ABSTRACT
Serratia marcescens corresponde a un bacilo gram negativo, miembro de la familia Enterobacteriaceae. Este microorganismo tiene una alta capacidad de supervivencia en condiciones hostiles y ha sido implicado en infecciones del tracto respiratorio, vía urinaria, meningitis, endocarditis y sistema musculoesquelético. No obstante, es considerado una causa rara de infecciones cutáneas. Esta última tiene distintas presentaciones clínicas, la más frecuente es fascitis necrotizante seguida de celulitis. Los nódulos, las pápulas después de inyecciones de rellenos, las erupciones papulares diseminadas, las placas eritematosas, las pústulas y las úlceras son parte del amplio espectro de formas clínicas descritas en la literatura. Presentamos el caso de una paciente de 50 años, con historia de compromiso del estado general, lesiones cutáneas polimorfas y fiebre. Se confirmó una infección cutánea por Serratia marcescens mediante cultivos. Se destaca el polimorfismo y la coexistencia de distintas manifestaciones en una misma paciente, incluyendo celulitis, nódulo, ulceras y necrosis cutánea y la importancia del estudio microbiológico para el adecuado tratamiento antibiótico.
Serratia marcescens corresponds to gram negative bacillus, a member of the Enterobacteriaceae family. This microorganism has a high survival capacity in hostile conditions and has been implicated in respiratory tract, urinary tract, meningitis, endocarditis and musculoskeletal system infections. However, it is considered a infrequent cause of cutaneous infections. Has different clinical presentations, the most frequent is necrotizing fasciitis followed by cellulite. Nodules, papules after filler injections, disseminated papular eruption, erythematous plaques, pustules and ulcers are part of the broad spectrum of clinical forms described in the literature. We present the case of a 50 year old patient with a history of compromised general condition, polymorphic cutaneous lesions and fever. Serratia marcescens cutaneous infection was confirmed by cultures. The polymorphism and the coexistence of different manifestations in the same patient, including cellulitis, nodule, ulcers and skin necrosis, and the importance of the microbiological study for the adequate antibiotic treatment are highlighted.
Subject(s)
Humans , Female , Middle Aged , Serratia Infections/diagnosis , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/microbiology , Serratia marcescens/isolation & purification , Skin Ulcer/microbiology , Serratia Infections/microbiology , Serratia Infections/pathology , Serratia Infections/drug therapy , Skin Diseases, Bacterial/pathology , Skin Diseases, Bacterial/drug therapy , Cellulite/microbiology , Anti-Bacterial Agents/therapeutic use , NecrosisABSTRACT
Acinetobacter skin and soft tissue infection outside of the traumatic wound setting are rare occurrences. The majority of cases occur in the presence of significant comorbilities and by Acinetobacter baumanii. Herein a case is reported of community-onset, health-care-associated, non-traumatic cellulitis caused by Acinetobacter, species junii-johnsonii with bacteremia. This is the first reported case of Acinetobacter junii-johnsonii skin and soft tissue infection. Hemorrhagic bullae might be one of the clinical features of Acinetobacter cellulitis.
La infección de piel y tejidos blandos por Acinetobacter no relacionada con trauma es una presentación inusual. La mayoría de los casos descritos presentan enfermedades concomitantes y son causados por Acinetobacter baumanii. Se describe un caso de celulitis no traumática por A. junii-johnsonii con bacteriemia, de inicio en la comunidad y asociado con el tratamiento médico. De acuerdo con nuestro conocimiento, éste sería el primer caso reportado de infección de tejidos blandos y piel por A. junii-johnsonii. La vesícula hemorrágica podría ser una característica clínica de celulitis por Acinetobacter.
