Infección por morganella morganii en paciente postransplantado de riñón: reporte de caso y revisión de literatura / Morganella morganii infection in post-transplant kidney patient: Case Report and literature review

Las infecciones humanas por Morganella morganii es poco frecuente hasta el 3% de las infecciones del tracto urinario, puede producir diversos tipos de infecciones, su papel etiológico es dudoso. Hay pocos reportes a nivel mundial en la literatura sobre infecciones causadas por este patógeno y ninguna en Honduras. Descripción de Caso. Masculino 46 años con antecedentes de trasplante renal hace 4 años por IRC, manejado con prednisona, micofelonato y sirulimus, diabético e hipertensión arterial crónica tratado con Insulina NPH 20 u. cada día y Carvedilol 12.5 mg, referido por el servicio de Nefrología a la Emergencia del HEU por iebre de una semana, continua, sugestivamente alta, no cuantiicada, diaforesis con escalofrío, con disuria de un día de evolución y un episodio de vomito. Con signos vitales P/A 90/60 mmHg, FC 88 x ́, FR 22 x ́, afebril, examen físico normal. Cuatro horas posteriores al ingreso; comenzó con iebre de 38.9 °C agregando antipiréticos al manejo establecido, con hiponatremia, falla renal aguda, uroanálisis patológico. Ecografía renal: Riñón trasplantado de corteza engrosada correspondiendo a pielonefritis aguda, sin masas, colecciones, litos e hidronefrosis, midiendo 12.7x5.8x4.9 cm. Urocultivo: crecimiento de Morganella morganii, resistente a fosfosil, nitrofurantoina, sensible a ciproloxacino y ceftazidime. Paciente se mantuvo afebril, mejorando al manejo establecido con ciproloxacino IV se da alta al quinto día posterior a su ingreso con seguimiento estricto por servicio de nefrología. Conclusiones. Reportamos una patología vista con frecuencia, pero en un paciente especial como es un post trasplante renal que pudo traer múltiples complicaciones para el paciente sumado al que el patógeno es conocida como agente infección de la vía urinaria pero rara vez causa infecciones en personas inmunocompetentes, pero si puedes llegar a ser causa de infección nosocomiales en personas inmunocomprometidas. Debemos de tener seguimiento estricto de este tipo de pacientes desde el más mínimo síntoma para evitar secuelas y/o complicaciones severas

Cristaluria masiva asociada a infección urinaria ureolítica: un caso exepcional / Massive crystalluria associated whit ureolitic urynary infection: an exceptional

Introducción y Objetivos. Las infecciones urinarias por gérmenes ureolíticos se asocian generalmente con la eliminación y/o formación de cálculos infectivos de estruvita (fosfato amónico magnésico, fosfato triple). Sin embargo no tenemos conocimiento de que se haya comunicado ningún caso de emisión masiva de cristales con visualización macroscópica y recuperación de las arenillas en el "poso seco" del sedimento de la orina. El objetivo de este breve artículo es comunicar un infrecuente caso de cristaluria masiva de fosfato amónico magnésico secundaria a infección urinaria por la asociación de dos gérmenes: Citrobacter freundii (no ureolítico) y Morganella morgagnii (ureolítica). Caso Clínico. Mujer de 72 años sin antecedentes urológicos previos que consultó por presentar desde hace 1 año expulsión de gran cantidad de arenillas en las micciones, hasta el punto de que en alguna ocasión le ocluían momentáneamente la uretra. La paciente aportó una muestra de la cristaluria (arenilla) recuperada del poso seco del sedimento de su orina, donde se aprecia un gran volumen de polvo y arena (microcristales). El estudio del sedimento urinario mostró PH 8, densidad de 1035 (n 1005-1030), nitritos (+), bacteriuria y abundante cantidad de cristales incoloros en forma de prisma o "ataúd" sugestivos de corresponder a cristales de fosfato amónico magnésico. En el urinocultivo existían 500.000 UFC/ml y se aislaron 2 gérmenes uno no ureolítico (Citrobacter freundii) y otro ureolítico (Morganella morgagnii). Radiografía simple de aparato urinario y ecografía normales. El análisis químico de la arenilla mostró una composición de 80 por ciento fosfato amónico magnésico y 20 por ciento oxalato cálcico. Se instauró tratamiento según antibiograma con ciprofloxacino 500 mg cada 12 horas 7 días y se acidificó la orina con vitamina C (ácido ascórbico) 500 mg día 20 días, consiguiendo erradicar la infección urinaria, normalizar el PH urinario a 5, y frenar definitivamente la expulsión de cristales. En un control a los 6 meses permanecía asintomática y con urinocultivo estéril. Conclusiónes. Este caso es una forma de presentación excepcional de una infección urinaria ureolítica, sin los síntomas clásicos habituales. Su única manifestación clínica fue la expulsión de gran cantidad de cristales (arenilla) en las micciones que en ocasiones provocaban obstrucciones intermitentes de uretra de resolución espontánea. Este singular caso demuestra que escuchando a los pacientes, a veces nos cuentan hechos casi imposibles y la mayoría de las veces son verídicos (AU)

