormone (TSH), Prostate-specific antigen (PSA), Liver function test (LFT), Renal function test (RFT), Lipid profile test ( LPT), HbA1C, and Urine Culture and Sensitivity (C/S). The moderate number of pus cells (20-25/HPF) in Urine Microscopy with an abnormal level of TSH (10.88 μIU/mL), and PSA (8.4 ng/mL) with normal findings of LFT, RFT, LPT, HbA1C and CBC except polymorphonuclear cells (72%) and low level of lymphocytes (17%). Urine Culture showed 105CFU/mL of Kluyvera intermedia and antibiogram as shown in the image.
Kluvyvera intermedia is an aerobic, gram-negative, catalase-positive, flagellated bacterium. It was initially noticed by Kluyver and colleagues in 1936 as a distinctive group in the family Enterobacteriaceae. Asai et.al. later described a group of bacteria that they believed were the same as those identified by Kluyver et .al. They proposed the genus be named Kluyvera, only to later propose the removal of the genus since they believed the organism was phenotypically identical to Escherichia. In 1981, Farmer et. a. proposed that Kluyvera should exist as its own genus again.
The genus, Kluyvera has four species-K. ascorbata, K. cryocrescens, K. georgiana, and K. intermedia. Those are also part of the normal flora of the human gastrointestinal, respiratory, and urinary tracts, but it also found in the environment, particularly in water, soil, sewage, and hospital sinks. Despite being a part of the normal human flora, several case reports and literature reviews demonstrate the organism’s potential to be a significant pathogen, even if it is largely not encountered in clinical practice. Kluvyera is the etiological agent of urinary tract infection, bloodstream infection, intra-abdominal infection, soft tissue, respiratory tract, meningitis, and rectourethral fistula infections.
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