Due to the fact that bacteria belonging to the Serratia spp. class can affect a multitude of organs, a Serratia infection can lead to symptoms that vary and are categorized depending on the affected system.

Urinary tract infections (UTIs) are amongst the most common types of infection caused, and patients usually present with symptoms typically expected in a UTI. These include dysuria, fever, hematuria and abnormally frequent urination. Prior instrumentation of the urinary tract or surgical procedures are reported in up to 50% of the patients diagnosed with a Serratia urinary tract infection; patients suffering from diabetes mellitus or renal failure are at a greater risk of developing such an infection.

Infections of the respiratory tract can also be caused by a bacterium of the Serratia species, especially in patients affected by chronic pulmonary conditions, such as chronic obstructive pulmonary disease (COPD). The infection may progress to pneumonia, although this is an uncommon occurrence. Typical symptoms of pneumonia include thoracic pain, cough, fever, hypotension, dyspnea and pseudo hemoptysis [1] [2].

Serratia spp can also cause cerebral abscesses or meningitis. Underlying conditions such as sepsis in neonates and children and open trauma, as well as invasive procedures (neurosurgery, lumbar puncture), increase the risk for such a central nervous system infection [3]. Symptoms elicited by a Serratia meningitis encompass lethargy, cephalalgia, vomiting, a decreased level of consciousness, and even coma.

Serratia can also be responsible for infections of the abdominal cavity, such as abdominal abscesses or peritonitis. Fever, malaise, abdominal discomfort or pain are the symptoms expected in the case of an intra-abdominal infection; peritonitis should be suspected in patients presenting with severe abdominal pain, high fever, and chills. Peritoneal dialysis may be complicated by peritonitis caused by Serratia bacterium [4].

Intravenous drug use, intra-articular injections, open trauma or surgery can lead to osteomyelitis and arthritis due to a Serratia colonization. Osteomyelitis induces symptoms such as pain, edema, and erythema in the affected region, fever, and chills, whereas arthritis leads to painful and inflamed joints. Chronic granulomatous disease in infants is frequently complicated by osteomyelitis due to Serratia [5].

Finally, Serratia spp. may be responsible for various other types of human infections. Patients may present with otalgia and otorrhea due to otitis media; with fever, respiratory compromise, hypotension and, in a comatose state in generalized sepsis. Soft tissues are also susceptible to Serratia infections and patients may present with infected scars, phlebitis, and cellulitis. Women who breastfeed may report their breastmilk turning pink, which is a typical symptom of Serratia postpartum mastitis [6] [7].

• Sepsis

  A41.4 Sepsis due to anaerobes A41.5 Sepsis due to other Gram-negative organisms A41.50 Gram-negative sepsis, unspecified A41.51 Sepsis due to Escherichia coli [E. coli] A41.52 Sepsis due to Pseudomonas A41.53 Sepsis due to Serratia A41.59 Other Gram-negative [icd10data.com]

  A global report on causes of neonatal sepsis in developing countries cited Serratia species as the fifth most common cause, accounting for 0.5% and 0.3% of early and late neonatal sepsis, respectively.[5] In their report on bloodstream infections in neonates [scielo.org.za]

  Patients may present with otalgia and otorrhea due to otitis media; with fever, respiratory compromise, hypotension and, in a comatose state in generalized sepsis. [symptoma.com]

  All patients were severely immunocompromised, as evidenced by a mean CD4+ lymphocyte count of Serratia spp. infection was more frequent than community-acquired infection and was significantly related to AIDS, neutropaenia, and sepsis. [link.springer.com]

  Serratia Marcescens Symptoms: Serratia Sepsis Common symptoms in patients suffering from Serratia Sepsis include: Fever Chills Respiratory distress Shock Fever is one of the most common causes of bacterial infection and should be treated immediately. [deadlymicrobes.com]

• Pain

  Osteomyelitis induces symptoms such as pain, edema, and erythema in the affected region, fever, and chills, whereas arthritis leads to painful and inflamed joints. [symptoma.com]