Subject(s)
Humans , Male , Middle Aged , Acinetobacter Infections/microbiology , Acinetobacter/isolation & purification , Cellulitis/microbiology , Opportunistic Infections/microbiology , Acinetobacter Infections/complications , Acinetobacter Infections/diagnosis , Acinetobacter Infections/drug therapy , Adenocarcinoma/complications , Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , Coinfection , Cellulitis/complications , Cellulitis/diagnosis , Cellulitis/drug therapy , Community-Acquired Infections/complications , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Drug Therapy, Combination , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Opportunistic Infections/complications , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Prostatic Neoplasms/complications , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/radiotherapy , Serratia Infections/complications , Serratia Infections/drug therapy , Serratia Infections/microbiology , Serratia marcescens/isolation & purification , Shock, Septic/etiology , Shock, Septic/therapy , Spinal Cord Injuries/complications , Spinal Fractures/complications , Staphylococcal Infections/complications , Thoracic Vertebrae/injuries , Urinary Tract Infections/complications , Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiologyABSTRACT
BACKGROUND: Cerebral abscesses are extremely rare in neonates. Serratia marcescens is an unusual cause of sepsis and neurological spread is especially ominous. PURPOSE: To report the case of a 34-week neonate who developed this rare condition and to discuss diagnostic and therapeutic measures. CASE REPRT: A 34-week male neonate sequentially developed respiratory distress syndrome, early sepsis and necrotizing enterocolitis; later cultures revealed S. marcescens. After deterioration, a cerebral abscess became evident, which revealed S. marcescens. Clinical improvement ensued after high-dose amikacin and meropenem. CONCLUSION: Clinical signs are often non-specific. Proper diagnostic measures, neurosurgical consultation and aggressive antibiotic therapy are essential for these high-risk neonates.
INTRODUÇÃO: Abscessos cerebrais são extremamente raros em neonatos. Serratia marcescens é causadora incomum de sepse nestes pacientes e a disseminação no sistema nervoso central é grave. OBJETIVO: Relatar um prematuro de 34 semanas que desenvolveu esta condição e discutir as medidas diagnósticas e terapêuticas. RELATO DE CASO: Prematuro masculino de 34 semanas desenvolveu síndrome do desconforto respiratório, sepse neonatal e enterocolite necrotizante; hemoculturas revelaram S. marcescens. Após deterioração clínica, evidenciou-se um abscesso cerebral cuja drenagem revelou S. marcescens. Houve melhora após introdução de amicacina e meropenem. CONCLUSÃO: Os sinais clínicos são inespecíficos. Passos diagnósticos apropriados, avaliação neurocirúrgica precoce e antibioticoterapia agressiva são essenciais para estes prematuros.
Subject(s)
Humans , Infant, Newborn , Male , Brain Abscess/microbiology , Diseases in Twins/microbiology , Serratia marcescens , Serratia Infections/microbiology , Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Brain Abscess/diagnosis , Brain Abscess/drug therapy , Diseases in Twins/diagnosis , Diseases in Twins/drug therapy , Serratia Infections/diagnosis , Serratia Infections/drug therapy , Thienamycins/therapeutic useABSTRACT
We report a case of spondylodiscitis caused by multiresistant Serratia marcescens in a cirrhotic patient who had several Serratia bacteremias after the placement of a transjugular intrahepatic portosystemic shunt (TIPS) device. We concluded that an endovascular stent that can not be removed makes management of recurrent bacteremia difficult. Furthermore, back pain due to bacteremia is indicative of spondylodiscitis. Serratia marcescens can be an aggressive pathogen, causing spinal infection.
Subject(s)
Humans , Male , Middle Aged , Bacteremia/microbiology , Discitis/microbiology , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Serratia Infections/diagnosis , Serratia marcescens/isolation & purification , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/drug therapy , Discitis/diagnosis , Discitis/drug therapy , Imipenem/therapeutic use , Serratia Infections/drug therapyABSTRACT
O caso de um homem de 21 anos, procedente da zona rural da Paraíba, estado do nordeste do Brasil, com esquistossomose mansônica associada com bacteremia esquistossomose mansônica associada com bacteremia por Serratia marcescens, é relatado. Suas queixas principais à admissäo foram febre, sudorese e calafrios por dez dias, e diarréia por quatro dias. Ao exame físico, apresentava icterícia e hepatoesplenomegalia. O diagnóstico da bacteremia foi feito pelo isolamento da bactéria em hemoculturas, e a esquistossomose foi diagnosticada através de biópsias retal e hepática. Esta é a primeira vez que a associaçäo de bacteremia por S. marcescens e esquistossomose mansônica é reconhecida. Embora nosso caso näo se enquadre na definiçäo clássica de bacteremia prolongada associada à esquistossomose, ele pode se considerado como uma forma leve desta associaçäo. Com a melhoria da assistência médica e dos recursos de diagnóstico laboratorial, o reconhecimento precoce da associaçäo será feito mais freqüentemente, o diagnóstico será realizado poucos dias após o início dos sintomas, e casos prolongados tornar-se ao mais raros