A Rare Presentation of Serratia marcescens Endocarditis

Serratia marcescens is uncommon and rarely causes bacterial endocarditis. It can follow a rapid and progressive course with high mortality. Here, we present the case of a 27-year-old gentleman with bacterial endocarditis secondary to S. marcescens who was successfully treated medically.

A Sixty-Nine-Year-Old Female With Serratia marcescens Infection

Serratia marcescens is a bacterial pathogen that tends to cause opportunistic infections, mainly in immune-compromised patients. In this case, we present a 69-year-old female who presented to the emergency department (ED) at Mount Sinai Hospital in Chicago on February 11th, 2022, after a mechanical fall. She had a medical history of metastatic lung cancer treated with chemotherapy, hypertension, pulmonary embolism, polysubstance abuse, and chronic obstructive pulmonary disease (COPD). The patient was found to be positive for systemic inflammatory response syndrome (SIRS). The patient was then started on broad-spectrum antibiotics, including vancomycin and cefepime. Blood cultures were ordered and came back positive for Serratia marcescens. This patient had multiple factors for immune suppression, including metastatic lung cancer, chemotherapy, and polysubstance abuse. The infectious disease department was consulted for the blood culture results, and ceftriaxone was recommended. Later on, levofloxacin was recommended. Blood cultures were negative two days after being positive. Afterward, the patient was kept for monitoring until discharge. Serratia marcescens is found in several reservoirs in nature. Therefore, preventing contact with this pathogen in immune-compromised patients can be difficult. It is important to have a degree of clinical suspicion for opportunistic pathogens like Serratia marcescens whenever a patient with factors for immune compromise presents for any condition.

Infection of Multiple Tunneled Dialysis Catheters Resulting From the Contamination of the Chlorhexidine Solution by Serratia marcescens

Tunnelled dialysis catheters continue to be a choice in several patients as hemodialysis access. According to Kidney Disease Outcomes Quality Initiative guidelines, its handling implies disinfection, that can be performed using chlorhexidine solutions. Theoretically, these solutions have bactericidal capacity at concentrations greater than 0.12%. We present a curious situation of failure of the antiseptic process due to contamination of the chlorhexidine solution 4% of aqueous base. In this hemodialysis clinic, three cases of infections by the bacteria Serratia marcescens were identified over 2 weeks - in two of the cases, identified in blood culture, and in the other case in the exudate from the exit site of the catheter. Considering the abnormal number of infections by this agent and the fact that these patients were on different shifts, were treated in different rooms, and handled by different nurses, the antiseptic solutions used in the different hemodialysis rooms were analyzed, as well as a closed package from the same batch. After microbiological tests were performed on the antiseptic solution, we identified the growth of Serratia marcescens. This result identified the culprit as being the contamination of the 4% chlorhexidine solution. The competent authorities were notified, and the disinfection method was changed to use a chlorhexidine alcohol-based solution.

Complete Spinal Cord Injury Secondary to Serratia marcescens Spinal Epidural Abscess: A Report of Significant Neurological Improvement After a Delayed Presentation

The exact time at which neurological deficits secondary to a spinal cord injury (SCI) become permanent is unknown. However, urgent decompression within 24 hours of insult is advocated to maximize the return of function. Despite previous literature showing poor neurological recovery with intervention after 24-72 hours, multiple cases have since shown noteworthy clinical improvement following significant delays in presentation. We report the case of a 55-year-old incarcerated male who presented to our hospital with a four-week history of a complete (American Spinal Injury Association (ASIA) A) SCI after a prison altercation. The patient exhibited profound deficits of over one-month duration, and magnetic resonance imaging (MRI) revealed an epidural abscess at T7-T8 with severe cord compression and another epidural abscess at L4-L5. This prompted immediate IV antibiotic therapy. A full neurological examination at hospital admission showed a complete absence of sensation, motor, rectal tone, and rectal function below T8, indicating a grade ASIA A SCI. Blood cultures grew Serratia marcescens. After thorough deliberation, considering over a month of complete neurological deficits, it was decided that surgical intervention would be unlikely to improve the patient's clinical status. Nonetheless, after only 24 hours of IV antibiotic administration, the patient progressed from an ASIA A to B, with a return of 100% accurate, although dull, sensation below T8. Within one week, his abscesses diminished on follow-up MRI, yet T7-T8 remained under significant pressure with no further clinical improvements. Due to his unexpected improvement to an ASIA B, which then plateaued at this level, surgery was again discussed in an attempt to maximize recovery. The patient wished to proceed, even given low chances of a meaningful recovery. He subsequently underwent evacuation and decompression. Two weeks postoperatively, the patient advanced from an ASIA B to C; he remained so until discharge 46 days after presentation and 30 days after surgical decompression. This case is noteworthy within the literature due to two compelling features. Firstly, it represents a significantly delayed presentation of a complete SCI with unexpected, meaningful, and swift improvement after medication and surgical intervention. Secondly, it is one of the few documented cases of Serratia marcescens spinal epidural abscess (SEA).