  […] these pain med.s and it takes all day to recover from taking half of one of these pain med.s. [healthboards.com]

  Discussion Our patient presented with acute red eye, pain and decreased vision. [webeye.ophth.uiowa.edu]

  A liver abscess can start out as fever and fatigue, but it may also cause pain over the right upper abdomen. [primaryimmune.org]

• Rigor

  As the patient developed rigors, transfusion was stopped. Serratia marcescens was isolated from this patient's blood and blood transfusion bottle. Remaining cases were sporadic and the isolation of Serratia was spread out over a period of 6 months. [jpgmonline.com]

  The early identification of colonized or infected patients and the prompt implementation of infection control measures, particularly rigorous hand hygiene and contact precautions, are essential in order to curb the spread of infection. [mdpi.com]

  Following discharge, the patient remained well for a further eight months until he presented to hospital with pyrexia of unknown origin (PUO) with rigors and elevated C-reactive protein. [hindawi.com]

  […] liquefaciens infection was defined as any patient who underwent hemodialysis in section C during the study period who had a blood culture that was positive for S. liquefaciens (bloodstream infection) or in whom fever (a temperature of at least 38°C [100°F]) or rigor [nejm.org]

• Chills

  Osteomyelitis induces symptoms such as pain, edema, and erythema in the affected region, fever, and chills, whereas arthritis leads to painful and inflamed joints. [symptoma.com]

  In heroin addicts, the bacteria may cause endocarditis, which is inflammation of the heart wall linings, with symptoms including abnormal urine color, chills, excessive sweating, fatigue, fever, and joint pain. [deadlymicrobes.com]

  Signs & Symptoms of Serratia Marcescens Infection There are a variety of symptoms associated with Serratia Marcescens: Sepsis Infection Fever Nausea Chills Vomiting Shock Convulsions Death Bacteremia Urinary tract infections Empyema Lymphadenitis Endocarditis [schmidtlaw.com]

  Uninfected living worker bees were collected, chilled on ice, and microbes from their digestive tracts were obtained and diluted in sterile water. [journals.plos.org]

• Malaise

  Fever, malaise, abdominal discomfort or pain are the symptoms expected in the case of an intra-abdominal infection; peritonitis should be suspected in patients presenting with severe abdominal pain, high fever, and chills. [symptoma.com]

  He had a measurable fever of 38.5 accompanied by a general feeling of malaise. Lymphadenopathy or systemic symptoms were not evident. [hindawi.com]

  The only other symptom of the mother was a general feeling of malaise. Serratia Marcescens symptoms are commonly associated with urinary tract infections, but in 30% to 50% of reported cases, there are no symptoms to assist diagnosis. [deadlymicrobes.com]

  In 11 cases the clinical picture was similar, with hypotension and general malaise during the haemodialysis session. Fever was present in a further 7 cases. In 3 cases the presentation was asymptomatic and was detected by blood cultures. [revistanefrologia.com]

• Dyspnea

  Typical symptoms of pneumonia include thoracic pain, cough, fever, hypotension, dyspnea and pseudo hemoptysis. Serratia spp can also cause cerebral abscesses or meningitis. [symptoma.com]

• Vomiting

  Symptoms elicited by a Serratia meningitis encompass lethargy, cephalalgia, vomiting, a decreased level of consciousness, and even coma. [symptoma.com]

  Serratia Marcescens Symptoms Here are some symptoms linked with Serratia Marcescens: Chills Fever Sepsis (pus-forming bacteria in the body) Infection (by pathogenic microorganisms) Nausea Vomiting Shock Convulsions Bacteremia (bacteria in the blood) Urinary [deadlymicrobes.com]

  Signs & Symptoms of Serratia Marcescens Infection There are a variety of symptoms associated with Serratia Marcescens: Sepsis Infection Fever Nausea Chills Vomiting Shock Convulsions Death Bacteremia Urinary tract infections Empyema Lymphadenitis Endocarditis [schmidtlaw.com]

