Also see Raoultella Planticola -- changed 2001 from Klebsiella planticola
Klebsiella aerogenes (formerly Aerobacter aerogenes)
Enterobacter aerogenes (formerly Klebsiella aerogenes)
Klebsiella pneumoniae, Formerly known as Friedlander's bacillus; pneumobacillus.
Also known as aerobacter , Enterobacteria Aerogenes and BACILLUS FRIEDLANDER -- see below
A genus of bacteria of the family Enterobacteriaceae containing nonmotile, gram-negative, frequently encapsulated
rods that are arranged singly, in pairs, or in short chains. It includes some human pathogens.
Super bug kills dozens in hospitals across country
Published: 03.07.07, 09:53 / Israel News
"Between 400 to 500 people have been infected by the bug, and 30 to 40 percent of them have already died. However,
it is important to note that most of them were in a serious condition, and some were suffering from prior medical
conditions," said Prof. Yehuda Carmeli, the head of the epidemiology unit at the Sourasky Medical Center in Tel Aviv.
Deadly Superbugs in 2009
April 23, 2009 by Jenny Blake
In 2000, at Tisch Hospital in Brooklyn, NY, doctors were shocked to see Klebsiella,a deadly antibiotic resistant
superbug isolated from a single patient. The doctors realized that they were facing the first outbreak of Klebsiella ever
in the United States. Of the 34 patients infected, half died. (The New Yorker, 8/11/2008, Jerome Groupman) The
outbreak eventually ended, but only after extreme decontamination efforts on the part of hospital staff. This superbug
is still being seen and treated here in the U.S. in 2009.
Klebsiella - all species and all serotypes
Klebsiella ( a coliform & fecal coliform) are part of the Enterobacteriaceae family. Some serotypes
have become coliform superbugs immune to antibiotics. Infections include, but not limited to:
aneurysms, endocarditis, urinary tract infection, pneumonia, lung destruction, surgical wound
infections, blood infections (known as bacteremia), may progress to shock and death if not treated
early in an aggressive fashion, especially with necrotizing fasciitis, i.e., "flesh eating” infections. Now
produces poisonous Hydrogen Sulfide (H2S) gas.
In the legal article, “Klebsiella Pneumoniae Disease Injury Lawsuits”, Parker Waichman Alonso LLP,
stated, “Klebsiella pneumoniae is a common hospital-acquired infectious agent, causing urinary tract
and abdominal infections and hospital infected pneumonia. Klebsiella pneumoniae can be found in a
person’s mouth, skin, and intestines. Klebsiella is second to E. coli as the cause of urinary tract
infections. The reported number of cases is up approximately 50% in the last five years and there is a
66% mortality rate in untreated patients.” http://www.yourlawyer.com/
This information is not new. Joseph J. Curry, Assistant in Pathology, Harvard Medical School, was one
of the first to report on the pathogenic aspect of Klebsiella pneumoniae in 1898. Curry reported on
finding Klebsiella in Acute lobar pneumonia, Acute endocarditis, with gangrene of lung, Acute
croupous pneumnonia complicated with acute otitis media (middle ear infection), Fracture of the skull,
accompanied, by acute otitis media, throat infection, and Tonsillitis. He said, “Subcutaneous
inoculation of guiniea pigs was fatal in from 5 to 7 days. Intra-peritoneal injection was fatal in 24
In a 1990 study, “Klebsiella pneumoniae gastroenteritis masked by Clostridium perfringens,” R.P.
Rennie, et al., University of Saskatchewan at Saskatoon, reported, “An unusual food-borne outbreak of
gastroenteritis associated with contaminated turkey occurred at a catered company meal. The average
incubation period was 10 h, and the predominant symptoms were watery diarrhea and cramps.
Vomiting did not occur. Initial epidemiological features and cultures from turkey and feces of infected
patients suggested that the causative agent was Clostridium perfringens, but Klebsiella pneumoniae of
capsular type K15 was also isolated in large numbers from both the turkey and feces of the same
patients. Plasmid analysis and enterotoxin results supported the role of K. pneumoniae as the causative
agent in this outbreak. Organisms other than commonly identified pathogens should not be ignored if
present in high concentrations in both food and feces of infected persons.
