Morganella Infections: Background, Pathophysiology, Epidemiology

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Sections Morganella Infections
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Medication
References

Overview

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 epidemiological 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 is usually opportunistic pathogen in hospitalized patients, particularly those on antibiotic therapy.

Prognosis

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

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

Clinical Presentation

Tucci V, Isenberg HD. Hospital cluster epidemic with Morganella morganii. J Clin Microbiol. 1981 Nov. 14(5):563-6. [Medline].
McDermott C, Mylotte JM. Morganella morganii: epidemiology of bacteremic disease. Infect Control. 1984 Mar. 5(3):131-7. [Medline].
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. [Medline].
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. [Medline].
Ranu SS, Valencia GB, Piecuch S. Fatal early onset infection in an extremely low birth weight infant due to Morganella morganii. J Perinatol. 1999 Oct-Nov. 19(7):533-5. [Medline].
Verboon-Maciolek M, Vandertop WP, Peters AC, et al. Neonatal brain abscess caused by Morganella morgagni. Clin Infect Dis. 1995 Feb. 20(2):471. [Medline].
Krebs VL, Koga KM, Diniz EM. Necrotizing fasciitis in a newborn infant: a case report. Rev Hosp Clin Fac Med Sao Paulo. 2001 Mar-Apr. 56(2):59-62. [Medline]. [Full Text].
Gautam V, Gupta V, Joshi RM, et al. Morganella morganii-associated arthritis in a diabetic patient. J Clin Microbiol. 2003 Jul. 41(7):3451. [Medline].
Katz LM, Lewis RJ, Borenstein DG. Successful joint arthroplasty following Proteus morganii (Morganella morganii) septic arthritis: a four-year study. Arthritis Rheum. 1987 May. 30(5):583-5. [Medline].
Schonwetter RS, Orson FM. Chronic Morganella morganii arthritis in an elderly patient. J Clin Microbiol. 1988 Jul. 26(7):1414-5. [Medline].
Jorge MT, Ribeiro LA, da Silva ML, et al. Microbiological studies of abscesses complicating Bothrops snakebite in humans: a prospective study. Toxicon. 1994 Jun. 32(6):743-8. [Medline].
Lopez-Sabater EI, Rodriguez-Jerez JJ, Hernandez-Herrero M, et al. Incidence of histamine-forming bacteria and histamine content in scombroid fish species from retail markets in the Barcelona area. Int J Food Microbiol. 1996 Jan. 28(3):411-8. [Medline].
Otwell WS. Scombroid Poisoning. US Food and Drug Administration, Sea Grant Extension Fact Sheet. 1995. [Full Text].
Mastroianni A, Coronado O, Chiodo F. Morganella morganii meningitis in a patient with AIDS. J Infect. 1994 Nov. 29(3):356-7. [Medline].
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. [Medline].
Chen HW, Lin TY. Tumor abscess formation caused by Morganella morganii complicated with bacteremia in a patient with gastrointestinal stromal tumor. Clin Res Hepatol Gastroenterol. 2011 Sep 14. [Medline].
Abdalla J, Saad M, Samnani I, et al. Central nervous system infection caused by Morganella morganii. Am J Med Sci. 2006 Jan. 331(1):44-7. [Medline].
Pomeranz A, Korzets Z, Eliakim A, et al. Relapsing Henoch-Schonlein purpura associated with a tubo-ovarian abscess due to Morganella morganii. Am J Nephrol. 1997. 17(5):471-3. [Medline].
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. [Medline].
Bagel J, Grossman ME. Hemorrhagic bullae associated with Morganella morganii septicemia. J Am Acad Dermatol. 1985 Mar. 12(3):575-6. [Medline].
Bensman A, Roubach L, Allouch G, et al. Urolithiasis in children. Presenting signs, etiology, bacteriology and localisation. Acta Paediatr Scand. 1983 Nov. 72(6):879-83. [Medline].
Casanova-Roman M, Sanchez-Porto A, Casanova-Bellido M. Early-onset neonatal sepsis caused by vertical transmission of Morganella morganii. Scand J Infect Dis. 2002. 34(7):534-5. [Medline].