  In addition, mouth sores, frequent vomiting, problems with urination and sometimes damage to the kidneys can be seen due to the inflammation associated with CGD. [primaryimmune.org]

• Nausea

  Signs & Symptoms of Serratia Marcescens Infection There are a variety of symptoms associated with Serratia Marcescens: Sepsis Infection Fever Nausea Chills Vomiting Shock Convulsions Death Bacteremia Urinary tract infections Empyema Lymphadenitis Endocarditis [schmidtlaw.com]

  Serratia Marcescens Symptoms Here are some symptoms linked with Serratia Marcescens: Chills Fever Sepsis (pus-forming bacteria in the body) Infection (by pathogenic microorganisms) Nausea Vomiting Shock Convulsions Bacteremia (bacteria in the blood) Urinary [deadlymicrobes.com]

  Five months after the initiation of automated peritoneal dialysis (APD), the patient presented with abdominal pain and nausea to our PD clinic. [scielo.isciii.es]

• Diarrhea

  Individuals with CGD can have severe abdominal pain, diarrhea, weight loss, and sometimes abnormal narrowing in parts of the intestines. [primaryimmune.org]

  It is unclear whether the strain of Serratia responsible for this incident is multidrug-resistant, or whether any of the infants in this NICU were suffering from acute diarrhea. Read Dr. [lfm-hcs.com]

  The same strain was isolated in stool samples obtained from 8 neonates with diarrhea during the summer of 2000. [academic.oup.com]

• Ulcer

  [n=2]35,40; abscesses in immunocompetent patient [n=1]41; and necrotizing skin ulceration [n=1]36). [mdedge.com]

  The infections quickly progressed to flap ulceration and detachment despite treatment. [reviewofophthalmology.com]

  Skin ulcers caused by Serratia marcescens: three cases and a review of the literature. Eur J Dermatol. 2016;26:373–6. DOI Top Figure Figure. Culture plate containing the bacterium Serratia marcescens. [wwwnc.cdc.gov]

  Stenotrophomonas maltophilia Cardiobacteriaceae Cardiobacterium hominis HACEK Aeromonadales Aeromonas hydrophila / Aeromonas veronii Aeromonas infection ε Campylobacterales Campylobacter jejuni Campylobacteriosis, Guillain–Barré syndrome Helicobacter pylori Peptic ulcer [ipfs.io]

• Skin Lesion

  No accompanying other skin lesions, enlarged lymph nodes, or signs of systemic involvement were detected. Laboratory data revealed normal biochemical and haematological study results. [medicaljournals.se]

  During the next 48 hours the patient developed severe sepsis with confusion, acute renal failure (creatinine: 231 µmol/L vs 138 µmol/L at baseline [reference range, 53–106 µmol/L), and worsening of skin lesions. [mdedge.com]

• Erythema

  Osteomyelitis induces symptoms such as pain, edema, and erythema in the affected region, fever, and chills, whereas arthritis leads to painful and inflamed joints. [symptoma.com]

  Erythema with multiple abscesses on the left ankle and leg at presentation (A), day 1 following surgical debridement of infected tissues (B), and 2 months later with complete healing following a skin graft (C). Figure 2. [mdedge.com]

• Eruptions

  The other clinical manifestations of S marcescens skin infection reported in the literature included disseminated papular eruptions in patients infected with human immunodeficiency virus with folliculitis on the trunk. [mdedge.com]

• Arthritis

  Intravenous drug use, intra-articular injections, open trauma or surgery can lead to osteomyelitis and arthritis due to a Serratia colonization. [symptoma.com]

  Original Article A Malhas, R Chana, F Khan Keywords knee arthroscopy, septic arthritis., serratia marcescens Citation A Malhas, R Chana, F Khan. A Case report of a Serratia Marcescens infective arthritis after a knee arthroscopy. [ispub.com]

  Outbreaks of S. marcescens meningitis, wound infections, and arthritis have occurred in pediatric wards. [8] Cases of Serratia arthritis have been reported in outpatients receiving intra-articular injections. [en.wikipedia.org]

