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Cutaneous abscess and bacteremia due to Serratia ficaria

Editor Serratia ficaria is a Gram-negative rod involved in the fig tree ecosystem. Although S. ficaria is very rarely isolated from clinical specimens with a questionable role as a pathogen, it has been associated with infections in compromised individuals. We describe the first recorded case of a S. ficaria strain that caused generalized infection including cutaneous abscess and bacteremia in a previously healthy man following a wild dog bite. A 47-year-old hunter was attacked and bitten by a wild dog at his shoulders and at the anterior area of his right forearm and thumb. He was taken to a local Health Center where the wounds were cleansed. He received cefaclor plus metronidazole and a tetanus toxoid injection. One day later, he noticed that the anterior part of his right forearm became red, painful and swollen. Three days later, the patient was admitted to our hospital with high fever, chills as well as swelling and erythema of his right forearm with a purulent discharge. The anterior area of his right forearm was erythematous, oedematous with a purulent discharge. Teeth marks were noted on the shoulders. Laboratory findings included a leucocyte cell count of 21 300/mm (granulocytes 88%) with a left shift and a toxic granulation, and a C-reactive protein level of 21 mg/L. Blood cultures as well as wound cultures from right anterior forearm area revealed the growth of S. ficaria. Gram’s stain of purulent discharge and microscopic examination disclosed numerous Gramnegative rods as well as many polymorphonuclear cells. The Gram-negative rod exhibited a biochemical profile number of 1206773 (corresponding to S. ficaria) when tested by the API 20E System. Furthermore, identification of Gram-negative microorganisms and susceptibility testing were performed by two automated systems (Phoenix and Microscan) using a Gram-negative identification panel and a microbroth dilution method. The isolate presented the susceptibility pattern shown in Table 1. As soon as S. ficaria infection was confirmed, and according to the results of the antibiotic susceptibility testing, cefotaxime and amikacin were administered parenterally for 12 days with clinical success. A frequent complication of mammalian bite wounds is bacterial polymicrobial infection with mixed aerobic and anaerobic species. Pasteurella species and especially Pasteurella multocida represent the most frequent microorganisms associated with infected animal bite wounds in humans; Streptococcus and Staphylococcus species are the next commonest isolates from dog bites. S. ficaria is an aerobic, non-spore-forming, motile, catalase-positive, oxidase-negative, mesophilic Gramnegative rod that belongs to the unusual Serratia species. Although S. ficaria strains are recovered from clinical specimens in few instances as part of a polymicrobial growth, their clinical significance remains unknown and has not been studied in depth. Its definite role as human pathogen was only established in two studies. S. ficaria has been isolated from a leg ulcer, sputum and tracheal aspirations as part of a mixed microbial flora, from blood in a compromised patient, and from corneal graft causing purulent endophtalmitis. Furthermore, S. ficaria was found to cause gallbladder empyemas and sepsis in areas that cultivate fig trees such as Mediterranean France. A literature search revealed no reports of a prior simultaneous isolation of S. ficaria from blood and wound following a dog bite. Most importantly, all S. ficaria isolates exhibited the same susceptibility profile. It seems that all these strains were probably identical. In summary, this is the first case, to our knowledge, of cutaneous abscess and bacteremia caused by S. ficaria following a dog bite, which further expands the spectrum of disease caused by this microorganism. Clinicians should recognize S. ficaria as a potential zoonotic pathogen. Isolation of the bacterium from blood and wound cultures should prompt the commencement of adequate antibiotic treatment. Table 1 Minimal inhibitory concentrations of antibiotics to S. ficaria