Cox CE. Aztreonam therapy for complicated urinary tract infections caused by multidrug-resistant bacteria. Rev Infect Dis. 1985 Nov-Dec. 7 Suppl 4:S767-71. [Medline].
Cunningham ET Jr, Whitcher JP, Kim RY. Morganella morganii postoperative endophthalmitis. Br J Ophthalmol. 1997 Feb. 81(2):170-1. [Medline].
Del Pozo J, Garcia-Silva J, Almagro M, et al. Ecthyma gangrenosum-like eruption associated with Morganella morganii infection. Br J Dermatol. 1998 Sep. 139(3):520-1. [Medline].
Dutta S, Narang A. Early onset Neonatal Sepsis due to Morganella morganii. Indian Pediatr. 2004 11 7. 41(11):1155-1157. [Medline]. [Full Text].
Gebhart-Mueller Y, Mueller P, Nixon B. Unusual case of postoperative infection caused by Morganella morganii. J Foot Ankle Surg. 1998 Mar-Apr. 37(2):145-7. [Medline].
Isobe H, Motomura K, Kotou K, et al. Spontaneous bacterial empyema and peritonitis caused by Morganella morganii. J Clin Gastroenterol. 1994 Jan. 18(1):87-8. [Medline].
Lee IK, Liu JW. Clinical characteristics and risk factors for mortality in Morganella morganii bacteremia. J Microbiol Immunol Infect. 2006 Aug. 39(4):328-34. [Medline].
Müller HE. Occurrence and pathogenic role of Morganella-Proteus-Providencia group bacteria in human feces. J Clin Microbiol. 1986 Feb. 23(2):404-5. [Medline].
O'Hara CM, Brenner FW, Miller JM. Classification, identification, and clinical significance of Proteus, Providencia, and Morganella. Clin Microbiol Rev. 2000 Oct. 13(4):534-46. [Medline].
Piccolomini R, Cellini L, Allocati N, et al. Comparative in vitro activities of 13 antimicrobial agents against Morganella-Proteus-Providencia group bacteria from urinary tract infections. Antimicrob Agents Chemother. 1987 Oct. 31(10):1644-7. [Medline].
Rowen JL, Lopez SM. Morganella morganii early onset sepsis. Pediatr Infect Dis J. 1998 Dec. 17(12):1176-7. [Medline].
Salen PN, Eppes S. Morganella morganii: a newly reported, rare cause of neonatal sepsis. Acad Emerg Med. 1997 Jul. 4(7):711-4. [Medline].
Samonis G, Anatoliotaki M, Apostolakou H, et al. Fatal septicemia and meningitis due to Morganella morganii in a patient with Hodgkin's disease. Scand J Infect Dis. 2001. 33(7):553-5. [Medline].
Stock I, Wiedemann B. Identification and natural antibiotic susceptibility of Morganella morganii. Diagn Microbiol Infect Dis. 1998 Mar. 30(3):153-65. [Medline].
Williams EW, Hawkey PM, Penner JL, et al. Serious nosocomial infection caused by Morganella morganii and Proteus mirabilis in a cardiac surgery unit. J Clin Microbiol. 1983 Jul. 18(1):5-9. [Medline].
Vinogradov E, Nash JH, Foote S, Young NM. The structure of the Morganella morganii lipopolysaccharide core region and identification of its genomic loci. Carbohydr Res. 2015 Jan 30. 402:232-5. [Medline].
Liu H, Zhu J, Hu Q, Rao X. Morganella morganii, a non-negligent opportunistic pathogen. Int J Infect Dis. 2016 Sep. 50:10-7. [Medline].
Podeur G, Dalgaard P, Leroi F, Prévost H, Emborg J, Martinussen J, et al. Development of a real-time PCR method coupled with a selective pre-enrichment step for quantification of Morganella morganii and Morganella psychrotolerans in fish products. Int J Food Microbiol. 2015 Jun 16. 203:55-62. [Medline].

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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.

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 Health Sciences Center; 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, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

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
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
References

Morganella Infections

Background

Pathophysiology

Epidemiology

Frequency

Prognosis

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Morganella Infections

Background

Pathophysiology

Epidemiology

Frequency

Prognosis

References

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