In the 1998 study, “A new variant of food poisoning: enteroinvasive Klebsiella pneumoniae and
Escherichia coli sepsis from a contaminated hamburger.” J.M. Sabota, et al., Northeastern Ohio
Universities College of Medicine, Affiliated Hospitals at Canton, reported, “For the first time, we
report Klebsiella pneumoniae as an enteroinvasive food-borne pathogen transmitted from a
hamburger. A 28-year-old previously healthy African-American male ingested a portion of a hamburger
from a fast food chain. Symptoms of gastroenteritis rapidly deteriorated to multiorgan failure. Blood
and hamburger cultures grew Escherichia coli and Klebsiella pneumoniae. Since Klebsiella had not
previously been reported as enteroinvasive, the isolates were compared. Full biochemical profiles,
antimicrobial sensitivity, plasmid profile, and toxin assay by DNA hybridization probe were completely
concordant. The patient survived the episode of food-borne sepsis. Deliberate or inadvertent employee
contamination of food products with feces may be a potential source of life-threatening food-borne
illness. ” http://www.ncbi.nlm.nih.gov/pubmed/9448190
In a 2004 study, “Four cases of necrotizing fasciitis caused by Klebsiella species”, C.H. Wong, et al.,
said, “Presented here are four cases of necrotizing fasciitis caused by Klebsiella spp. that were treated
at one hospital over a 2-year period. Klebsiella necrotizing fasciitis can occur via direct inoculation,
local trauma or, more commonly, hematogenous spread from other septic foci. Early, aggressive,
surgical debridement and appropriate antimicrobial treatment are the cornerstones of treatment for this
condition. Necrotizing fasciitis due to Klebsiella spp. is unique in that it is commonly associated with
multiple septic foci. While liver abscesses and endogenous endophthalmitis are better-known
associations of disseminated Klebsiella infection, necrotizing fasciitis is increasingly recognized as one
of the manifestations of this syndrome. When treating Klebsiella necrotizing fasciitis, awareness of the
potential for multiorgan involvement should prompt a thorough search for associated foci of infection.”
In a 2004 study, “Outbreak of Klebsiella pneumoniae Producing a New Carbapenem-Hydrolyzing
Class A ß-Lactamase, KPC-3, in a New York Medical Center,” Neil Woodford, et al., reported,
“Twenty-four patients in ICUs at the Tisch Hospital, NYU Medical Center, were colonized or infected
with carbapenem-resistant K. pneumoniae between April 2000 and April 2001 (Table 2). Klebsiellae
with this phenotype had not been detected in the hospital previously. All infections were nosocomially
acquired, with the patients having been hospitalized from 9 to 374 days prior to isolation of the
organism. Risk factors for acquisition included prolonged hospitalization, an ICU stay, and ventilator
usage. Carbapenem-resistant organisms were isolated predominantly from respiratory secretions but
also from urine and blood. Fourteen of the 24 patients were infected, and 8 of these died, with the
Klebsiella infection considered causative or contributory.”
According to Jerome Groopman writing about the same outbreak in the August 11, 2008 edition of the
New Yorker, “Superbugs: The new generation of resistant infections is almost impossible to treat,”
there were actually thirty-four patients with infections that year and nearly half died.
In March 2007, a Klebsiella pneumoniae outbreak hit Israel health care facilities. According to Prof.
