History
Sepsis
Patients with Serratia sepsis may present with fever, chills, shock, and respiratory distress.
Urinary tract infection
Approximately 30% to 50% of patients with Serratia urinary tract infections are asymptomatic. Symptoms may include fever, frequent urination, dysuria, pyuria, or pain upon urination.
In 90% of cases, patients have a history of recent surgery or instrumentation of the urinary tract.
Important risk factors for with Serratia urinary tract infections include diabetes mellitus, urinary tract obstruction, and renal failure.
Respiratory tract infection
Patients with Serratia respiratory tract infection are usually are colonized with Serratia species after instrumentation (eg, ventilation, bronchoscopy), especially those with chronic obstructive pulmonary disease.
Serratiapneumonia may develop, but this is rare. Patients with pneumonia may have fever, chills, productive cough (sometimes with pseudohemoptysis [21, 22] ), hypotension, dyspnea, and/or chest pain.
Meningitis or cerebral abscess
Serratia meningitis or cerebral abscesses may develop in premature children and neonates with prior sepsis. Patients who have experienced head trauma or have undergone neurosurgery, [23] lumbar puncture, or even epidural injections are at risk of developing meningitis or cerebral abscess.
The symptoms are those of gram-negative meningitis (eg, headache, fever, vomiting, stupor, coma).
Intra-abdominal infections
Patients with Serratia intra-abdominal infections may present with biliary drainage, hepatic abscess, pancreatic abscess, and peritoneal exudate. Serratia peritonitis can complicate peritoneal dialysis. [24]
Osteomyelitis and arthritis
Serratia osteomyelitis and arthritis may develop following hematogenous spread in persons who are addicted to intravenous drugs or may be caused exogenously by surgery, open trauma, or intra-articular injection. S marcescens osteomyelitis is a common presentation of chronic granulomatous disease in infancy. [25]
Endocarditis
Patients with Serratia endocarditis may present with fever, petechiae, and, occasionally, embolic complications (eg, stroke, arterial emboli).
Ocular infections
Patients with Serratia ocular infections present with keratitis or endophthalmitis.
Soft-tissue infections
Patients with Serratia soft-tissue infections may have surgical scars, cellulitis, phlebitis, or skin infections.
Otitis media
Patients with Serratiaotitis media present with earaches, hearing loss, and ear discharge.
Parotitis
Serratiaparotitis is rare.
Physical
Pink hypopyon in the absence of hyphema may suggest S marcescens endophthalmitis. [26]
Breast milk can turn pink with Serratia postpartum mastitis. [27, 28]
Causes
Sepsis or bacteremia
The main risk factor for Serratia sepsis/bacteremia is hospitalization. Placement of intravenous, intraperitoneal, or urinary catheters and prior instrumentation of the respiratory tract have been identified as risk factors among inpatients.
Other risk factors include cardiac valve replacement, transfusions, and the use of contaminated intravenous infusions. An outbreak of bacteremia was caused by pooling the residual contents of preservative-free epoetin vials for later use. Another outbreak was traced to tampering with an infused narcotic by a hospital employee. [29] A multistate outbreak of S marcescens bloodstream infection was linked to contaminated intravenous magnesium sulfate distributed in the United States by a compounding pharmacy. [30]
Contamination of a faucet resulted in two cases of bacteremia during an outbreak of 10 S marcescens infections in an intensive care unit. [31]
Urinary tract infection
Ninety percent of patients with Serratia urinary tract infection have a history of recent surgery or instrumentation of the urinary tract.
Important risk factors include diabetes mellitus, urinary tract obstruction, and renal failure.
Respiratory tract infection
Serratia respiratory tract infection may develop after instrumentation (eg, ventilation, bronchoscopy), especially in patients with chronic obstructive pulmonary disease. During an outbreak of S marcescens infections traced to a contaminated faucet (including consumption of tap water from the faucet) in an intensive care unit, nine patients developed respiratory tract infection (8 developed septic bronchitis; 1 developed empyema), while another nine patients developed only S marcescens colonization of the respiratory tract. [31]
Meningitis and cerebral abscess
Serratia meningitis or cerebral abscess may develop in premature children and neonates with prior sepsis. Serratia meningitis may also develop in adults who have experienced head trauma or have undergone neurosurgery, epidural injection, or lumbar puncture.
Osteomyelitis and arthritis
Osteomyelitis or arthritis can be hematogenous in people addicted to intravenous drugs, or can be caused exogenously by surgery, open trauma, or intraarticular injection.
Endocarditis
Although Serratia endocarditis tends to appear in intravenous drug abusers, it usually involves aortic or mitral valves. [32]
Ocular infections
Serratia infection frequently causes nonulcerating bacterial keratitis, which is associated with wearing rigid or soft contact lenses. [33]
Serratia endophthalmitis usually occurs after eye surgery.
Parotitis
Bacterial parotitis may develop in individuals with prior sialectasia.
Cutaneous infections
Poorly healing skin ulcers in combination with S marcescens infections at multiple sites are typical in young adults with chronic granulomatous disease. [25] Dermal abscesses and skin ulcers in the legs have appeared after a toe-web infection. [34]