  Infectious arthritis can be deadly because it can destroy your joint. I'm very taken aback by the doctors' conservative approach to that! [healthboards.com]

  Frequently, the infection has been associated with systemic risk factors such as diabetes mellitus, renal failure, alcoholism, and rheumatoid arthritis. [webeye.ophth.uiowa.edu]

• Otalgia

  Patients may present with otalgia and otorrhea due to otitis media; with fever, respiratory compromise, hypotension and, in a comatose state in generalized sepsis. [symptoma.com]

• Meningism

  Serratia spp can also cause cerebral abscesses or meningitis. [symptoma.com]

  […] majority of infants with meningitis. [scielo.org.za]

  Serratia can cause infections of the bloodstream, lower respiratory tract, urinary tract, surgical wounds, and skin and soft tissues in adult patients, as well as meningitis, wound infections, and arthritis have occurred in children. [digjamaica.com]

  The bacteremia was found in all patients associated with two meningeal locations. Blood cultures in all cases grew S. marcescens fully susceptible to imipenem, amikacin and ciprofloxacin ( Table 2 ). [omicsonline.org]

  In total, 21 patients were identified, with surgeries occurring between March and June/2020 (8 neurosurgeries, 11 orthopedic, 1 cardiac, 1 vascular), being 7 meningitis, 1 osteomyelitis, 9 deep incisional infections, 4 superficial incisional.No related [ijidonline.com]

• Headache

  Premature children and infants with an existing diagnosis of sepsis, or after experiencing some kind of head surgery or neurosurgery may develop meningitis caused by Serratia Marcescens with symptoms including headache, fever, vomiting, stupor and may [deadlymicrobes.com]

Given that the clinical presentation of a Serratia infection is extremely variable, the workup involved is non-specific and guided by the particular symptoms with which each patient presents.

Generally, blood samples should be taken and a complete blood count is expected to illustrate leucocytosis with distinctive neutrophilia, anemia and more than 10% of immature neutrophils. Leukopenia can be observed but is a rather uncommon laboratory result. A complete biochemical profile should also be carried out, in order to evaluate creatinine, glucose, urea and electrolyte levels.

A culture and antibiogram are mandatory in order to accurately diagnose a Serratia infection. The most common bacterial subtype isolated is S. marcenscens [8]. Blood, fluid from effusions, abscesses, catheters or IV fluids that are potentially contaminated all constitute good samples for a culture.

If meningitis is suspected, a lumbar puncture should be performed. A cerebrospinal fluid analysis will reveal pleocytosis of a polynuclear morphology, low glucose, and high protein levels. Respiratory infections are primarily investigated with a chest radiograph. An ultrasonographic (US) or computerized tomography (CT) scan can be used to detect possible intra-abdominal abscesses and echocardiography can be employed to detect valvular abnormalities consistent with endocarditis.

This rare skin infection with S. marcescens requires specific microbiological diagnosis and antibiotic treatment. The authors declare no conflicts of interest. REFERENCES [medicaljournals.se]

The treatment regimen was different at the 2 sites with the most patients affected. [revistanefrologia.com]

The patient also had uncontrolled diabetes mellitus and iron deficiency anemia, which altered her response to surgical treatment. [ncbi.nlm.nih.gov]

The patient had taken antitubercular treatment for three months in 1995, then again for one month in 1997. He had also undergone bronchoscopy in 1997. The patient was non-smoker. [ijmm.org]

An appropriate antimicrobial treatment attained clinical and microbiological cure in all cases, in absence of related mortality or relapses. [link.springer.com]

Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis. 2010; 51(suppl 1):S81–S87. Google Scholar 21. Laupland, KB, Parkins, MD, Gregson, DB, Church, DL, Ross, T, Pitout, JD. [journals.sagepub.com]

During this period, the most common etiologic microorganism was Staphylococcus aureus (22.2%), followed by coagulase-negative staphylococcus (21.6%). S. marcescens accounted for 8.3% of etiologic microorganisms. [aricjournal.biomedcentral.com]