Yehuda Carmeli, the head of the epidemiology unit at the Sourasky Medical Center in Tel Aviv,
"Between 400 to 500 people have been infected by the bug, and 30 to 40 percent of them have already
died.” The average age was 74-75. http://www.ynetnews.com/articles/0,7340,L-3373478,00.html
In the 2011 Medscape article, “Klebsiella Infections” Obiamiwe Umeh, MBBS and Chief Editor:
Burke A Cunha, MD, state, “Klebsiellae are ubiquitous in nature. In humans, they may colonize the
skin, pharynx, or gastrointestinal tract. They may also colonize sterile wounds and urine. Carriage rates
vary with different studies. Klebsiellae may be regarded as normal flora in many parts of the colon and
intestinal tract and in the biliary tract. – Klebsiellae have also been incriminated in nosocomial
infections. Common sites include the urinary tract, lower respiratory tract, biliary tract, and surgical
wound sites. The spectrum of clinical syndromes includes pneumonia, bacteremia, thrombophlebitis,
urinary tract infection (UTI), cholecystitis, diarrhea, upper respiratory tract infection, wound infection,
osteomyelitis and meningitis” http://emedicine.medscape.com/article/219907-overview#a0104
The Bioinformatics Consortium of Taiwan, reports, “K. pneumoniae is a gram-negative enteric rod
pathogen that can cause septicemia in immunocompromised patients. However, in the past fifteen
years, it appears that there is a new clinical symptom of K. pneumoniae infection in Taiwan. Patients
that have liver abscess, when infected with K. pneumoniae, can acquire complications such as
metastatic meningitis or ophthalmitis. In addition, the new symptom brings about 10~30% mortality
rate even though patients are treated with appropriate antibiotics therapy.” http://cbs.ym.edu.tw/cbs-
Klebsiella in Animals
In the 1983 article “Isolation and Identification of Ropy Bacteria in Raw Milk”, B. A. CHEUNG and
D. C. WESTHOFF, University of Maryland, reported, “Approximately 4.2% of 4,000 Maryland-
Virginia raw milk tanker samples developed ropiness when incubated at 10°C. Of the 56 bacterial
isolates 30 were identified by species. Klebsiella oxytoca and Pseudomonas aeruginosa were isolated
most frequently. Other ropy isolates were identified as Pseudomonas spp., Chromobacterium,
Flavobacterium multivorum, presumptive gersinia pestis, Enterobacter agglomerans, Klebsiella
pneumoniae, and Pasteurella-Actinobacter spp. Six of the Klebsiella oxytoca isolates were mesophilic
(optimum temperatures of 32.0 to 37.8°C) with two isolates having psychrotrophic tendencies
(optimum temperature of 26.8°C). All Pseudomonas aeruginosa isolates appeared to be psychrotrophic
in their temperature requirements (optimum temperatures of 23.0 to 31.0°C).”
In the 2011 article, "Differentiation of Klebsiella pneumoniae and K. oxytoca by Multiplex Polymerase
Chain Reaction", Yogesh Chander, et al., College of Veterinary Medicine, University of Minnesota at
Saint Paul, reported, "In animals, Klebsiella are mostly associated with sepsis, infections of urinary and
respiratory tracts, and mastitis. These disease syndromes cause serious economic consequences in some
cattle herds. In fact, clinical mastitis due to Klebsiella infections result in higher milk losses than those
due to Escherichia coli and may also result in the death of the affected cows. Both K. pneumoniae and
K. oxytoca are frequently isolated from domestic animals."
According to John Hobkins Medicine, Noreen A. Hynes, M.D., M.P.H., D.T.M.&H., states, “Klebsiella
granulomatis (formerly known as Calymmatobacterium granulomatis) is a member of the family
Enterobacteriaceae; reclassification is based upon nucleotide relatedness to other Klebsiella spp.
especially to K. rhinoscleromatis, another tropical infection (nasal). – Organism is difficult to
demonstrate microbiologically because it does not grow on any standard microbiological laboratory
In a 2009 letter to the editor, “Enteric Fever-Like Syndrome Caused by Raoultella ornithinolytica
(Klebsiella ornithinolytica),” Victoria Pulian Morais, et al., Microbiology Service Complexo
Hospitalario de Pontevedra, reported, “Raoultella ornithinolytica (formerly Klebsiella ornithinolytica)
is a gram-negative aerobic bacillus in the family Enterobacteriaceae. This species has been related to
histamine-producing bacteria causing subsequent fish poisoning (5). R. ornithinolytica has also been
isolated from dentin of infected root canals (8). However, human infections caused by bacteria of the
genus Raoultella are infrequent, and spontaneously occurring bacteremia cases have not been reported.
Here, we present a case of enteric fever-like syndrome and bacteremia caused by R. ornithinolytica.”
In a 2009 study, “Isolation and characterization of Raoultella ornithinolytica from Clinical Specimens
in Hilla city, Iraq,” Samir M. Al-Hulu, et al., Babylon University, College of Medicine, Department of
Microbiology, reported, “A total of 720 clinical samples were collected from three main hospitals in
Hilla city/ Babylon province, Iraq. Samples were screened for presence of Raoultella spp., as well as
studying their expression of virulence factors. A total of 144 bacterial isolates were recovered and
identified as Klebsiella-like organisms. Out of these, 11 isolates were identified as Raoultella
ornithinolytica, which represent 7.6% of all Klebsiella-like organisms found. Many virulence
factors expressed by R. ornithinolytica were studied in vitro. All isolates produced capsule
and expressed CFA/I, and CFA/III.
