First case of bacteremia caused by Moellerella wisconsensis: case report and a review of the literature

Infections Caused by Moellerella wisconsensis: A Case Report and a Systematic Review of the Literature

Background: Moellerella wisconsensis, a member of the family of Enterobacteriaceae, although isolated widely in nature, rarely causes infections in humans. Herein, we report a case of isolation of M. wisconsensis from pigtail end culture, urine culture and blood culture in a 76-year-old patient. Objective: To systematically address all the relevant information regarding M. wisconsensis through literature. Methods: We searched PubMed and Scopus databases up to January 2022 and performed a qualitative synthesis of published articles reporting infection from M. wisconsensis in humans. Results: We identified 25 records on PubMed and 43 additional records on Scopus. After removing duplicates, we examined in detail 15 articles. Ten studies with a total of 17 cases were included in our systematic review. Nine studies described isolated case reports, while 1 study described 8 cases. The origin of the infection was the alimentary tract in 9 cases, gallbladder in 4 cases, peritoneal cavity in 2 cases, respiratory tract in 1 case and hemodialysis catheter insertion site in 1 case. In 3 of the aforementioned cases M. wisconsensis was also isolated in blood cultures. Conclusion: Physicians should be aware that M. wisconsensis can be present in multiple clinical specimens and that the antibiotic resistance profile of the isolates may pose significant challenges.

ESBL-Producing Moellerella wisconsensis—The Contribution of Wild Birds in the Dissemination of a Zoonotic Pathogen

Simple Summary

Moellerella wisconsensis is a potentially zoonotic pathogen that has sporadically been isolated from animals and humans. In the present study, we describe the occurrence of the organism among 445 wild bird and 2000 human fecal samples, in the context of an investigation regarding antimicrobial resistant bacteria in Greece. According to our results, 0.9% (n = 4) of the examined wild birds were found to be colonized by M. wisconsensis, while no human was a carrier of the bacterium. Out of the total number of four M. wisconsensis strains that we detected, three presented resistance to 3rd generation cephalosporins, were phenotypically confirmed to produce extended spectrum beta lactamases (ESBLs) and harbored bla_CTX-M-1. Resistance to tetracyclines, aminoglycosides and trimethoprim/sulfamethoxazole was additionally detected in three, two and one of the ESBL isolates, respectively. This is the first report that presents the dissemination of M. wisconsensis in wild bird from Greece and describes CTX-M-1 production in multidrug resistant wild birds’ isolates of this bacterial species.

Abstract

Moellerella wisconsensis is an Enterobacteriaceae with unclarified dispersion and pathogenicity. During an ongoing investigation about antimicrobial resistance in Greece, the occurrence of M. wisconsensis was evaluated among wild birds and humans. A total of 445 wild bird and 2000 human fecal samples were collected and screened for the presence of the organism. Subsequently, all M. wisconsensis strains were phenotypically and molecularly characterized regarding their antimicrobial resistance characteristics. Four M. wisconsensis were isolated from a common pheasant (Phasianus colchicus), two Eurasian magpies (Pica pica) and a great white-fronted goose (Anser albifrons). Among these four strains, the three latter presented resistance to 3rd generation cephalosporins, were phenotypically confirmed to produce ESBLs and were found to harbor bla_CTX-M-1. The three ESBL isolates additionally exhibited resistance to tetracyclines, while resistance to aminoglycosides was detected in two of them and to trimethoprim/sulfamethoxazole in one. No Moellerella wisconsensis strains were retrieved from the human samples tested. This is the first report that provides evidence of M. wisconsensis dissemination among wild birds in Greece, describing CTX-M-1 production in multidrug resistant wild birds’ isolates of this bacterial species.

Bacterial Morphotypes as Important Trait for Uropathogenic E. coli Diagnostic; a Virulence-Phenotype-Phylogeny Study

Urinary tract infections (UTIs) belong to the most common pathologies in Mexico and are mainly caused by Uropathogenic Escherichia coli (UPEC). UPEC possesses a wide diversity of virulence factors that allow it to carry out its pathogenesis mechanism in the urinary tract (UT). The development of morphotypes in UT represents an important feature of UPEC because it is associated with complications in diagnosis of UTI. The aim of this study was to determine the presence of bacterial morphotypes, virulence genes, virulence phenotypes, antibiotic resistant, and phylogenetic groups in clinical isolates of UPEC obtained from women in Sonora, Mexico. Forty UPEC isolates were obtained, and urine morphotypes were observed in 65% of the urine samples from where E. coli was isolated. Phylogenetic group B2 was the most prevalent. The most frequent virulence genes were fimH (100%), fliCD (90%), and sfaD/focC (72%). Biofilm formation (100%) and motility (98%) were the most prevalent phenotypes. Clinical isolates showed high resistance to aminoglycosides and β-lactams antibiotics. These data suggest that the search for morphotypes in urine sediment must be incorporated in the urinalysis procedure and also that clinical isolates of UPEC in this study can cause upper, lower, and recurrent UTI.

American Dog Ticks (Dermacentor variabilis) as Biological Indicators of an Association between the Enteric Bacterium Moellerella wisconsensis and Striped Skunks (Mephitis mephitis) in Southwestern Manitoba, Canada

Total genomic (g)DNA from 100 American dog ticks (Dermacentor variabilis) collected from humans, dogs, raccoons, and skunks near Minnedosa (Manitoba, Canada) in 2005 was tested for the presence of Moellerella wisconsensis (Gammaproteobacteria: Enterobacteriales) using PCR. Although two gDNA samples derived from ticks attached to two striped skunks (Mephitis mephitis) contained M. wisconsensis DNA, it is unlikely that D. variabilis is a vector of this bacterium. Genomic DNA prepared from the washes of the external surfaces of these two ticks (i.e., before DNA extraction from the whole tick) and another two ticks attached to same skunks were also PCR positive for M. wisconsensis. This suggests that ticks acquired the bacterium by physical contact with contaminated or infected skunks. However, it does not exclude the possibility that the ticks may have also imbibed the bacterium from their host blood and lymph. Nonetheless, the results of this molecular study suggest that the four adult D. variabilis represent biological indicators of the presence of M. wisconsensis in association with their vertebrate hosts (i.e., striped skunks). Additional work is needed to determine if M. wisconsensis is present in the blood and lymph of striped skunks in southwestern Manitoba and if there are potential health risks for persons coming into contact with infected animals.