A 27-year-old man with recurrent sinopulmonary and cutaneous infections.

The increasing availability of genetic testing for modern immunologists in the evaluation of immune diseases could provide a definite diagnosis in elusive cases. A 27-year-old white male patient presented to the clinic with recurrent sinopulmonary and cutaneous infections since childhood. The patient's mother had seronegative polyarthritis, and one of two sisters of the patient had chronic sinopulmonary infections. Serum immunoglobulins, immunoglobulin G (IgG) subclasses, lymphocyte subset markers, mannose-binding lectin, mitogen and antigen stimulation, bacteriophage study, and Streptococcus pneumoniae titers to 23 serotypes were all normal. B-cell phenotyping revealed a decrease in both nonswitched memory B cells (CD19+CD27+IgD+) and switched memory B-cells (CD19+CD27+IgD-). Genetic testing and the improvement of clinical symptoms after IgG replacement led to the final diagnosis.

Risk of infection in patients undergoing urologic surgery based on the presence of asymptomatic bacteriuria: A prospective study.

BACKGROUND: Treatment of asymptomatic bacteriuria (ASB) is recommended in pregnant women and prior to urologic procedures with anticipated mucosal disruption. However, there is still insufficient evidence of the usefulness of treating ASB prior to urologic procedures. Therefore, the aim of this study was to ascertain the risk of infections in patients undergoing urologic surgery based on the presence of ASB. METHODS: We conducted a cohort study among patients undergoing urologic surgery at a single center located in Medellín, Colombia. All patients were screened for ASB prior to their procedures. Patients were evaluated for the development of any postoperative infectious complications for up to 30 days after the procedure. RESULTS: A total of 149 patients were included in this cohort. Incidence of ASB was 14.8%. Thirteen patients (8.72%) developed infectious complications: 3 (13.64%) with ASB and 10 (7.87%) without ABS. Factors associated with postoperative infectious complications included urologic cancers (hazard ratio [HR], 5.26; 95% confidence intervals [CI], 1.24-22.37), urologic interventions in the preceding 3 months (HR, 3.72; 95% CI, 1.02-13.51), and use of antibiotics 3 months prior to surgery (HR, 3.83; 95% CI, 1.01-15.49). Presence of ASB was not associated with postsurgical infectious complications (HR, 1.02; 95% CI, 0.26-3.96). CONCLUSIONS: There was no association between ASB and postoperative infectious complications. There were other factors associated with infectious complications, such as urologic cancer, previous history of urologic manipulation, and antibiotic use.

Serratia marcescens sepsis outbreak caused by contaminated propofol.

We presented a sepsis outbreak caused by Serratia marcescens from contaminated propofol to raise awareness. Three patients had sepsis syndrome after chest surgery. Isolation of S marcescens from patients' respiratory and blood samples alerted us to a possible outbreak. Four syringes filled with propofol and 1 saline solution yielded S marcescens. Nine of 10 isolates from samples of patients and environment genotyped by pulsed-field gel electrophoresis were the same. Disobeying aseptic injection rules of propofol is still causing outbreaks.

Serratia liquefaciens Causing Severe Ocular Damage in Noncontact Lens Wearer.

Serratia liquefaciens is a rarely encountered gram-negative organism in ophthalmology practice. The only reported ocular infections are from contamination of contact lenses. The authors report the first case of a patient who developed orbital cellulitis secondary to severe S. liquefaciens microbial keratitis.

Serratia marcescens Bullous Cellulitis in a Splenectomized Patient: A Case Report and Review of the Literature.

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.

Serratia marcescens thigh infection after transobturator sling without associated mesh exposure.

INTRODUCTION: Soft tissue complications of the thigh occur after transobturator slings and are reported to uniformly accompany mesh exposure. Most commonly identified microorganisms cultured from such soft tissue infections include Bacteroides and Streptococcus species. This is the first reported case of Serratia marcescens leading to thigh cellulitis after a transobturator sling and the complication occurred in the absence of exposed mesh. CASE: A 54-year-old presented 7 days after a transobturator sling with right thigh cellulitis and sepsis in the absence of mesh exposure. She underwent explantation of the sling and incision and drainage of the groin incision. Cultures grew S. marcescens. DISCUSSION: Soft tissue infections of the thigh after transobturator tape are rare, but commonly associated with exposed mesh. Mesh exposure does not lead to thigh complications uniformly. The fact that this patient had no exposed mesh poses several questions about the pathogenesis of soft tissue infections of the thigh after transobturator slings.

Chronic granulomatous disease mimicking early-onset Crohn's disease with cutaneous manifestations.