Nine isolates (81.8%) were able to produce siderophores. Four isolates (36.6%) were able to
produce bacteriocin. All R. ornithinolytica isolates were unable to produce extracellular
protease, hemolysin, and histamine. All isolates of R. ornithinolytica were resistant to
penicillin, ampicillin, gentamicin, chloramphenicol, rifampin, cephalothin, cephotaxime,
streptomycin, amoxicillin.,but they showed high sensitivity to nitrofurantoin and
ciprofloxacin, and all them were completely sensitive to meropenem. R. ornithinolytica
expressed a high degree of sensitivity to the effect of human serum when they grew in human
serum at 37 oC for 3 hrs. The present study represented the first record of occurrence of R.
ornithinolytica in human clinical samples in Iraq.”
In a 2007 case report, “A case of severe pancreatitis complicated by Raoultella planticola infection,”
M. S. Alves, et al., Universidade Federal de Juiz de Fora, Campus Universita´ rio, Bairro Martelos at
Juiz de Fora, reported, “A 45-year-old-male presented with severe pancreatitis. Two bacterial isolates
obtained from peritoneal fluid and abdominal purulent secretion were identified to the species level by
15 biochemical tests and four supplementary tests as Raoultella planticola. Identification was
confirmed by rpoB gene sequencing. R. planticola is difficult to identify in the clinical laboratory,
and the clinical significance of this isolation remains uncharacterized. This is the first report of
pancreatitis with a primary infection by R. planticola.”
In a 2010 case report, “A Rare Case of Soft-Tissue Infection Caused by Raoultella planticola,” Karina
O’ Connell, et al., Department of Medical Microbiology, University College Hospital at Galway,
reported, “Raoultella species are Gram-negative, non-motile bacilli primarily considered to be
environmental bacteria. Raoultella planticola is a rare cause of human infections. We report a case of
serious soft-tissue infection in a young male tiler who presented with cellulitis of his left thumb. He had
sustained a crush injury to his left thumb 10 days earlier in a soiled environment. He noted a minor
break in the skin and he washed the wound out with running water. One week later, he experienced
pain, erythema, and swelling of his thumb and attended his general practitioner who prescribed oral
flucloxacillin and penicillin V. Despite this treatment, he noticed progressive erythema and swelling of
his thumb requiring hospital admission 3 days later. He underwent washout and debridement of his
thumb. Tissue obtained intraoperatively cultured Raoultella planticola. He was treated with broadspectrum
antibiotics including ciprofloxacin and made a full and rapid recovery.”
In a 2011 case report, “Sepsis caused by Raoultella terrigena,” Muddassir Muhammad Shaikh and and
Marina Morgan, Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust,
reported, “We describe a second reported case of human infection caused by Raoultella terrigena. –
Raoultella terrigena (previously known as Klebsiella terrigena) is a rarely encountered gram-negative
bacterium and mainly reported as aquatic and soil organism.1 However, in 2007 the first human
infection caused by this organism was reported in a 45-year-old patient who developed endocarditis
due to R. terrigena post liver transplant.2 No other case reports of infections caused by this organism
have been published, and the clinical spectrum of diseases caused by this organism is unknown. The
correct identification of R. terrigena is not easily accomplished in most clinical microbiology
laboratories, and isolates can be easily misidentified as Klebsiella pneumoniae or other Klebsiella
species.3 We describe a patient with sepsis with a primary infection by R. terrigena.”
Klebsiella/Raoultella in Animals and Fish
Raoultella (formerly Klebsiella) is a gram-negative aerobic bacillus in the family Enterobacteriaceae.
In a 2002 study, “Klebsiella pneumoniae Produces No Histamine: Raoultella planticola and Raoultella
ornithinolytica Strains Are Histamine Producers,”Masashi Kanki, et al., Osaka Prefectural Institute of
Public Health, reported, “Histamine fish poisoning is caused by histamine-producing bacteria (HPB).
Klebsiella pneumoniae and Klebsiella oxytoca are the best-known HPB in fish. However, 22 strains of
HPB from fish first identified as K. pneumoniae or K. oxytoca by commercialized systems were later
correctly identified as Raoultella planticola (formerly Klebsiella planticola) by additional tests.
