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Cellulitis and Sepsis Secondary to Serratia marcescens in a Patient With HIV. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pithadia DJ, Weathers EN, Colombo RE, Baer SL. Severe and Progressive Cellulitis Caused by Serratia marcescens Following a Dog Scratch. J Investig Med High Impact Case Rep 2019; 7:2324709619832330. [PMID: 30929475 PMCID: PMC6444764 DOI: 10.1177/2324709619832330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Soft tissue infections occur in over 30% of patients with chemotherapy-induced neutropenia. Gram-positive bacterial infections predominate early in neutropenia, and likelihood of infection by resistant bacteria and fungi increases with prolonged neutropenia. Prior infections and exposures influence the risk of rare pathogens. A 55-year-old woman with chemotherapy-induced neutropenia was scratched on her forearm by a dog. She cleaned the wound with isopropanol and was treated empirically with amoxicillin-clavulanate. Over the next 4 days, she developed fever along with erythema, edema, and mild tenderness of the forearm without purulence or crepitus. She was hospitalized and received empiric treatment with intravenous vancomycin, piperacillin-tazobactam, tobramycin, and voriconazole. Despite therapy, her fevers persisted and the cellulitis progressed for over a week. After 10 days of hospitalization, her neutrophil count began to recover and a bulla developed at the wound site. Culture of the bullous fluid grew Serratia marcescens, and antibiotics were switched to cefepime based on susceptibility. She defervesced and showed substantial improvement of cellulitis within 48 hours and was discharged on oral ciprofloxacin. Serratia marcescens skin infections are rare, and this may be the first report of Serratia cellulitis associated with trauma from dog contact. This case highlights the need to consider unusual pathogens based on exposure history and immune status and to obtain cultures from fluid collections or tissue in cases of treatment-resistant soft tissue infections.
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Affiliation(s)
- Deeti J Pithadia
- 1 Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Erena N Weathers
- 1 Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Rhonda E Colombo
- 2 Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - Stephanie L Baer
- 1 Medical College of Georgia, Augusta University, Augusta, GA, USA.,3 Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
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Fournier JB, Dabiri G, Thomas V, Skowron G, Carson P, Falanga V. Serratia marcescens Bullous Cellulitis in a Splenectomized Patient: A Case Report and Review of the Literature. INT J LOW EXTR WOUND 2016; 15:161-8. [PMID: 27079487 DOI: 10.1177/1534734616636271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Serratia marcescens is a Gram-negative bacillus belonging to the Enterobacteriaceae family. Cutaneous infection with Serratia is rare, and usually occurs in immunocompromised individuals. Primary cutaneous infections are uncommon, but they are typically severe and are associated with significant morbidity and mortality. The pathogenetic factors leading to S. marcescens infection are not fully understood, but contributing virulence factors include proteases, secreted exotoxins, and the formation of biofilm. We report a case of cellulitis occurring in a splenectomized patient, which led to multiple wound debridements and a transmetatarsal amputation. This dramatic case led us to review the published literature on soft tissue infections caused by S. marcescens.
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Affiliation(s)
- John B Fournier
- Department of Dermatology, Roger Williams Medical Center, Providence, RI, USA Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Ganary Dabiri
- Department of Dermatology, Roger Williams Medical Center, Providence, RI, USA
| | - Vinod Thomas
- Department of Medicine, Roger Williams Medical Center Providence, RI, USA
| | - Gail Skowron
- Department of Medicine, Roger Williams Medical Center Providence, RI, USA
| | - Polly Carson
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Vincent Falanga
- Department of Biochemistry, Boston University, School of Medicine, Boston, MA, USA
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Necrotizing soft tissue infection caused by Serratia marcescens: A case report and literature review. J Infect Chemother 2016; 22:335-8. [PMID: 26778253 DOI: 10.1016/j.jiac.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/11/2015] [Accepted: 11/24/2015] [Indexed: 12/17/2022]
Abstract
A 64-year-old man with advanced liver cirrhosis was transferred to an emergency center due to septic shock and markedly inflamed left leg. Under a clinical diagnosis of necrotizing soft tissue infection (NSTI), the patient undertook intensive therapy but died 25 h after arrival. The pathogenic organism, Serratia marcescens, was later isolated from blood and soft tissue cultures. NSTI is very rarely associated with S. marcescens. A literature review showed that only 16 such cases, including our case, have been reported to date. Our case is the first evidence of an S. marcescens NSTI in a patient with liver cirrhosis. S. marcescens NSTI has an extremely high mortality rate; total mortality and mortality in cases involving the extremities were 75% (12 of 16 cases) and 83.3% (10 of 12 cases), respectively. Physicians need to be aware that S. marcescens can induce fatal infections in community patients.
