Background

Morganella morganii is a gram-negative rod commonly found in the environment and in the intestinal tracts of humans, mammals, and reptiles as normal flora. Despite its wide distribution, it is an uncommon cause of community-acquired infection and is most often encountered in postoperative and other nosocomial settings. M morganii infections respond well to appropriate antibiotic therapy; however, its natural resistance to many beta-lactam antibiotics may lead to delays in proper treatment.

The genus Morganella belongs to the tribe Proteeae of the family Enterobacteriaceae. The Proteeae, which also include the genera Proteus and Providencia, are important opportunistic pathogens capable of causing a wide variety of nosocomial infections. Currently, Morganella contains only a single species, M morganii, with 2 subspecies, morganii and sibonii. M morganii was previously classified under the genus Proteus as Proteus morganii.

In the late 1930s, M morganii was identified as a cause of urinary tract infections. Anecdotal reports of nosocomial infections began to appear in the literature in the 1950s and 1960s. Tucci and Isenberg reported a cluster epidemic of M morganii infections occurring over a 3-month period at a general hospital in 1977.^[1]Of these infections, 61% were wound infections and 39% were urinary tract infections.

In 1984, McDermott reported 19 episodes of M morganii bacteremia in 18 patients during a 5.5-year period at a Veterans Administration hospital.^[2]Eleven of the episodes occurred in surgical patients. The most common source of bacteremia was postoperative wound infection, and most infections occurred in patients who had received recent therapy with a beta-lactam antibiotic. Other important epidemiologic risk factors in these studies included the presence of diabetes mellitus or other serious underlying diseases and advanced age.

In 2011, Kwon et al reported a case of a 65-year-old man with an infected aortic aneurysm in which the pathogen was M morganii. Diagnosis requires a high index of suspicion and imaging tests.^[3]

Pathophysiology

M morganii has been associated with urinary tract infections, sepsis, pneumonia, wound infections, musculoskeletal infections, CNS infections, pericarditis, chorioamnionitis, endophthalmitis, empyema, and spontaneous bacterial peritonitis.

Frequency

United States

M morganii is a rare cause of severe invasive disease. It accounts for less than 1% of nosocomial infections. M morganii usually is an opportunistic pathogen in hospitalized patients, particularly those on antibiotic therapy.

International

M morganii infections have been reported worldwide, with cases in Spain, Italy, Iran, and China amongst other countries.^{[4, 5, 6, 7]}

Prognosis

The prognosis depends on the type of infection and the particular host.

Data suggest that inappropriate antimicrobials (ones to which an organism is resistant) are associated with a worse outcome.

Clinical Presentation

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Kwon OY, Lee JS, Choi HS, Hong HP, Ko YG. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings. Abdom Imaging. 2011 Feb. 36(1):83-5. [QxMD MEDLINE Link].
Guerra M, Marado D. Fulminans Purpura due to Morganella morganii. Eur J Case Rep Intern Med. 2022. 9 (11):003670. [QxMD MEDLINE Link]. [Full Text].
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Xiang G, Lan K, Cai Y, Liao K, Zhao M, Tao J, et al. Clinical Molecular and Genomic Epidemiology of Morganella morganii in China. Front Microbiol. 2021. 12:744291. [QxMD MEDLINE Link]. [Full Text].
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Shi H, Chen X, Yao Y, Xu J. Morganella morganii: An unusual analysis of 11 cases of pediatric urinary tract infections. J Clin Lab Anal. 2022 May. 36 (5):e24399. [QxMD MEDLINE Link].
Johnson JR, Feingold M. Case of chorioamnionitis in an immunocompetent woman caused by Morganella morganii. J Matern Fetal Med. 1998 Jan-Feb. 7(1):13-4. [QxMD MEDLINE Link].
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Arranz-Caso JA, Cuadrado-Gomez LM, Romanik-Cabrera J, et al. Pyomyositis caused by Morganella morganii in a patient with AIDS. Clin Infect Dis. 1996 Feb. 22(2):372-3. [QxMD MEDLINE Link].
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Choi SH, Lee JE, Park SJ, et al. Emergence of antibiotic resistance during therapy for infections caused by Enterobacteriaceae producing AmpC beta-lactamase: implications for antibiotic use. Antimicrob Agents Chemother. 2008 Mar. 52(3):995-1000. [QxMD MEDLINE Link].
Luo XW, Liu PY, Miao QQ, Han RJ, Wu H, Liu JH, et al. Multidrug Resistance Genes Carried by a Novel Transposon Tn7376 and a Genomic Island Named MMGI-4 in a Pathogenic Morganella morganii Isolate. Microbiol Spectr. 2022 Jun 29. 10 (3):e0026522. [QxMD MEDLINE Link].
Bagel J, Grossman ME. Hemorrhagic bullae associated with Morganella morganii septicemia. J Am Acad Dermatol. 1985 Mar. 12(3):575-6. [QxMD MEDLINE Link].
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Cunningham ET Jr, Whitcher JP, Kim RY. Morganella morganii postoperative endophthalmitis. Br J Ophthalmol. 1997 Feb. 81(2):170-1. [QxMD MEDLINE Link].
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Author

Shirin A Mazumder, MD, FIDSA Associate Professor of Medicine, Director of Infectious Disease Fellowship Program, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, University of Tennessee Methodist Physicians

Shirin A Mazumder, MD, FIDSA is a member of the following medical societies: American Academy of HIV Medicine, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Memphis Medical Society, Society for Healthcare Epidemiology of America, Tennessee Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Nupur Singh, BA MD Candidate, University of Tennessee Health Science Center College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University School of Medicine in Shreveport; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

James R Miller, MD Assistant Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences; Consulting Staff, Pediatric Infectious Diseases, Naval Medical Center at Portsmouth

James R Miller, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Sections Morganella Infections
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