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Serratia Marcescens, a Rare and Devastating Cause of Endocarditis: A Case Report and Review of the Literature

Serratia marcescens is a gram-negative bacillus that is an opportunistic agent in respiratory tract infections, urinary tract infections, and septicemia. It is rarely a cause of infective endocarditis, but in cases of endocarditis, it follows a rapid and devastating course. A previously healthy fema...

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Detalles Bibliográficos
Autores principales: Luttmann, Kelly, Starnes, Victoria R, Haddad, Michael, Duggan, Joan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249249/
https://www.ncbi.nlm.nih.gov/pubmed/35784988
http://dx.doi.org/10.7759/cureus.25572
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author Luttmann, Kelly
Starnes, Victoria R
Haddad, Michael
Duggan, Joan
author_facet Luttmann, Kelly
Starnes, Victoria R
Haddad, Michael
Duggan, Joan
author_sort Luttmann, Kelly
collection PubMed
description Serratia marcescens is a gram-negative bacillus that is an opportunistic agent in respiratory tract infections, urinary tract infections, and septicemia. It is rarely a cause of infective endocarditis, but in cases of endocarditis, it follows a rapid and devastating course. A previously healthy female in her mid-50s presented with fever, abdominal pain, right lower extremity pain, and diarrhea. Blood cultures were positive for S. marcescens, and additional evaluation revealed infarction in the spleen and kidneys, raising concern for endocarditis with associated embolic phenomena. The patient was subsequently found to have an embolus in the right popliteal artery and underwent a right popliteal thromboembolectomy. Antimicrobial therapy with cefepime and gentamicin was begun. A transesophageal echocardiogram revealed a large, mobile mitral valve vegetation. Care was complicated by intracranial hemorrhage, and the decision was made to withdraw care. A review of the databases Embase and PubMed revealed 63 additional cases of S. marcescens endocarditis. Analysis of these cases demonstrated a preponderance of aortic and mitral valve involvement, not tricuspid valve involvement, despite a risk factor of intravenous drug use in over 60% of cases. Mortality was 50%, and sequelae such as congestive heart failure and renal insufficiency occurred in the majority of survivors. In conclusion, S. marcescens is a rare but devastating cause of endocarditis with a primary risk factor of intravenous drug use but with a predilection for left-sided valvular lesions, not right-sided lesions.
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spelling pubmed-92492492022-07-02 Serratia Marcescens, a Rare and Devastating Cause of Endocarditis: A Case Report and Review of the Literature Luttmann, Kelly Starnes, Victoria R Haddad, Michael Duggan, Joan Cureus Cardiology Serratia marcescens is a gram-negative bacillus that is an opportunistic agent in respiratory tract infections, urinary tract infections, and septicemia. It is rarely a cause of infective endocarditis, but in cases of endocarditis, it follows a rapid and devastating course. A previously healthy female in her mid-50s presented with fever, abdominal pain, right lower extremity pain, and diarrhea. Blood cultures were positive for S. marcescens, and additional evaluation revealed infarction in the spleen and kidneys, raising concern for endocarditis with associated embolic phenomena. The patient was subsequently found to have an embolus in the right popliteal artery and underwent a right popliteal thromboembolectomy. Antimicrobial therapy with cefepime and gentamicin was begun. A transesophageal echocardiogram revealed a large, mobile mitral valve vegetation. Care was complicated by intracranial hemorrhage, and the decision was made to withdraw care. A review of the databases Embase and PubMed revealed 63 additional cases of S. marcescens endocarditis. Analysis of these cases demonstrated a preponderance of aortic and mitral valve involvement, not tricuspid valve involvement, despite a risk factor of intravenous drug use in over 60% of cases. Mortality was 50%, and sequelae such as congestive heart failure and renal insufficiency occurred in the majority of survivors. In conclusion, S. marcescens is a rare but devastating cause of endocarditis with a primary risk factor of intravenous drug use but with a predilection for left-sided valvular lesions, not right-sided lesions. Cureus 2022-06-01 /pmc/articles/PMC9249249/ /pubmed/35784988 http://dx.doi.org/10.7759/cureus.25572 Text en Copyright © 2022, Luttmann et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Luttmann, Kelly
Starnes, Victoria R
Haddad, Michael
Duggan, Joan
Serratia Marcescens, a Rare and Devastating Cause of Endocarditis: A Case Report and Review of the Literature
title Serratia Marcescens, a Rare and Devastating Cause of Endocarditis: A Case Report and Review of the Literature
title_full Serratia Marcescens, a Rare and Devastating Cause of Endocarditis: A Case Report and Review of the Literature
title_fullStr Serratia Marcescens, a Rare and Devastating Cause of Endocarditis: A Case Report and Review of the Literature
title_full_unstemmed Serratia Marcescens, a Rare and Devastating Cause of Endocarditis: A Case Report and Review of the Literature
title_short Serratia Marcescens, a Rare and Devastating Cause of Endocarditis: A Case Report and Review of the Literature
title_sort serratia marcescens, a rare and devastating cause of endocarditis: a case report and review of the literature
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249249/
https://www.ncbi.nlm.nih.gov/pubmed/35784988
http://dx.doi.org/10.7759/cureus.25572
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