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Majumdar R, Crum-Cianflone NF. Necrotizing fasciitis due to Serratia marcescens: case report and review of the literature. Infection 2015; 44:371-7. [PMID: 26498285 DOI: 10.1007/s15010-015-0855-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Necrotizing fasciitis is a severe, life-threatening infection. Serratia marcescens, a Gram-negative bacterium, is an extremely rare cause of necrotizing fasciitis. METHODS A case of S. marcescens necrotizing fasciitis is described, and a comprehensive review of the literature (1966-2015) of monomicrobial cases due to this organism performed. RESULTS We report the first case of S. marcescens necrotizing fasciitis in the setting of calciphylaxis associated with end-stage renal disease. A comprehensive review of the literature of S. marcescens necrotizing fasciitis is provided to enhance the awareness of this increasingly recognized infection, and to provide a concise summary of risk factors, treatment, and outcome. CONCLUSIONS Our case and review highlight the potential risk factors for S. marcescens necrotizing fasciitis, including underlying renal disease and open wounds, and demonstrate the emergence of this organism as a cause of severe, life-threatening soft tissue infections.
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Affiliation(s)
- Rohit Majumdar
- Infectious Diseases Department, Scripps Mercy Hospital, 4077 Fifth Ave, San Diego, CA, 92103, USA.
| | - Nancy F Crum-Cianflone
- Infectious Diseases Department, Scripps Mercy Hospital, 4077 Fifth Ave, San Diego, CA, 92103, USA.
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Ray U, Dutta S, Chakravarty C, Sutradhar A. A case of multiple cutaneous lesions due to Serratia marcescens in an immunocompromised patient. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ujjwayini Ray
- Apollo Gleneagles Hospitals, 58 Canal Circular Road, Kolkata 54, West Bengal
| | - Soma Dutta
- Apollo Gleneagles Hospitals, 58 Canal Circular Road, Kolkata 54, West Bengal
| | | | - Arpita Sutradhar
- Apollo Gleneagles Hospitals, 58 Canal Circular Road, Kolkata 54, West Bengal
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Lakhani NA, Narsinghani U, Kumar R. Necrotizing Fasciitis of the Abdominal Wall Caused by Serratia Marcescens. Infect Dis Rep 2015; 7:5774. [PMID: 26294949 PMCID: PMC4508534 DOI: 10.4081/idr.2015.5774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 11/23/2022] Open
Abstract
In this article, we present the first case of necrotizing fasciitis affecting the abdominal wall caused by Serratia marcescens and share results of a focused review of S. marcescens induced necrotizing fasciitis. Our patient underwent aorto-femoral bypass grafting for advanced peripheral vascular disease and presented 3 weeks postoperatively with pain, erythema and discharge from the incision site in the left lower abdominal wall and underwent multiple debridement of the affected area. Pathology of debrided tissue indicated extensive necrosis involving the adipose tissue, fascia and skeletal muscle. Wound cultures were positive for Serratia marcescens. She was successfully treated with antibiotics and multiple surgical debridements. Since necrotizing fasciitis is a medical and surgical emergency, it is critical to examine infectivity trends, clinical characteristics in its causative spectrum. Using PubMed we found 17 published cases of necrotizing fasciitis caused by Serratia marcescens, and then analyzed patterns among those cases. Serratia marcescens is prominent in the community and hospital settings, and information on infection presentations, risk factors, characteristics, treatment, course, and complications as provided through this study can help identify cases earlier and mitigate poor outcomes. Patients with positive blood cultures and those patients where surgical intervention was not provided or delayed had a higher mortality. Surgical intervention is a definite way to establish the diagnosis of necrotizing infection and differentiate it from other entities.
