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CASE REPORT
Year : 2002  |  Volume : 20  |  Issue : 3  |  Page : 167-168
 

Pulmonary infection with serratia marcescens


Department of Microbiology, Jawahar Lal Nehru Medical College, Ajmer - 305001, Rajasthan, India

Correspondence Address:
Department of Microbiology, Jawahar Lal Nehru Medical College, Ajmer - 305001, Rajasthan, India

 ~ Abstract 

A case of pulmonary infection, presenting with fever and productive cough (pseudohaemoptysis) was diagnosed as having infection with Serratia marcescens on performing culture and sensitivity tests. The organism was confirmed upto species level using the standard biochemical tests.

How to cite this article:
Rastogi V, Purohit P, Peters B P, Nirwan P S. Pulmonary infection with serratia marcescens. Indian J Med Microbiol 2002;20:167-8


How to cite this URL:
Rastogi V, Purohit P, Peters B P, Nirwan P S. Pulmonary infection with serratia marcescens. Indian J Med Microbiol [serial online] 2002 [cited 2017 Oct 22];20:167-8. Available from: http://www.ijmm.org/text.asp?2002/20/3/167/6946


Serratia marcescens is a member of Enterobacteriaceae family and like other members of this family, resides as a normal commensal in the alimentary canal. It is also present in water and soil as a saprophyte. Till now, it had not been reported from clinical samples such as sputum, urine etc. in Rajasthan. To the best of our knowledge, this is the first time, that Serratia marcescens is being reported from sputum.

 ~ Case Report Top

A thirty five year old man was admitted in Kamla Nehru Institute for Tuberculosis and Chest Diseases on January 2, 2001. He was complaining of productive cough with blood-tinged sputum, fever off and on and oral ulcers. The patient had taken antitubercular treatment for three months in 1995, then again for one month in 1997. He had also undergone bronchoscopy in 1997. The patient was non-smoker. On the admission day, X-ray chest was done, which showed prominent hilar shadows bilaterally. No lesion suggestive of tuberculosis was evident. The patient was negative for HIV-1 and HIV-2 antibodies. Apparently, he was immunocompromised with a body-weight of only 33 kilograms and presence of oral thrush. Patient's height and weight (162 cm and 33 kg, respectively) and recurrent oral thrush for last three years indicate towards an immunocompromised state.
He was provisionally diagnosed as a case of Intermittent Respiratory Failure and was given empirical treatment with tetracycline, to which he did not respond. On sixth day (i.e. January 8, 2001), his sputum was sent to the Department of Microbiology, J L N Medical College for culture of Mycobacteria as well as for any pyogenic bacteria. The culture was found to be negative for Mycobacteria.
Grossly, the sputum appeared pinkish in colour. Smears were prepared. On Ziehl-Neelsen staining, no acid fast bacilli were seen. On examining Gram stained smear, several Gram-negative bacilli along with pus cells and yeast-cells without any pseudohyphae were seen. In direct wet mount preparation, yeast cells were seen, but no red blood corpuscles and in India ink-preparation, no capsulated yeasts suggestive of Cryptococcus neoformans were seen.
The sputum was inoculated onto blood agar, nutrient agar, MacConkey's agar and into trypticase soya broth. After aerobic incubation at 370 C for 24 hours, the blood agar showed large beta-haemolytic as well as smaller non haemolytic colonies. On Gram staining, the former were of gram negative bacilli, while the latter were the colonies of yeast. The MacConkey's agar plate showed dark pink colonies. Nutrient agar also showed dark pink colonies the pigment of which was not diffusible into the medium.
Biochemical tests, viz. indole, methyl red, citrate-utilization, urease, triple sugar iron agar, gelatin-liquefaction, DNAse and lipase-production tests were done with the red pigment-producing colonies and based on the results the organism was identified as S.marcescens.
Antimicrobial susceptibility test was performed with modified Kirby-Bauer technique and the organism was found to be sensitive to cotrimoxazole, gentamicin, amoxycillin, chloramphenicol, ciprofloxacin, tobramycin and amikacin.
The above mentioned procedures were repeated with another sputum-sample on the second consecutive day along with a culture on Sabouraud dextrose agar, which gave exactly the same results, except for the yeast, which were absent in the direct wet mount and Gram stained smear as well as on blood agar plate and Sabouraud dextose agar.
The patient was treated with amoxycillin and nystatin (local application in oral cavity). He responded well to the treatment and was discharged from hospital on January 13, 2001.

 ~ Discussion Top

As Serratia marcescens is a normal commensal of alimentary canal, the sample was repeated to rule out the possibility of contamination. Isolation of the same organism in pure culture indicated its role in causation of the disease. Haemoptysis being complained by the patient was in fact a pseudohaemoptysis, because no red blood corpuscles were seen on direct microscopy. The sputum was red-tinged due to the red pigment, Prodigiosin produced by Serratia marcescens.
The yeast-bodies seen in direct wet mount of the sputum-sample were not associated with the pulmonary lesion, as no pseudohyphae were seen in the direct mount and also, no yeast was isolated on a repeat culture of sputum on blood agar plate as well as on Sabouraud dextrose agar. Serratia marcescens was perhaps introduced during the bronchoscopy done in past, as it is a well documented nosocomial pathogen.[3],[4]
Keeping in view, that the patient was immunocompromised, that he did not respond to the initial treatment with tetracycline and that the organism isolated was an uncommon one we strongly recommend that culture and antimicrobial susceptibility tests should always be sought before instituting any empirical antimicrobial therapy. 

 ~ References Top

1.Crichton PB. In : Mackie & MacCartney Practical Medical Microbiology, 14th ed. Collee JG, Fraser AG, Marmion BP, Simmons A, Eds (Churchill Livingstone, New York) 1996:371.  Back to cited text no. 1    
2.Citron DM, Edelstein MAC, Garcia LS, Robert DG, Thomson Jr. RB, Washington II JA. In : Bailey & Scott's Diagnostic Microbiology, 9th ed. Baron EJ, Peterson LR, Finegold SM, Eds (Mosby-Year Book, Inc, St. Louis) 1994:371.  Back to cited text no. 2    
3.Wenzel RP, Edmond MB. Tuberculosis infection after bronchoscopy (Editiorial). JAMA 1997;278:1111.  Back to cited text no. 3    
4.Haddy R, Mann B, Nadkarni D, Cruz R, Elshoff D, Buendia F, Domus T, Oberhen A. Nosocomial infection in the community hospital : Severe infection due to Serratia species. The Journal of Family Practice 1996;42:273-277.  Back to cited text no. 4    
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