Prodigiosin: a promising biomolecule with many potential biomedical applications

Pigments are among the most fascinating molecules found in nature and used by human civilizations since the prehistoric ages. Although most of the bio-dyes reported in the literature were discovered around the eighties, the necessity to explore novel compounds for new biological applications has made them resurface as potential alternatives. Prodigiosin (PG) is an alkaloid red bio-dye produced by diverse microorganisms and composed of a linear tripyrrole chemical structure. PG emerges as a really interesting tool since it shows a wide spectrum of biological activities, such as antibacterial, antifungal, algicidal, anti-Chagas, anti-amoebic, antimalarial, anticancer, antiparasitic, antiviral, and/or immunosuppressive. However, PG vehiculation into different delivery systems has been proposed since possesses low bioavailability because of its high hydrophobic character (XLogP3-AA = 4.5). In the present review, the general aspects of the PG correlated with synthesis, production process, and biological activities are reported. Besides, some of the most relevant PG delivery systems described in the literature, as well as novel unexplored applications to potentiate its biological activity in biomedical applications, are proposed.

Serratia marcescens Endocarditis

Infective endocarditis (IE) secondary to Staphylococcus aureus and streptococcus species comprises the majority of cases in literature with Gram negative bacterial insults occurring infrequently. Serratia marcescens is a Gram negative bacillus which is classified as motile, non-lactose fermenting, and a facultative anerobe. The presumed risk factor for the development of S. marcescens IE is intravenous drug use (IVDU). We report two cases of IE causes by S. marcescens: first case describes IE of tricuspid and aortic valve requiring surgical intervention further complicated by epidural abscess. The second case was associated with renal and splenic infarct. These cases highlight the severity and complicated nature of S. marcescens IE. Given S. marcescens IE has been infrequently described in the literature, we believe that our cases are worth reporting to contribute to the present incidence and management of S. marcescens IE.

Chiari III Malformation on Prenatal and Postnatal Imaging Complicated by Syndrome of Inappropriate Secretion of Anti-diuretic Hormone (SIADH) and Serratia marcescens Meningitis

Among various types of Chiari malformations (CMs), CM III is the most infrequently encountered. In this article, we present a case of CM III with occipital cephalocele appreciated on both prenatal imaging and postnatal follow-up MRI. This case illustrates not only the evolution of this malformation from the in-utero images of fetal MRI to the newborn MRI but also highlights the complications that may accompany this diagnosis such as hydrocephalus and infection. The patient also developed syndrome of inappropriate secretion of anti-diuretic hormone (SIADH). The most current thoughts on the pathophysiology of this entity are also reviewed along with an approach to the differential diagnosis and treatment.

Successful treatment of Serratia Marcescens peritonitis in a patient receiving peritoneal dialysis

An old man receiving peritoneal dialysis was diagnosed with Serratia marcescens peritonitis, a rare case with poor prognosis. Powerful antibiotics based on culture results and enough duration cured the case successfully despite its high virulence.