Similarly, five strains of Raoultella ornithinolytica (formerly Klebsiella ornithinolytica) were isolated
from fish as new HPB. R. planticola and R. ornithinolytica strains were equal in their histamineproducing
capabilities and were determined to possess the hdc genes, encoding histidine decarboxylase.
On the other hand, a collection of 61 strains of K. pneumoniae and 18 strains of K. oxytoca produced
no histamine,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC126807/
In a 2011 study, “Sources of Klebsiella and Raoultella species on dairy farms: Be careful where you
walk”, R.N. Zadoks, et al., Cornell University, reported, “Klebsiella spp. are a common cause of
mastitis, milk loss, and culling on dairy farms. Control of Klebsiella mastitis is largely based on
prevention of exposure of the udder to the pathogen. To identify critical control points for mastitis
prevention, potential Klebsiella sources and transmission cycles in the farm environment were
investigated, including oro-fecal transmission, transmission via the indoor environment, and
transmission via the outdoor environment. A total of 305 samples was collected from 3 dairy farms in
upstate New York in the summer of 2007, and included soil, feed crops, feed, water, rumen content,
feces, bedding, and manure from alleyways and holding pens. Klebsiella spp. were detected in 100% of
rumen samples, 89% of water samples, and approximately 64% of soil, feces, bedding, alleyway, and
holding pen samples. Detection of Klebsiella spp. in feed crops and feed was less common. Genotypic
identification of species using rpoB sequence data showed that Klebsiella pneumoniae was the most
common species in rumen content, feces, and alleyways, whereas Klebsiella oxytoca, Klebsiella
variicola, and Raoultella planticola were the most frequent species among isolates from soil and feed
crops. Random amplified polymorphic DNA-based strain typing showed heterogeneity of Klebsiella
spp. in rumen content and feces, with a median of 4 strains per 5 isolates. Observational and
bacteriological data support the existence of an oro-fecal transmission cycle, which is primarily
maintained through direct contact with fecal contamination or through ingestion of contaminated
drinking water. Fecal shedding of Klebsiella spp. contributes to pathogen loads in the environment,
including bedding, alleyways, and holding pens.” http://www.journalofdairyscience.org/article/S0022-
Endogenous Klebsiella endophthalmitis in a Vietnamese immigrant 2009
Klebsiella pneumoniae is now the most common cause of liver abscess in the United States, overtaking Escherichia coli
Although the common causative agents of endogenous endophthalmitis in North America are Candida species and
gram-positive organisms such as Staphylococcus aureus, K. pneumoniae has emerged over the last 20 years as the
predominant pathogen in Southeast Asia, with the majority of early reports coming from Taiwan.
Endogenous endophthalmitis is a vision-threatening infection of the vitreous cavity that presents with pain, decreased
visual acuity and intraocular inflammation of the anterior and posterior segments. About 50%–80% of patients have
fever or other systemic symptoms such as arthralgia, fatigue, anorexia, nausea and vomiting. 1,2 Liver abscesses,
pneumonia, endocarditis and skin and soft tissue infections are the most common infectious foci associated with
endogenous endophthalmitis, although any source of bacteremia or fungemia can cause endophthalmitis. 2 Unlike
exogenous endophthalmitis, endogenous endophthalmitis is not associated with eye trauma, surgery or manipulation.
endogenous Klebsiella endophthalmitis usually causes poor visual outcomes
Experimental endogenous septicaemia caused by Klebsiella pneumoniae and Escherichia coli in mice (1995)
Multi-resistant Klebsiella pneumoniae have recently occured in several nosocomial outbreaks of septicaemia. An
animal model resembling the pathophysiology of these infections in man would be very useful. A new model of
endogenous septicaemia caused by K. pneumoniae and Escherichia coli strains in mice has been established.
