A Case of Giant Hepatic Hydatid Cyst Infected with Morganella morganii and the Literature Review

Bacterial and Fungal Occurrence in Hydatid Cysts from Livestock in Central Iran

Echinococcus granulosus sensu lato causes Cystic echinococcosis. This study investigated the bacterial and fungal species in the liver and lung hydatid cysts obtained from sheep, goats, cattle, and camels slaughtered in Yazd abattoir, Central Iran. In this study, 84 hydatid cysts were obtained from 20 sheep, 13 goats, 25 cattle, and 26 camels. The fertility and viability rates were assessed using light microscopy and eosin staining, respectively. The aspirated hydatid cysts were cultured to detect the presence of any bacteria and fungi. Bacterial isolates were identified by biochemical tests. DNA was also extracted from germinal layers, and then genotyping was carried out targeting the cox 1 gene. The statistical analysis was performed by SPSS version 16.0. This study showed that 22.62% (19/84) of hydatid cysts had bacterial occurrence, and none of the samples had fungal species. Among the fertile cysts, 52.6% had bacterial occurrence, of which 40% were viable. Most bacteria detected in hydatid cysts included Staphylococcus saprophyticus, Escherichia coli, and S. epidermidis. Hydatid cysts with bacterial occurrence were identified as G1-G3, G5, and G6/G7. The bacterial species occurrence in hydatid cysts had no significant relationship with fertility and viability (P > 0.05), without any significant relation with viability (P > 0.05), animal species (P > 0.05), involved organ in animals (P > 0.05), and hydatid cyst genotypes (P > 0.05). It should also be mentioned that this is the first study to assess the relationship between hydatid cyst genotyping and the occurrence of fungal and bacterial species.

Diversity in the swimming motility and flagellar regulon structure of uropathogenic Morganella morganii strains

In current times, the opportunistic pathogen Morganella morganii is increasingly becoming a cause of urinary tract infections. The condition has been further complicated by the multiple drug resistance of most isolates. Swimming motility plays an important role in the development of urinary tract infections, allowing bacteria to colonize the upper urinary tract. We determined the differences between the growth, swimming motility, and biofilm formation of two M. morganii strains MM 1 and MM 190 isolated from the urine of patients who had community-acquired urinary tract infections. MM 190 showed a lower growth rate but better-formed biofilms in comparison to MM 1. In addition, MM 190 possessed autoaggregation abilities. It was found that a high temperature (37 °C) inhibits the flagellation of strains and makes MM 190 less motile. At the same time, the MM 1 strain maintained its rate of motility at this temperature. We demonstrated that urea at a concentration of 1.5% suppresses the growth and swimming motility of both strains. Genome analysis showed that MM 1 has a 17.7-kb-long insertion in flagellar regulon between fliE and glycosyltransferase genes, which was not identified in corresponding loci of MM 190 and 9 other M. morganii strains with whole genomes. Both strains carry two genes encoding flagellin, which may indicate flagellar antigen phase variation. However, the fliC2 genes have only 91% identity to each other and exhibit some variability in the regulatory region. We assume that all these differences influence the swimming motility of the strains.

A novel method for treatment of pseudomonas pyogenic hepatic abscess complicating an echinococcal cyst by irrigation with acetic acid. A case report and literature review

Hepatic hydatid cysts can be complicated by pyogenic abscesses. We report a case of hepatic hydatid cysts presenting to Sultan Qaboos University Hospital (SQUH) on 29 June 2010 complicated by secondary infection with fully sensitive Pseudomonas aeruginosa. The infection persisted despite standard treatment (drainage and systemic antibiotics) and was eventually cured with a novel method using acetic acid.

Methods

Instillation of acetic acid (in the form of white vinegar) into the hepatic abscess through the pig tail drainage tube.

Results

The administration of acetic acid (6%) in the form of white vinegar was well tolerated and safe to the patient and resulted in complete clinical and radiographic resolution of the hepatic abscess.

Conclusion

Acetic acid (vinegar) irrigation can be used to clear a refractory pyogenic hepatic abscess due toP aeruginosa infection.