Background and Objetives. Ureolytic urinary tract infections are generally associated with the elimination and / or formation of struvite infective stones (magnesium ammonium phosphate, triple phosphate). However, we are not aware of any reports of massive emission of crystals with macroscopic visualization and recovery of the sand in the "dry" sediment of the urine. The objective of this brief article is to report an infrequent case of massive crystalluria of magnesium ammonium phosphate secondary to urinary infection due to the association of two germs: Citrobacter freundii (non ureolytic) and Morganella morgagnii (ureolytic). Clinical Case. A 72-year-old woman with no prior urological history who consulted for the past 1 year of expulsion of a large amount of sand in the micturition, to the point that she had occasion ally occluded the urethra. The patient provided a sample of the crystalluria (sand) recovered from the dry sediment of her urine, where a large volume of dust and sand (microcrystals) was seen. The study of the urine sediment showed PH 8, density of 1035 (n 1005-1030), nitrites (+), bacteriuria and abundant amount of colorless crystals in the form of prism or "coffin" suggestive of corresponding magnesium ammonium phosphate crystals. In the urinoculture there were 500,000 CFU / ml and two non-ureolytic (Citrobacter freundii) and one ureolytic (Morganella morgagnii) were isolated. Simple x-ray of normal urinary system and ultrasound. The chemical analysis of the grit showed a composition of 80 pertcent magnesium ammonium phosphate and 20 pertcent calcium oxalate. Therapy was initiated according to antibiogram with ciprofloxacin 500 mg every 12 hours 7 days and the urine was acidified with vitamin C (ascorbic acid) 500 mg day 20, succeeding in eradicating the urinary tract infection, normalizing the urinary pH to 5, and finally stopping expulsion Of crystals. In a control at 6 months, he remained asymptomatic and with sterile urine culture. Conclusions. This case is an exceptional presentation of a urethritic urinary infection, without the usual classic symptoms. Its only clinical manifestation was the expulsion of large amounts of crystals (sand) in micturitions that occasionally caused intermittent urethral obstructions of spontaneous resolution. This unique case demonstrates that listening to patients, sometimes tell us almost impossible facts and most of the time are true.(AU)

Changing resistance proifle ofProteus, Serratia, Citrobacter, Morganella andProvidencia isolates in hospitals across China：data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014 / 中国感染与化疗杂志

Objective To understand the changing resistance proifle ofProteus,Serratia,Citrobacter,Morganella andProvidencia in hospitals across China according to the data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014.Methods Antimicrobial susceptibility was tested by using Kirby-Bauer method or automatic minimum inhibitory concentration determination according to a uniifed protocol.Results A total of 21 663 clinical isolates were collected from January 2005 to December 2014. The proportion ofProteus andSerratia isolates increased with time from 1.41% in 2005 to 2.09% in 2014, and from 0.99% in 2005 to 1.28% in 2014 among all the isolates. No change was found for the proportion ofCitrobacter,Morganella, orProvidencia. Less than 10% of theProteus isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, ceftazidime, cefoxitin, amikacin and tigecycline. Less than 10% of theSerratia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, amikacin and tigecycline. Less than 20% of theCitrobacter isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 10% of theMorganella isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 20% of theProvidencia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, cefoxitin and tigecycline.Conclusions The antibiotic resistance ofProteus,Serratia, Citrobacter,Morganella andProvidencia isolates in hospitals across China is growing during the period from 2005 to 2014. Strengthening infection control and rational antibiotic use are effective to slow the growth of drug resistance.

Arapidly progressing, deadly disease of Actias selene (Indianmoonmoth) larvae associated with a mixed bacterial and baculoviral infection.