"The etiology of white pox, a lethal disease of the Caribbean elkhorn coral, Acropora palmata ". Proc Natl Acad Sci USA. 99 (13): 8725–30. doi : 10.1073/pnas.092260099. PMC 124366. PMID 12077296. ^ Vasantharajan VN, Munirathnamma N (1978). [en.wikipedia.org]

Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis. 2010 Aug 1. 51 Suppl 1:S81-7. [QxMD MEDLINE Link]. Posluszny JA Jr, Conrad P, Halerz M, Shankar R, Gamelli RL. [emedicine.medscape.com]

the journal of the Society for Healthcare Epidemiology of America. [shea-online.org]

There have been many reports concerning the identification, antibiotic susceptibility, pathogenicity, epidemiological investigations and typing of this organism. Accurate identification is important in defining outbreaks. [doi.org]

To read this article in full you will need to make a payment References Maki DG Hennekens CG Phillips CW Shaw WV Bennett JV Nosocomial urinary tract infection with Serratia marcescens: an epidemiologic study. [amjmed.com]

Infection Control and Hospital Epidemiology, 19(10), 791-794. [jhu.pure.elsevier.com]

Infection Control & Hospital Epidemiology ISSN: 0899-823X EISSN: 1559-6834 URL: /core/journals/infection-control-and-hospital-epidemiology × [cambridge.org]

[…] opportunistic pathogen in humans. [10] Derivatives of prodigiosin have recently been found to have immunosuppressive properties and antitumor activity in vivo [11, 12] and are also currently being considered as a candidate treatment for Chagas disease. [13] Pathophysiology [emedicine.medscape.com]

It might also prevent the timely implementation of infection-control measures crucial to interrupt the transmission of Serratia among infants in a NICU. [lfm-hcs.com]

Containment/Prevention To prevent spreading Klebsiella infections between patients, healthcare personnel must follow specific sanitation and infection control precautions. [digjamaica.com]

This case illustrates the necessity for early identification of infective organisms and determining their antibiotic sensitivity, as well as the need for prophylactic removal of impacted teeth to prevent complications such as those presented. [ncbi.nlm.nih.gov]

Source: Centers for Disease Control and Prevention, 1985. [wwwnc.cdc.gov]

Aragon D, & Sole ML. (2006) Implementing Best Practice Strategies to Prevent Infection in the ICU. Crit. Care Nurs. Clin. North Am. 18 (4) 441- 452. [profinf.net]

1. Mahlen SD. Serratia Infections: from Military Experiments to Current Practice. Clin Microbiol Rev. 2011 Oct; 24(4): 755–791.
2. Rastogi V, Purohit P, Peters BP, et al. Pulmonary infection with serratia marcescens. Indian J Med Microbiol. 2002 Jul-Sep; 20(3):167-8.
3. Zarogoulidis P, Porpodis K, Konoglou M, et al. Serratia pneumonia presenting as hemoptysis in a patient with sarcoidosis: a case report. Int J Gen Med. 2011; 4:661-4.
4. Wu YM, Hsu PC, Yang CC, et al. Serratia marcescens meningitis: Epidemiology, prognostic factors and treatment outcomes. J Microbiol Immunol Infect. 2013 Aug;46(4):259-65
5. Hiremath S, Biyani M. Technique survival with Serratia peritonitis. Adv Perit Dial. 2006; 22:73-6.
6. Friend JC, Hilligoss DM, Marquesen M, et al. Skin ulcers and disseminated abscesses are characteristic of Serratia marcescens infection in older patients with chronic granulomatous disease. J Allergy Clin Immunol. 2009 Jul; 124(1):164-6.
7. Faro J, Katz A, Berens P, Ross PJ. Premature termination of nursing secondary to Serratia marcescens breast pump contamination. Obstet Gynecol. 2011 Feb; 117(2 Pt 2):485-6.
8. Jones J, Crete J, Neumeier R. A case report of pink breast milk. J Obstet Gynecol Neonatal Nurs. 2014 Sep; 43(5):625-30.