Morganella morganii: an uncommon cause of diabetic foot infection Tran Tran, DPM, Jana Balas, DPM, & Donald Adams, DPM, FACFAS MetroWest Medical Center, Framingham, MA INTRODUCTION LITERATURE REVIEW RESULTS RESULTS (Continued) followed in both wound care and podiatry clinic. During his Diabetic foot ulcers are at significant risk for causing Gram- Morganella morganii is a facultative gram negative anaerobic The patient was admitted to the hospital for intravenous stay in a rehabilitation facility, the patient developed a left negative bacteraemia and can result in early mortality. bacteria belongs to the Enterobacteriacea family and it is Cefazolin and taken to the operating room the next day heel decubitus ulcer. The left second digit amputation site Morganella morganii is a facultative Gram-negative anaerobe beta-lactamase inducible. It becomes important when it where extensive debridement of nonviable bone and soft has greatly reduced in size, with most recent measurements commonly found in the human gastrointestinal tract as manifests as an opportunistic pathogenic infection elsewhere tissue lead to amputation of the left second digit (Image 1). being 1.5 x 1.0 x 0.4 cm with granular base and the decubitus normal flora but can manifest in urinary tract, soft tissue, and in the body. The risk of infection is particularly high when a Gram stain showed gram negative growth and antibiotics ulcer is stable. abdominal infections. M. morganii is significant as an patient becomes neutropenic that can make a patient more were changed to Zosyn. Intraoperative deep tissue cultures infectious opportunistic pathogen. In diabetics it is shown to susceptible to bacteremia. Immunocompromised patients are grew M. morganii three days later. He was discharged cause septic arthritis of the knee, which could easily leads to most susceptible to bacteremia (1). following five days of inpatient therapy to a rehabilitation CONCLUSION bacteraemia. The authors present a case study to discuss M. facility with oral Ciprofloxacin for one month. Outpatient morganii as one of the organisms in diabetic foot infections Gas gangrene from M. morganii in a diabetic patient that was noninvasive vascular studies showed left posterior tibial This case study presents an isolated example of a diabetic (DFI) and the possible sequelae the organism poses. only treated conservatively with IV antibiotics due to several artery had an ABI of 0.34 with a noncompressible dorsalis foot infection with M. morganii. From our literature review, comorbidities and the patient died 72 hours later. Production pedis and monophasic flow to both arteries. An arteriogram there are four case studies presenting with M. morganii as of extended spectrum beta-lactamases and induction of beta- was then performed by a vascular surgeon. The results the pathogenic organism resulting in severe sequelae. M. MATERIALS & METHODS lactamases upon therapy has been widely reported with demonstrated that the left tibioperoneal artery trunk was morganii has the potential to cause foot infections, joint Morganella. Carbapenems are considered as the first-line open, but the posterior tibial and peroneal arteries were sepsis, and/or bacteraemia in the diabetic population. The antibiotics for the treatment of life-threatening infections due absent distally. There was also complete occlusion of the left authors hope to reinforce the importance of treating DFI as a An 81 year-old, IDDM male with CKD stage 3 and PVD with to Morganella (2). A case of septic arthritis caused by M. dorsalis pedis artery. The arteriogram unfortunately caused polymicrobial infection with the appropriate antibiotic chronic ulceration to the left dorsal second digit initially morganii, where the knee arthrocentesis showed presence of the patient to advance to end-stage renal disease requiring regiment. We are limited to one patient with this case study measuring 0.2 x 0.2 x 0.1 cm that turned the entire digit straw-colored, cloudy fluid without crystals (3). hemodialysis. The patient had an arteriovenous fistula and a but a larger population would be helpful for further necrotic and progressed to wet gangrene due to patient’s hemodialysis catheter placed, along with debridement of the investigation. noncompliance with wound care instructions of painting the A report of post-operative infection in an insulin dependent nonhealing second toe stump of the left foot and area with betadine and keeping the area dry. The patient was diabetic patient with Charcot deformity and chronic ulcer at osteomyelitis of the second metatarsal head. Patient was Level of evidence: Level 4 taken to the OR for debridement of nonviable bone and soft the plantar 1st metatarsal-cuneiform joint that healed. Patient tissue. Intraoperative deep cultures grew M. morganii after was taken to OR for an exostectomy of the joint. Three days REFERENCES three days. after the procedure, the patient developed infection in the incision site with the wound cultures growing M. morganii. 1. Kim JH, Cho CR, Um TH, Rhu JY, Kim ES, Jeong JW, Lee HR. “Morganella Table 1. Frequently Isolated Organisms in Diabetic Foot Ulcers The patient was then treated with local wound care, irrigation morganii sepsis with massive hemolysis.” J Korean Med Sci. 2007 Dec;22(6):1082-4. Staphylococcus aureus and antibiotics. Immunocompromised patients with such 2. Ghosh S, Bal AM, Malik I, Collier A. “Fatal Morganella morganii bacteraemia in a Staphylococcus epidermidis conditions as diabetes mellitus, may be unable to mount a diabetic patient with gas gangrene.”J Med Microbiol. 2009 Jul;58(Pt 7):965-7. doi: Bacteroides fragilis response. It is speculated by the authors that the patient had 10.1099/jmm.0.008821-0. Epub 2009 Jun 5. Streptococcus species the M. morganii infection prior to the surgery and the stress of 3. Cetin M, Ocak S, Kuvandik G, Aslan B, Temiz M, Aslan A. “Morganella morganii- Pseudomonas aeruginosa the surgical procedure proliferated the infectious process (4). associated arthritis in a diabetic patient.” Adv Ther. 2008 Mar;25(3):240-4. doi: 10.1007/s12325-008-0026-x. Table 1. Kimberlee B. Hobizal, DPM and Dane K. Wukich, MD. “Diabetic foot 4. Gebhart-Mueller Y, Mueller P, Nixon B. “Unusual case of postoperative infection infections: current concept review.” Diabeti Foot Ankle, 2012; 3: Image 1. One week following initial left second digit caused by Morganella morganii.” J Foot Ankle Surg. 1998 Mar-Apr;37(2):145-7. 10.34002/dfa.v3i0. 18409 amputation. Fibrotic plug with probe to bone. Post debridement measurements were 2.0 x 1.8 x 0.8 cm..