The outbreak of an infectious disease in captive-bred Lepidoptera can cause death of all the caterpillars within days. A mixed baculoviral–bacterial infection observed among Actias selene (Hübner 1807), the Indian moon moth (Insecta: Lepidoptera: Saturniidae), larvae was characterized and followed by a photographic documentation of the disease progression. The etiological agents were determined using mass spectrometry and polymerase chain reaction (PCR). It appeared that the disease was caused by a mixed infection of larvae with a baculovirus and Morganella morganii. A molecular phylogenetic analysis of the virus and microbiological description of the pathogenic bacterium are presented.

Isolation and molecular analysis of blaNDM-1-positive Morganella morganii / 中华检验医学杂志

Objective To investigate the molecular background of the New Delhi-metallo-1 (NDM-1)-producing Morganella morganii.Methods Two carbapenem-resistant M.morganii named 1 and 2 were isolated in the Second Hospital of Jiaxing,Zhejiang on October 4th and 29th,respectively.Antimicrobial susceptibility was determined by agar dilution method.Pulsed-field gel electrophoresis (PFGE) was performed to analyse the homololgy of isolates.Amplification with specific primers,DNA sequencing,conjugation experiments and genetic environment analysis were conducted to investigate the molecular mechanisms of resistance.Results The two M.morganii isolates were resistant to carbapenem and fluoroquinolones,while susceptible to aztreonam.PFGE analysis indicated that the two isolates were distinguishable.Amplification and DNA sequencing confirmed the coexistence of blaNDM-1,blasHv-12,qnrS1 and aac(6')-Ib-cr in both isolates.Transconjugants were detected with blaNDM.1 and qnrS1 simultaneously.Genetic environment analysis demonstrated that the blaNDM-1-bleMBL-trpF-dsbC-cutA1 structure was in consistence with those from known blaNDM-1-carrying Klebsiella pneumoniae.Conclusion The blaNDM-1 in M.morganii isolates possiblely obtained from K.pneumoniae through translatable plasmids.

Prevalence and plasmid characterization of the qnrD determinant in Morganella morganii isolates / 中华微生物学和免疫学杂志

Objective To investigate the prevalence and plasmid size of qnrD determinant in Morganella morganii (M.morganii) isolates.Methods A total of 100 non-duplicated M.morganii clinical isolates were collected from inpatients.Standard ager dilution method was used to determine the minimum inhibitory concentrations (MICs) of fluoroquinolones against M.morganii isolates.PCR were performed to detect plasmid-mediated quinolone resistance determinants (PMQRs) in M.morganii isolates and the prevalence of extended-spectrum β-lactamase (ESBL) genes and AmpC β-lactamase genes in PMQRs-positive M.morganii strains.The homology analysis among qnrD-positive M.morganii strains were conducted by using pulsed-field gel electrophoresis (PFGE).The location of qnrD gene and the size of plasmid carrying it were determined by southern hybridization.The transferability of qnrD gene was determined by conjugation experiment.Results Thirty out of 100 M.morganii isolates (30％) were found carrying PMQRs including 17 qnrD-positive strains,14 aac (6')-Ib-cr-positive strains and 5 qepA-positive strains.PCR and sequencing confirmed that thirty PMQRs-positive isolates carried blaDHA-1.Among them,six isolates were positive for ESBLs genes (four for blaCTX-M-14,one for blaCTX-M-3 and one for blaCTX-M-24) and four isolates were positive for blaTEM-1.Almost all PMQRs-positive M.morganii isolates showed reduced susceptibility to fluoroquinolones.Moreover,seventeen qnrD-positive M.morganii isolates harbored blaDHA-1 including five (29.4％) harboring aac(6')-Ib-cr gene,four (23.5％) harboring blaCTX-M-14,two (11.8％) harboring blaTEM-1 and one harboring aac(6')-Ib-cr gene,blaCTX-M-14 and blaDHA-1.PFGE analysis showed that the 17 qnrD-positive M.morganii isolates were divergent from each other and not clone-related.Southern hybridization analysis showed that qnrD genes of all M.morganiiis isolates were mainly located in a 2.7 kb plasmid,but only a few of them were located in a size of 5.1 kb plasmid.M.morganiiis isolates failed to transfer qnrD gene to E.coli EC600 through conjugation.Conclusion PMQRs were widely distributed in M.morganiiis isolates.qnrD gene was the predominant determinants with a high prevalence rate of 17.0％,followed by aac(6')-Ib-cr gene.qnrD gene was located on a non-conjugative plasmid of approximately 2.7 kb or 5.1 kb.One qnrD-positive M.morganii isolate carrying aac(6')-Ib-cr gene,blaCTX-M-14 and blaDHA-1 was detected.

