Morganella morganii in sinonasal region: A rare case report

Abstract

Morganella morganii is a gram negative pathogen and may cause potentially lethal disease especially in patients with underlying or immunosuppressive disease. It is commonly found in long-term urinary catheter used and immune system deficiency patients as nosocomial disease. Involving other systems such as skin, skeletal system and central nervous system can be seen too. Sporadic occurrence is rare and can be seen in any system by various causes like AIDS, snake bites and poisoning. In this case we present sporadic Morganella morganii infection on sinonasal region with the presence of sinusitis, sino-cutaneous fistula, preseptal cellulitis and hard palate defect on 58 year old male diabetic patient. Microbiological assessment from open wound and sinuses were reported as Morganella morganii. To our knowledge, this is the first case of sino-nasal Morganella morganii infection with sino-cutaneous fistula, preseptal cellulitis and maxillofacial bone destruction. J Clin Exp Invest 2013; 4 (3): 383-386

Keywords

• Morganella Morganii, sino-nasal fistula, preseptal cellulitis, bone destruction

Sinonazal bölgede Morganella morganii: Nadir bir olgu sunumu

Öz

Morganella morganii, özellikle immunsupresif, uzun dönem idrar yolu kateteri kullanan kişilerde ölümcül hastalıklara yol açabilen Gram-negatif fırsatçı bir patojendir. Sıklıkla üriner sistem enfeksiyonlarına yol açmasına rağmen kas-iskelet sistemi, santral sinir sistemi ve cilt enfeksiyonlarına da sebep olabilmektedir. Sporadik enfeksiyon olguları nadir olmakla birlikte AİDS, zehirlenmeler ve yılan ısırmaları ile birlikte görülebilmektedir. Sino-kutanöz fistül, preseptal selülit ve oro-maksiller fistül gelişimi görülen, 58 yaşındaki diabetik erkek hastada yapılan tetkikler sonucu M morganii enfeksiyonu saptandı. Hastaya fronto-etmoidektomi ve mediyal maksillektomi yapıldı. İki hafta uygulanan medikal tedavi sonucu genel durumu düzeldi. Bu olgu, araştırmalarımıza göre sinonazal bölgede ilk kez görülen M. morganii enfeksiyonu olup tanı, tedavi ve klinik yönleriyle tartışılmıştır.

Anahtar Kelimeler

• Morganella morganii, sinonazal fistül, preseptal selülit, kemik defekti

References

1. O’Hara CM, Brenner FW, Miller JM. Classification, identification and clinical significance of Proteus, Providencia and Morganella. Clin Microbiol Rev 2000;13:534-546.
2. Tucci V, Isenberg HD. Hospital cluster epidemic with Morganella morganii. J Clin Microbiol 1981;14:563- 566.
3. Jorge MT, Ribeiro LA, da Silva ML, et al. Microbio- logical studies of abscesses complicating Bothrops snakebite in humans: a prospective study. Toxicon 1994;32:743-748.
4. Abdalla J, Saad M, Samnani I, et al. Central nervous system infection caused by Morganella morganii. Am J Med Sci 2006;331:44-47.
5. Clinical and Laboratory Standards Institute. Perfor- mance standards for antimicrobial susceptibility test- ing; Twenty-second Informational Supplement. Docu- ment M100-S22. Wayne, PA 2012.
6. Morgan H de R. Report XCV. Upon the bacteriology of the summer diarrhea of infants. Br Med J 1906;1:908- 912.
7. Winslow CEA, Kligler IJ, Rothberg W. Studies on the classification of the colon-typhoid group of bacteria with special reference to their fermentative reactions. J Bacteriol 1919;4:429-503.
8. Brenner DJ, Farmer JJ III, Fanning GR, et al. Deoxyri- bonucleic acid relatedness of Proteus and Providen- cia species. Int J Syst Bacteriol 1978;28:269-282.

9. McDermott C, Mylotte JM. Morganella morganii: epidemiology of bacteremic disease. Infect Control 1984;5:131-137.
10. Biedenbach DJ, Jones RN, Erwin ME. Interpretive ac- curacy of the disk diffusion method for testing newer orally administered cephalosporins against Morgan- ella morganii. J Clin Microbiol 1993;31:2828-2830.