Severe and Progressive Cellulitis Caused by Serratia marcescens Following a Dog Scratch

Abstract

Soft tissue infections occur in over 30% of patients with chemotherapy-induced neutropenia. Gram-positive bacterial infections predominate early in neutropenia, and likelihood of infection by resistant bacteria and fungi increases with prolonged neutropenia. Prior infections and exposures influence the risk of rare pathogens. A 55-year-old woman with chemotherapy-induced neutropenia was scratched on her forearm by a dog. She cleaned the wound with isopropanol and was treated empirically with amoxicillin-clavulanate. Over the next 4 days, she developed fever along with erythema, edema, and mild tenderness of the forearm without purulence or crepitus. She was hospitalized and received empiric treatment with intravenous vancomycin, piperacillin-tazobactam, tobramycin, and voriconazole. Despite therapy, her fevers persisted and the cellulitis progressed for over a week. After 10 days of hospitalization, her neutrophil count began to recover and a bulla developed at the wound site. Culture of the bullous fluid grew Serratia marcescens , and antibiotics were switched to cefepime based on susceptibility. She defervesced and showed substantial improvement of cellulitis within 48 hours and was discharged on oral ciprofloxacin. Serratia marcescens skin infections are rare, and this may be the first report of Serratia cellulitis associated with trauma from dog contact. This case highlights the need to consider unusual pathogens based on exposure history and immune status and to obtain cultures from fluid collections or tissue in cases of treatment-resistant soft tissue infections.

Acquired perforating dermatosis with associated complicated cellulitis and amputation in a hemodialysis patient

“…Although Serratia skin and soft tissue infections are uncommon, they mostly affect immunocompromised patients, namely those with renal failure and who are subjected to instrumentation and prior antibiotic therapy [ 11 , 12 ]. Chronic vascular disease and venous insufficiency also predispose these patients to local infection.…”

“…Chronic vascular disease and venous insufficiency also predispose these patients to local infection. These cases are frequently resistant to conventional antibiotics, and surgery may be considered [ 11 , 12 ]. Several presentations have been described, which include plaques, bullous cellulitis, nodules, or necrotizing cellulitis, and may lead to life-threatening sepsis if spread [ 12 ].…”

“…These cases are frequently resistant to conventional antibiotics, and surgery may be considered [ 11 , 12 ]. Several presentations have been described, which include plaques, bullous cellulitis, nodules, or necrotizing cellulitis, and may lead to life-threatening sepsis if spread [ 12 ]. Awareness of this difficult-to-treat cellulitis that affects immunocompromised patients is essential to achieving better outcomes.…”

Serratia marcescens isolated from neonate patients with septicemia and study of the inhibition effect of Garlic plant extracts compared to antimicrobial agents in Thi Qar province in Iraq

“…In neonatal intensive care units (NICUs), Serratia marcescens causes sepsis, pneumonia, urinary tract infections, and conjunctivitis, but it is a rather uncommon pathogen (Jones et al, 2000;Stoll et al, 2002;Ulu-Kilic et al, 2013) The urinary tract was one of the most important isolation sources for S. marcescens, with infection closely linked to urologic interventions such cystoscopy, transurethral surgery, contamination of urine containers and urination sites, and especially catheterization (Buffet-Bataillon et al, 2009). Serratia has also been linked to more dangerous diseases such as cellulitis, which is an inflammation of the subcutaneous connective tissue (Pithadia et al, 2019).…”

Necrotizing Fasciitis Due to Serratia marcescens Infection Following Snake Bite

“…Oral cavity of a snake is colonized by various bacteria especially the gram-negative Enterobacteriaceae family. Grim et al [1] and Pithadia et al [2] described Serratia marcescens infection following lizard bite and dog scratch, respectively. Similar to our case, Subramani et al [3] reported a case of bullous cellulitis caused by serratia following unknown snake bite in an adult from India.…”