Detection of plasmid-mediated carbapenem-hydrolyzing β-lactamase KPC-2 in Morganella morganii / 中华微生物学和免疫学杂志

ObjectiveTo investigate the molecular epidemiology and mechanisms of carbapenem resistance of Morganella morganii.MethodsSeven carbapenem-non-susceptible M.morganii were isolated from Hangzhou Traditional Chinese Medicine Hospital from October 2010 to February 2011.Pulsed-field gel electrophoresis (PFGE) was performed to analysis the molecular epidemiology of isolates.Antibiotic susceptibilities were determined by agar dilution method.Conjugation experiments were carried out in mixed broth cultures.Plasmid DNA was obtained by an alkalinelysis technique and examined by electrophoresis.Specific PCRs and DNA sequencing were preformed to confirm the genotype of β-lactamases.ResultsPFGE indicated that 6 M.morganii isolates from emergency care unit were indistinguishable or closely related and 1 isolate from intensive care unit was distinguishable.Seven M.morganii showed similar antibiotic susceptibility patterns.M.morganii isolates were resistant to imipenem,were susceptible to meropenem,and were susceptible or intermediate resistant to ertapenem,with MICs of 8 μg/ml,1 μg/ml,and 0.25-0.50 μg/ml,respectively.M.morganii isolates were resistant to penicillins,aztreonam,and ciprofloxacin,were resistant or susceptible to cephalosporins,and were susceptible to amikacin.E.coli (EC600) acquired an approximately 60 kb plasmid from M.morganii by conjugation studies and resistant or intermediate resistant to carbapenems and other β-lactams.PCRs and DNA sequence analysis confirmed that all M.morganii isolates and their E. coli transconjugants produced the KPC-2 carbapenemase and carried the qnrS1 gene.ConclusionIt is the first detection of KPC-2 in M.morganii isolates.Production of KPC-2 mainly contributed to the carbapenem resistance in M.morganii.

Spontaneous Eyeball Rupture in a 94-Year-Old Patient

PURPOSE: To report a case of spontaneous eye ball rupture without trauma in a 94-year-old patient. CASE SUMMARY: A 94-year-old female patient diagnosed with cataract in both eyes 20 years was referred to this ophthalmologic department for treatment consultation of a painful left eye with spontaneous bleeding. She has used anti-cataract eye drops and artificial tears three times a day for several years without consulting a doctor. Fifteen days prior to presentation, the patient suffered severe left eyeball pain and headache and was diagnosed with acute angle-closure glaucoma secondary to hypermature cataract. She underwnet eviceration after ocular examination and systemic evaluation. Surgical findings included a thin cornea at the inferior limbus and protruding intraocular tissues. Additionally, the eyeball was filled with a blood clot from a choroidal hemorrhage. Morganella morganii were grown in a bacterial swap culture, and a corneal biopsy revealed suppurative inflammation. CONCLUSIONS: In old age, a thin corneal limbus due to infection and complicated acute angle-closure glaucoma can cause massive suprachoroidal hemorrhage with spontaneous eyeball rupture.

The relationship of resistance mechanism of two strains of Enterobacteriaceae resistant to carbapenems isolated from a single specimen / 中华微生物学和免疫学杂志

Objective To investigate the relationship of resistance mechanisms of a Klebsiella pneumoniae strain and a Morganella morganii strain resistance to carbapenems isolated from a single specimen. Methods Sensibility of antimicrobial agents was detected by agar dilution method. Specific PCR and DNA sequence analysis were performed to detect resistance genes. Plasmid feature was detected by plasmid conjugation and electrophoresis analysis. Genetic environment around blaKPC was analyzed with sequencing. The changes of outer membrane permeability were analyzed with electrophoresis of outer membrane proteins. Results blaKPC-2 was detected in 2 original isolates strains and their transconjugants. Carbapenem-resistance was successfully transfered by conjugation experiments. blaKPC-2 was located on dissimilar plasmids, but genetic environment around blaKPC-2 was the same sequence. The Morganella morganii isolate showed a loss of 38 ×103 OMPs and an additional 36 ×103 OMPs appearance, while the Klebsiella pneumoniae isolate showed a loss of OMPK36. Conclusion blaKPC-2 was detected in 2 isolates. This gene encoded by two plasmids with different sizes was located on the same composite transposon. The lack of outer membrane proteins could also play an important role causing isolates to exhibite resistance to carbapenems.