Prevalence and bacterial isolation from hydatid cysts in dromedary camels (Camelus dromedarius) slaughtered at Sharkia abattoirs, Egypt

Cystic echinococcosis (CE) is a severe neglected zoonotic parasitic disease caused by the larval stage of the dog tapeworm, Echinococcus granulosus. The objectives of this study were to determine the prevalence of hydatid cysts in dromedary camels (Camelus dromedarius) at Sharkia province, Egypt and investigate the occurrence of bacteria in hydatid fluid. A total of 6416 dromedary camels slaughtered in five abattoirs in Sharkia province, Egypt during the period from January and December 2018 were investigated for the presence of hydatid cysts. Furthermore, the bacterial species in 10 hydatid fluid isolated from lungs and livers was identified. The current findings revealed that the prevalence of hydatid cysts was 3.7%. Among those, the infection rate in lungs was 78.2%, which was significantly higher than hepatic infections (21.8%). The prevalence of hydatid cysts was the highest in winter (7.4%) and the lowest in spring (1.5%). The most common bacterial species found inside hydatid fluid collected from lungs were Salmonella spp., Staphylococcus spp., Enterococci and Pseudomonas spp. Meanwhile, Staphylococcus spp. were isolated from hepatic hydatid fluid. In conclusion, hydatid cysts infection is prevalent in dromedary camels in Sharkia province, Egypt as well as various aerobic and anaerobic bacterial species were isolated from hydatid fluid from camel lungs and livers.

Comparative Genome Analysis of Uropathogenic Morganella morganii Strains

Morganella morganii is an opportunistic bacterial pathogen shown to cause a wide range of clinical and community-acquired infections. This study was aimed at sequencing and comparing the genomes of three M. morganii strains isolated from the urine samples of patients with community-acquired urinary tract infections. Draft genome sequencing was conducted using the Illumina HiSeq platform. The genomes of MM 1, MM 4, and MM 190 strains have a size of 3.82–3.97 Mb and a GC content of 50.9–51%. Protein-coding sequences (CDS) represent 96.1% of the genomes, RNAs are encoded by 2.7% of genes and pseudogenes account for 1.2% of the genomes. The pan-genome containes 4,038 CDS, of which 3,279 represent core genes. Six to ten prophages and 21–33 genomic islands were identified in the genomes of MM 1, MM 4, and MM 190. More than 30 genes encode capsular biosynthesis proteins, an average of 60 genes encode motility and chemotaxis proteins, and about 70 genes are associated with fimbrial biogenesis and adhesion. We determined that all strains contained urease gene cluster ureABCEFGD and had a urease activity. Both MM 4 and MM 190 strains are capable of hemolysis and their activity correlates well with a cytotoxicity level on T-24 bladder carcinoma cells. These activities were associated with expression of RTX toxin gene hlyA, which was introduced into the genomes by a phage similar to Salmonella phage 118970_sal4.

Giant simple biliary cyst infection treated with minimally invasive percutaneous drainage

We describe a minimally invasive alternative approach in a patient with infected hepatic cyst to stabilize the patient before definitive surgery. A 58-year-old man presented with fever and hypotension after 2 weeks of asthenia, chills, weight loss, slight abdominal pain, and a previous asymptomatic simple hepatic cyst. On ultrasound, a giant heterogeneous hepatic cyst with thick wall was noted. A positron emission tomography-computed tomography scan was indicated and demonstrated high uptake (standardized uptake value = 7.6) in the wall of the cyst, suggestive of infection. He underwent percutaneous drainage guided by the tomography. A 12 Fr drain was positioned inside the collection and 5 L of purulent material was aspirated from the cyst, and at day 12^th, surgical resection was performed. Histopatological analysis confirmed a simple biliary cyst. The patient remains asymptomatic on 1-year follow-up. Percutaneous drainage before surgical treatment allowed the definitive approach to be performed with the patient in better clinical conditions.

Persistent infection with metallo-beta-lactamase and extended spectrum β-lactamase producer Morganella morganii in a patient with urinary tract infection after kidney transplantation

Organ transplant recipients under immunosuppressive therapy have a highly increased risk of acquiring unusual opportunistic infections. Diagnosis of the etiology of infection may be difficult in clinical manifestations, which need further histological and biological investigations. Here in we report, for the 1^st time in the Iran, a Morganella morganii isolate harboring blaVIM, blaCTX-M, and blaSHV genes after kidney transplantation with persistent urinary infections.

Morganella morganii causing abscess over the anterior chest wall- a case report

A 17-year-old female college student presented with recurrent abscess over the anterior chest wall since one and half year. Morganella morganii was isolated from the aspirated pus. Patient was started on oral ciprofloxacin and the lesion resolved in two weeks.