1982, Approximately 4.2% of 4,000 Maryland-Virginia raw milk tanker samples developed ropiness when incubated at
10°C. Of the 56 bacterial isolates 30 were identified by species. Klebsiella oxytoca and Pseudomonas aeruginosa were
isolated most frequently. Other ropy isolates were identified as Pseudomonas spp., Chromobacterium,
Flavobacterium multivorum, presumptive gersinia pestis, Enterobacter agglomerans, Klebsiella pneumoniae, and
Pasteurella-Actinobacter spp. Six of the Klebsiella oxytoca isolates were mesophilic (optimum temperatures of 32.0 to
37.8°C) ~vith two isolates having psychrotrophic tendencies (optimum temperature of 26.8°C). All Pseudomonas
aeruginosa isolates appeared to be psychrotrophic in their temperature requirements (optimum temperatures of 23.0
1990, An unusual food-borne outbreak of gastroenteritis associated with contaminated turkey occurred at a catered
company meal. The average incubation period was 10 h, and the predominant symptoms were watery diarrhea and
cramps. Vomiting did not occur. Initial epidemiological features and cultures from turkey and feces of infected patients
suggested that the causative agent was Clostridium perfringens, but Klebsiella pneumoniae of capsular type K15 was
also isolated in large numbers from both the turkey and feces of the same patients. Plasmid analysis and enterotoxin
results supported the role of K. pneumoniae as the causative agent in this outbreak. Organisms other than commonly
identified pathogens should not be ignored if present in high concentrations in both food and feces of infected persons.
1998, For the first time, we report Klebsiella pneumoniae as an enteroinvasive food-borne pathogen transmitted from a
hamburger. A 28-year-old previously healthy African-American male ingested a portion of a hamburger from a fast food
chain. Symptoms of gastroenteritis rapidly deteriorated to multiorgan failure. Blood and hamburger cultures grew
Escherichia coli and Klebsiella pneumoniae. Since Klebsiella had not previously been reported as enteroinvasive, the
isolates were compared. Full biochemical profiles, antimicrobial sensitivity, plasmid profile, and toxin assay by DNA
hybridization probe were completely concordant. The patient survived the episode of food-borne sepsis.
Klebsiella: Klebsiella's pathogenicity can be attributed to its production of a heat-stable enterotoxin. K. pneumoniae
is second only to E. coli as a urinary tract pathogen. Klebsiella infections are encountered far more often now than in
the past. This is probably due to the bacterium's antibiotic resistance properties. Klebsiella species may contain
resistance plasmids (R-plasmids) which confer resistance to such antibiotics as ampicillin and carbenicillin. To make
matters worse, the R-plasmids can be transferred to other enteric bacteria not necessarily of the same species.
IngentaConnect Four cases of necrotizing fasciitis caused by ...Klebsiella necrotizing fasciitis can occur via direct
inoculation, local trauma or, ... Necrotizing fasciitis due to Klebsiella spp. is unique in that it is ...
- Similar pages
[PDF] Four cases of necrotizing fasciitis caused by Klebsiella speciesFile Format: PDF/Adobe Acrobat
tions of disseminated Klebsiella infection, necrotizing ..... which the term “Klebsiella necrotizing fasciitis” appeared. in
the abstract were retrieved. ...
www.springerlink.com/index/W3QMP64XC5DTPCR6.pdf - Similar pages
Klebsiella pneumoniae is a common hospital-acquired infectious agent, causing urinary tract and abdominal infections
and hospital infected pneumonia. Klebsiella pneumoniae can be found in a person’s mouth, skin, and intestines.
Klebsiella is second to E. coli as the cause of urinary tract infections. The reported number of cases is up
approximately 50% in the last five years and there is a 66% mortality rate in untreated patients.
THE BACILLUS CAPSULATUS (BACILLUS PNEUMONILE OF FRIEDLANDER?), WITH SPECIAL REFERENCE TO ITS
CONNECTION WITH ACUTE LOBAR PNEUMONIA. JOSEPH J. CURRY. (Assistant in Pathology, Harvard Medical
School.) (Abstract.) 1898
The twelve cases in which this organism was found were as follows:
Case I. Acute lobar pneumonia. The capsule bacillus was found in cultures of the lung along with the diplococcus
lanceolatus. The growth of the capsule bacillus was so profuse in the cultures that it obscured the growth of the
diplococcus. Sections of the lung showed the capsule bacillus chiefly in the bronchi, and the diplococcus lanceolatus ii'
the alveolar exudate, and on the pleura.
Case II. Acute endocarditis, with gangrene of lung. Capsule bacillus found in pure culture in the heart vegetations, and
with other organisms in the gangrenous cavity. In both these cases pure cultures of the capsule bacillus were found in
the internal organs. Case III. Acute croupous pneumnonia complicated with acute otitis media. The bacillus capsulatus
and the diphtheria bacillus were found in cultures made from the middle ear. The micrococcus lanceolatus in the lung,
heart's blood, and kidney, but not in the middle ear.