BACKGROUND: Chronic granulomatous disease is a rare inherited disorder of the innate immune system. In patients with a clinical history of recurrent or persistent infections, especially infections caused by uncommon species, chronic granulomatous disease should be considered. CASE PRESENTATION: We report the case of a 5-year-old boy with a presumptive diagnosis of Crohn's disease with extraintestinal manifestations. Chronic granulomatous disease was suspected in this case after Serratia marcescens was isolated from a skin ulcer culture. Granulomas were confirmed on histology and chronic granulomatous disease was diagnosed. CONCLUSION: This case emphasizes the importance of high clinical suspicion of an alternative diagnosis of immune deficiency in patients with presumed inflammatory bowel disease and opportunistic infections, especially when disease occurs in early life.

[Serratia marcescens osteomyelitis as the first manifestation of chronic granulomatous disease]. / Granulomatose septique chronique révélée par une ostéomyélite à Serratia marcescens.

Chronic granulomatous disease is a rare, primary immunodeficiency disorder characterized by a defect in oxidative metabolism in phagocytes and recurrent bacterial and fungal infections. We report a case in a 2-month-old infant admitted with metacarpic osteomyelitis due to Serratia marcescens. Chronic granulomatous disease is rare but must be considered in cases of uncommon or atypical infection.

Serratia marcescens meningitis following spinal anaesthesia and arthroscopy.

We present case of nosocomial bacterial meningitis, caused by Serratia marcescens (ESBL), occurred following spinal anaesthesia. Although very rare bacterial meningitis is serious complication of spinal anaesthesia and early diagnosis as well as effective treatment is extremely important. Previously healthy individual, admitted to Orthopaedic Department for routine arthroscopy, approximately within 24 hours after operation was performed complained of headache and fever. Infectious Diseases physician was consulted, lumbar puncture was performed and purulent meningitis was confirmed. Cerebrospinal fluid and blood cultures of patient confirmed Serratia marcescens (ESBL), resistant pathogen and important nosocomial agent. Patient was successfully treated. Cases of spinal meningitis caused by Serratia marcescens are rare. Local resistance pattern is important and should be always considered when starting therapy. Infection control team was appointed because of similar case of meningitis one month before in the same Department, and after investigation discovered Serratia in anaesthetic vial used in procedures. New measures and recommendations regarding infection control were implemented at Orthopaedic Department. Meningitis as a complication should always be considered as a possible differential diagnosis with patients after spinal anaesthesia complaining on headache and fever. Early diagnosis and early treatment is extremely important. Knowledge and practice of infection control measures is mandatory and should be always emphasized to performing staff.

Primary total knee arthroplasty infected with Serratia marcescens.

We report an unusual case of a Serratia marcescens infection of total knee arthroplasty 4 weeks after the procedure following aspiration carried out on the ward (contrary to local protocol). This was successfully treated with thorough wound debridement, irrigation, change of the polyethylene liner and systemic antibiotics using intravenous meropenem for 3 weeks followed by oral ciprofloxacin for another 3 weeks. Our patient made an uneventful recovery and there was no reported recurrence of infection at 8 months of follow-up. We are unsure as to whether the infection was introduced at the time of the joint aspiration or was a complication of the initial procedure despite all the standard aseptic measures taken at the time of surgery.

Necrotizing fasciitis caused by Serratia marcescens after venous access port implantation in a child with acute lymphoblastic leukemia.

Necrotizing fasciitis is a potentially life-threatening infection of deep skin layers and subcutaneous tissues that can easily spread across the fascia plate and is usually the result of a combined infection with anaerobic and aerobic microorganisms. The patient typically complains of excruciating pain, which is not necessarily in accordance with clinical signs. Early recognition of the condition is very important, and aggressive treatment with a combination of antibiotics and surgical procedure is crucial. We present a case of a 15-year-old girl with acute lymphoblastic leukemia who developed necrotizing fasciitis after venous access port implantation during induction chemotherapy.

Necrotizing fasciitis caused by Serratia marcescens: a fatal complication of nephrotic syndrome.

Necrotizing fasciitis is an uncommon complication of nephrotic syndrome. There have been only four cases of necrotizing fasciitis complicating nephrotic syndrome reported in the English literature. We report a 40-year-old woman with minimal-change nephrotic syndrome receiving cyclosporine therapy, who suffered from necrotizing fasciitis of her left leg. Cultures of blood and surgical specimens yielded Serratia marcescens. Despite aggressive treatment, the patient expired shortly after surgery. We review the literature and find eight cases of necrotizing fasciitis caused by S. marcescens. Most of these patients had an immunocompromised background, and the mortality rate was high.