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Affiliation(s)
- Naheed A Lakhani
- Department of Family and Preventive Medicine, Emory University School of Medicine , Dunwoody, GA, USA
| | - Umesh Narsinghani
- Department of Pediatrics, Mercer University School of Medicine , Macon, GA, USA
| | - Ritu Kumar
- Department of Internal Medicine, Mercer University School of Medicine , Macon, GA, USA
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Necrotizing fasciitis in an immunocompromised elderly woman. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:38-9. [PMID: 24421792 DOI: 10.1155/2013/489587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rathore R, Cheesbrough J, Pasztor M, Woywodt A. Sepsis and a painful shoulder in a haemodialysis patient. Clin Kidney J 2011; 4:439-42. [PMID: 25984219 PMCID: PMC4421646 DOI: 10.1093/ndtplus/sfr088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 06/20/2011] [Indexed: 11/14/2022] Open
Affiliation(s)
- Roshni Rathore
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - John Cheesbrough
- Department of Microbiology, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Monika Pasztor
- Department of Microbiology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancashire, UK
| | - Alex Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
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Acute dermal abscesses caused by Serratia marcescens. J Am Acad Dermatol 2008; 58:891-3. [DOI: 10.1016/j.jaad.2008.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 11/26/2007] [Accepted: 01/13/2008] [Indexed: 11/21/2022]
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Son D, Lee JS, Cheong MH, Lee K, Park BD, Lee MH, Kim JJ. Deep Cutaneous Ulcer Caused by Serratia marcescens after Fresh Water Exposure. Infect Chemother 2008. [DOI: 10.3947/ic.2008.40.6.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Dongwook Son
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Moon-Hyun Cheong
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Kwangsoo Lee
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Byoung Do Park
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Moon-Hee Lee
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Jin Ju Kim
- Department of Laboratory Medicine, College of Medicine, Inha University, Incheon, Korea
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Abstract
The essence of dermatology is morphology. The most important instrument in the practice of dermatology has always been, and still is, the naked eye; however, "We see only what we are ready to see, what we have been taught to see" (Jean Martin Charcot). Although most practitioners will easily correctly diagnose common bacterial skin diseases (such as cellulitis, erysipelas, impetigo, etc), only a trained and updated dermatologist will recognize the unusual forms and rare variants of these diseases. Bacterial skin diseases are sometimes acute and life-threatening. The mortality rates from necrotizing fasciitis range from 20% to 40%, to name just one example. It is not unreasonable to expect that dermatologists, whether in clinical practice or in referral centers, will be the first physicians to be confronted with unusual variants of bacterial skin diseases that have been unrecognized by non-dermatologists. Some of these cases might even be life-threatening, and only prompt and early recognition, diagnosis, and treatment can make the difference between losing and saving a patient's life. In short, we dermatologists should hone our clinical diagnostic skills and expand our knowledge of the rare forms and unusual and atypical variants of skin diseases: the textbook variants will probably be recognized and treated by general practitioners.
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Affiliation(s)
- Hagit Matz
- Dermatology Unit, Kaplan Medical Center, Rechovot 76100, Israel
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Bachmeyer C, Sanguina M, Turc Y, Reynaert G, Blum L. Necrotizing fasciitis due to Serratia marcescens. Clin Exp Dermatol 2004; 29:673-4. [PMID: 15550150 DOI: 10.1111/j.1365-2230.2004.01597.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Serratia marcescens Cellulitis: A Case Report and Review of the Literature. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2002. [DOI: 10.1097/01.idc.0000090385.89010.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Serratia Marcescens Necrotizing Fasciitis in a Bone Marrow Transplant Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2002. [DOI: 10.1097/00019048-200201000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nieves DS, James WD. Painful red nodules of the legs: a manifestation of chronic infection with gram-negative organisms. J Am Acad Dermatol 1999; 41:319-21. [PMID: 10426919 DOI: 10.1016/s0190-9622(99)70374-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Skin infection secondary to gram-negative organisms is uncommon and is typically limited to persons who are immunocompromised. When these do occur, they are acute, progressive, and severe. Here we report 2 cases of painful red nodules that presented with a waxing and waning course over a long period. One case is that of a 45-year-old healthy white man who developed Serratia marcescens infection in 1 leg. The other case is that of a 78-year-old man with chronic lymphocytic leukemia treated with prednisone who developed infection of the leg secondary to Pseudomonas aeruginosa. In the first case, symptoms were present for 2 years before definitive diagnosis and treatment. In the second case, 4 months elapsed. Ultimately, both patients responded to antibiotic therapy and recovered. These cases illustrate an unusual presentation of chronic red painful nodules of the leg secondary to infection with gram-negative organisms and underscore the importance of culture even when infection seems unlikely.
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Affiliation(s)
- D S Nieves
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
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Abstract
Bullous cellulitis is a distinctive form of cellulitis most often caused by beta hemolytic streptococci. This report describes a case of bullous cellulitis caused by Serratia marcescens in an elderly diabetic woman with peripheral vascular disease. A discussion of this ubiquitous, nosocomial pathogen follows.
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Affiliation(s)
- C L Cooper
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Shelley WB, Talanin N, Shelley ED, Freimer EH. Occult Streptococcus pyogenes in cellulitis: demonstration by immunofluorescence. Br J Dermatol 1995; 132:989-91. [PMID: 7662580 DOI: 10.1111/j.1365-2133.1995.tb16961.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 23-year-old man developed cellulitis and ascending lymphangitis of the right leg. Blood cultures and skin saline aspirates were sterile. Gram stain of the aspirate did not show any bacteria. Direct and indirect immunofluorescent staining with polyclonal and monoclonal antibodies to Streptococcus pyogenes revealed streptococci in the reticular dermis. The cellulitis resolved following treatment with intravenous cefazoline.
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Affiliation(s)
- W B Shelley
- Department of Medicine, Medical College of Ohio, Toledo 43699-0008, USA
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