Case IV. Fracture of the skull, accompanied, by acute otitis media. The capsule bacillus found in pure culture in middle
Cases V., VI., VII., VIII., X., XII. Diphtheria. Capsule bacillus obtained from the throat. Cases IX. and XI. Tonsillitis.
Capsule bacillus obtained from the throat. In one of the diphtheria cases the capsule bacillus and diphtheria bacilli
were found in pure culture. In the nose there were no capsule bacilli, but an abundant growth of diphtheria bacilli. In the
cultures from the throat, the capsule bacilli grew so profusely that the diphtheria colonies could not be made out.
Diphtheria bacilli in small numbers were seen only after smearing from the general surface of the tube, and in the water
of condensation. The growth of the capsule bacilli in the throat cleared up in a few days. Then the diphtheria colonies
grew luxuriantly. In another case, the growth of the capsule bacillus persisted some time after the growth of the
diphtheria bacillus. Inspection of the throat showed the mucous membrane of the pharynx to be congested and
granular. It was covered with a thick, glairy, opaque, sticky material, closely resembling the diffuse growth of the
capsule bacillus on blood serum. This material, when touched with a platinum loop, would draw out in long threads.
Three other cases showed the same condition of the throat, but not so marked. In the six diphtheria cases in which the
capsule bacillus was found, the disease in every case was mild. The two cases of tonsillitis presented no unusual
symptoms, and recovered after a few days. Weichselbaum, in i888, reported a case of endocarditis due to a capsule
bacillus closely resembling the case reported here. Cultures and inoculation showed the bacillus in each of the twelve
cases to be the same. Subcutaneous inoculation of guiniea pigs was fatal in from 5 to 7 days. Intra-peritoneal injection
was fatal in 24 hours. The organism was recovered from the blood, and from the various organs. The lymph glands are
enlarged, the spleen is large and soft, the blood somewhat thickened, but not to the degree described by Pfeiffer in his
experiments with the capsule bacillus. The adrenal glands were hemorrhagic. The organism seen in these twelve cases
is closely related to, if not identical with, the capsule bacilli described by Friedlander, Wright and Mallory, and Pfeiffer.
Fasching, von Dungern, Morri, Mandry, Abel, Paulsen, and Marschand have described capsule bacilli differing from
ours only in minor detail, and many of them are probably identical. For stainingt he capsules the following method,
which is a modification of the method given by Welch for staining the capsules of the diplococcus lanceolatus, gives the
I. Cover the preparation with glacial acetic acid for a few seconds.
2. Wash off the acetic acid with a i per cent. solution of potassium hydroxid.
3. Stain with aniline gentian violet for one minute without previously washing off the potassium solution.
4. Wash off excess of stain quickly in water.
5. Dry thoroughly with filter paper and over low flame, and mount in balsam. This method also gives good results in
staining the capsules of the micrococcus lanceolatus.
The writer has specimens which have remained stained after two years. The connection of this organism with acute
croupous pneumonia is interesting. The results of bacteriological investigation of this disease at the City Hospital have
shown that it is invariably due to the micrococcus lanceolatus. The first case reported here throws a great deal of light
on those cases of pneumonia which have been considered to be due to the capsule bacillus. In these cases the growth
of the capsule bacillus in cultures is so profuse that it entirely obscures the growth of the diplococcus. Examination of
sections of the lung in this case, which were stained both with the Gram Weigert stain and with strong solutions of
methylene blue, showed that the bacilli were decolorized by the Gram stain, and the diplococci were present in large
numbers in the alveoli, and in the pleural exudation. With the methylene blue stain the bacilli were found in large
numbers, chiefly in the bronchi. In Case IV., in which pure cultures of the bacilli were found in the middle ear, there was
no extension into the mastoid cells, or into the cranial cavity. Reports of cases of otitis media due to the capsule
bacillus, while not uncommon abroad, especially in Germany, are very unusual in this country. In Case III. the capsule
bacillus was found, together with the diphtheria bacillus, and it is a question whether the capsule bacillus was
responsible for the inflammation, as we have observed several cases of acute otitis media due to the diphtheria