Serratia marcescens Tricuspid Valve Vegetation and Successful Use of the AngioVac® System

Serratia marcescens bacteremia is common in patient populations with a history of intravenous drug use (IVDU), but it rarely causes infective endocarditis. We are reporting a 27-year-old female with a medical history significant for IVDU and hepatitis C virus infection who presented to the emergency department complaining of fever and shortness of breath. Computed tomography of the chest with intravenous (IV) contrast revealed extensive bilateral pulmonary infiltrates with multiple cavitary lesions. The patient was treated with IV vancomycin and piperacillin/tazobactam. Blood culture grows methicillin-sensitive Staphylococcus aureus (MSSA) and S. marcescens, both sensitive to cefepime/meropenem. Transesophageal echocardiogram revealed 3.4 x 2 cm tricuspid valve vegetation. Cardiothoracic surgery was consulted, who recommended transcatheter aspiration with the AngioVac® system (AngioDynamics Inc., Latham, NY). Post-procedure transesophageal echocardiogram revealed a significant reduction of vegetation size. Vegetation tissue culture grew MSSA and S. marcescens. The repeated blood culture revealed no growth, and the patient significantly improved clinically. She completed a six-week course of IV meropenem as an inpatient until she was discharged home.

A Rare Case of Serratia marcescens Causing Mycotic Aneurysm and Septic Emboli in Intravenous Drug User

There are few literatures highlighting the presence of a mycotic aneurysm in the setting of bloodstream infection by Serratia. A 33-year-old male with a history of Marfan syndrome, mitral valve prolapse, and intravenous drug use (IVDU) presented to the ED with fever, nausea, and non-bloody emesis, and vague abdominal pain with concern for sepsis. With the strong association between IVDU and infective endocarditis, transthoracic and transesophageal echocardiograms were performed and were negative for vegetations. Abdominal CT and positron emission tomography (PET) scan were performed and revealed thrombosis at the first jejunal branch of the superior mesenteric artery (SMA), left renal pole infarct, and superior splenic pole infarct. Following CT angiography for potential thrombolysis, aneurysmal formation was discovered proximal to the filling defect within mid-SMA. Blood cultures drawn at presentation grew Serratia marcescens. The patient was treated with appropriate antibiotic, and recommended indefinite anticoagulation. The patient was then recommended to follow up with vascular surgery within two weeks for repeat abdominal CT angiogram.

A Complicated Case of Vertebral Osteomyelitis by Serratia Marcescens

Osteomyelitis is an infection of the bone and bone marrow that can be caused by an exogenous source or by hematogenous spread. The hematogenous spread of bacteria usually results in bacteremia with subsequent infection of the bone. The most commonly associated pathogen with this type of infection is Staphylococcus aureus, with other gram-negative organisms, such as Pseudomonas aeruginosa, also frequently encountered. The microorganism Serratia marcescens is a rare and infrequently encountered cause of this condition known to cause nosocomial infections. This organism can be notoriously difficult to treat, with resistance to many commonly used antibiotics. The case presented is one of vertebral osteomyelitis in an intravenous drug user caused by Serratia marcescens with subsequent treatment and management of the condition. This case allows for investigation into the continued management of intravenous drug user infections, with the isolation and treatment of less commonly encountered pathogens.

Gram-negative Cranial Bone Flap Infection Treated with Continuous Gentamicin Irrigation: A Case Report

A 57-year-old male presented with severely altered mental status in the setting of diabetic ketoacidosis. Neuroimaging revealed two intracranial masses. Days following surgical resection of an olfactory groove meningioma, the patient developed Serratia marcescens bacteremia along with an enlarging epidural and subgaleal fluid collection. Subgaleal fluid aspiration was also positive. The patient later returned to the operating room for wound washout where purulent collections were discovered in the subgaleal, epidural, and left subdural spaces. The wound was evacuated and the bone flap was thoroughly cleansed with betadine and soaked in peroxide prior to replacement. Four drains were placed (two subgaleal and two epidural) with two serving as inlets and two as outlets. Continuous irrigation of the subgaleal and epidural spaces with gentamicin solution was performed for five days. The bone flap was successfully salvaged and the patient was discharged from inpatient rehab three weeks following washout.

On the role of sawdust in the development of mastitis in cows

Sawdust was aspirated into one of the teatcups of the milking unit by induced liner slip during milking of 10 cows, which were then slaughtered. Sawdust particles were recovered from the interior of the quarters, the teat skin and the inside of the liners corresponding to both treated and untreated teats, and from the milk claw and the bucket as well. Sterile sawdust was introduced into the teat cisterns of three quarters of one cow. Clinical mastitis developed. The investigation was initiated by an outbreak of Serratia-mastitis in a dairy herd and supports the view that the outbreak was caused by contaminated sawdust used as litter in combination with improper detachment of the milking units. Widening of the impact concept is propsosed.