Sepsis neonatal precoz causada por transmisión vertical de Morganella morganii, en un embarazo de término / Fatal neonatal sepsis caused by vertical transmission of Morganella morganii. Report of one case

We report a term neonate who developed early-onset sepsis due to Morganella morganii. The child was vaginally delivered after a short labor, and presented signs of perinatal asphyxia. Blood cultures taken soon after birth and from mother's lochia were positive for this microorganism. The infection was unresponsive to treatment with cefotaxime, to which the microorganism was susceptible, and the infant died at 17 days of age. M morganii is an opportunistic and uncommon pathogen, causing disease mainly in patients with underlying illness or after surgery. It is a rare perinatal pathogen, causing severe disease in premature infants, in association with maternal chorioamnionitis and premature rupture of the membranes (RevMéd Chile 2009; 137: 1201-4).

Morganella Morganii Sepsis with Massive Hemolysis

Morganella morganii is a facultative gram-negative and anaerobic rod. It may be a cause of devastating infections in neonates and immunocompromised hosts. Some bacterial infections such as Clostridium and Vibrio are associated with hemolysis. However, massive hemolysis caused by M. morganii sepsis has not yet been reported. We observed a 59-yr-old man who had chemotherapy-induced neutropenia and was found to have massive hemolysis and metabolic acidosis due to sepsis. He died 6 hr after admission in spite of aggressive treatment. Two sets of blood cultures revealed the growth of M. morganii. We report here that M. morganii sepsis can cause fatal massive hemolysis leading to death.

Characterization of a New Integron Containing VIM-2 Metallo-beta-Lactamase Gene Cassette in an Isolate of Morganella morganii from a Urine Specimen / 대한비뇨기과학회지

PURPOSE: The main objectives of this work were to characterize the mechanism of resistance to imipenem of Morganella morganii KU158 isolated in Busan, Korea and to analyze the structure of the integron, which carries the resistance gene that confers resistance to imipenem. MATERIALS AND METHODS: Antimicrobial susceptibilities of M. morganii KU158 were tested by using the disk diffusion method. The modified Hodge and EDTA-disk synergy tests were performed for the screening of metallo-beta-lactamase-producing isolates. blaIMP and blaVIM genes were detected using the polymerase chain reaction (PCR) amplification. To detect the presence of the integron, the PCR method was used. The PCR product was cloned through the use of primers, 5'CS-F and 3'CS-R, and it was used to determine the sequence of the integron through the dideoxy-mediated chain termination method. RESULTS: M. morganii KU158 was intermediately resistant to imipenem and showed a positive result for the modified Hodge and EDTA-disk synergy tests, which suggest the production of metallo-beta-lactamase, and also was positive in the PCR result for the detection of blaVIM gene. The genotype of the PCR product from the blaVIM gene was blaVIM-2. Sequencing of the 5,031 bp-cloned fragment revealed the structure of the class I integron, such as the 5'-CS element containing an Intl1 integrase gene with its own promoter region, the attI1 recombination site, and the 3'-CS element containing qacE1. The integron contained insert gene cassettes blaVIM-2, aac(6')-Ib, aadA1, "orfII", and "orfIII". The blaVIM-2 gene was located immediately downstream of the aac(6')-Ib gene. CONCLUSIONS: M. morganii KU158 acquired the resistance to imipenem through the production of metallo-beta-lactamase VIM-2. The gradual increase in the number of VIM-2-producing bacterial species may indicate the highly mobile nature of the blaVIM-2 cassette. The spread of blaVIM-2 could compromise the future usefulness of carbapenem in treating gram-negative bacilli infections.

A Case of Subdural Abscess Caused by Morganella morganii / 소아과

Morganella morganii, a gram-negative bacillus and part of normal faecal flora, is recognised as a common cause of urinary tract infection. We report a rare case of subdural abscess caused by M. morganii in an infant. It was secondary to purulent meningitis. The patient improved with treatment that consisted of surgical excision and systemic antibiotics.

Skin Ulcers Possibly Induced by Morganella Morganii / 대한피부과학회지

Morganella morganii, a gram, negative rod is often regarded as an opportunistic, secondary invader rather than a primary pathogen on the skin. It has been isolated from blood, sputa, and pus from patients with respiratory tract and wound infections or with bacteremia. A 2-year-old boy presented with erythematous ulcerative lesions on the cheeks and left knee which had a tendency to superficial scarring. The organism isolated from the ulcer displayed a biochemical char acteristics typical of Morganella morganii. The lesions responded well to systemic antibiotic therapy with amikacin and carbenicillin, which were recognized as effective drugs in in vitro sensitivity testing.