[Serratia osteomyelitis and chronic granulomatous disease]. / Osteomielite por serratia e doença granulomatosa crónica.

Chronic Granulomatous Disease (CGD) is a primary immunodeficiency disorder characterized by recurrent purulent infections of the skin, lungs, and reticuloendothelial organs, primarily due to staphylococci, enteric bacteria, fungi, and occasionally mycobacteria. More than two thirds of all cases are X-linked and result from defects in the CYBB gene that encodes the gp91-phox subunit of NADPH oxidase. The authors present a case of a three month old child admitted with a metacarpic steomyelitis by Serratia marcescens. Studies confirmed an abnormal respiratory burst in activated neutrophils and absence of gp91-phox expression on patient and a brother (with previous Nocardia infection). Both hemizygous for a pathogenic mutation detected in exon 3 of CYBB gene (c.252 G>A, p.Ala84Ala), a variant that affects the splicing. At two years of age he is still on prophylaxis with cotrimoxazol and itraconazol, without relevant complications. CGD is rare but must be evocated in cases of uncommon or atypical infections.

Urinary tract infections in the early posttransplant period after kidney transplantation: etiologic agents and their susceptibility.

OBJECTIVE: Urinary tract infection (UTI) is among the most common infections in solid organ transplantation, especially in kidney transplantation. PATIENTS AND METHODS: This study included 295 adult patients undergoing KTx between September 2001 and December 2007. All patients were followed prospectively for UTI during the first 4 weeks after surgery. Samples of urine were investigated by bacteriological cultures to identify microorganisms in accord with standard procedures. Susceptibility testing was performed using Clinical and Laboratory Standards Institute procedures. RESULTS: Urine specimens (n=582) were obtained from 84.5% of 245 recipients during the first month after transplantation. Among the isolated bacterial strains (n=291), the most common were Gram-negative bacteria (56.4%) predominantly Serratia marcescens (32.3%) and Enterobacter cloacae (14.6%). Extended- spectrum beta-lactamase (ESBL+) strains were isolated in 52.5% of cases. Gram-positive bacteria comprised 35.7%; most commonly, high-level aminoglycoside resistant (HLAR; 87.8%) and vancomycin-resistant (VRE; 11%) Enterococci. There were fungal strains in 23 cases (7.9%). CONCLUSION: Our study showed predominantly Gram-negative rods from the Enterobacteriaceae family comprising (84.8%) of Gram-negative isolates: 52.5% ESBL and resistant enterococci (87.5%) in Gram-positive isolates. The increased proportion of isolates of multi-drug-resistant bacterial agents which can cause severe UTIs may be due to our frequent use of ceftriaxone for perioperative bacterial prophylaxis.

X-linked chronic granulomatous disease with voriconazole-induced photosensitivity/ photoaging reaction.

Due to the mutations in the nicotinamide dinucleotide phosphate (NADPH) oxidase complex in X-linked chronic granulomatous disease (CGD), the phagocytic activity in these patients is curtailed by a dysfunctional respiratory burst. This can lead to life-threatening bacterial and fungal infections. The prognosis for patients with CGD has dramatically improved with the advent of effective prophylactic drugs targeting catalase-positive bacteria, opportunistic Gram-negative bacteria and fungi. Voriconazole, a second-generation triazole, is a commonly used agent for prophylaxis in this population. The authors report a case of photoaging and photosensitivity reaction associated with voriconazole exposure in a 10-year-old boy with X-linked CGD. With broad-spectrum sunscreen, topical steroids, and discontinuation of voriconazole, the patient showed significant improvement.

[Postoperative infection due to contaminated propofol]. / Postoperatieve infectie door gecontamineerde propofol.

Seven patients operated on in a period of two consecutive days in the Havenziekenhuis, Rotterdam, the Netherlands developed symptoms of sepsis following a relatively minor procedure. One patient developed fever and hypotension a few hours after surgery, and developed thrombocytopenia and leucopenia. Postoperative bleeding occurred as a result of the thrombocytopenia, necessitating further surgery. This patient developed serious multi-organ failure, and required prolonged intensive care treatment. The other six patients developed less serious infections, the main symptoms of which were fever, leucopenia, thrombocytopenia and impairment of liver- and kidney function. They recovered quickly. Bacteriological investigation revealed that the infection was caused by extrinsic contamination of the intravenous anaesthetic propofol with Klebsiella pneumoniae and Serratia marcescens. Due to the high risk of contamination of the lipid formulation of this preparation, the use of propofol requires the following measures: syringes should be used just once; vials should be punctured just once; and administration should take place within 12 h after opening the vial or the ampoule. Hygienic working methods are also of crucial importance.