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Neonatal Sulfhemoglobinemia and Hemolytic Anemia Associated With Intestinal Morganella morganii.

Abstract
Sulfhemoglobinemia is a rare disorder characterized by the presence of sulfhemoglobin in the blood. It is typically drug-induced and may cause hypoxia, end-organ damage, and death through oxygen deprivation. We present here a case of non-drug-induced sulfhemoglobinemia in a 7-day-old preterm infant complicated by hemolytic anemia. Microbiota compositional analysis of fecal samples to investigate the origin of hydrogen sulphide revealed the presence of Morganella morganii at a relative abundance of 38% of the total fecal microbiota at the time of diagnosis. M morganii was not detected in the fecal samples of 40 age-matched control preterm infants. M morganii is an opportunistic pathogen that can cause serious infection, particularly in immunocompromised hosts such as neonates. Strains of M morganii are capable of producing hydrogen sulphide, and virulence factors include the production of a diffusible α-hemolysin. The infant in this case survived intact through empirical oral and intravenous antibiotic therapy, probiotic administration, and red blood cell transfusions. This coincided with a reduction in the relative abundance of M morganii to 3%. Neonatologists should have a high index of suspicion for intestinal pathogens in cases of non-drug-induced sulfhemoglobinemia and consider empirical treatment of the intestinal microbiota in this potentially lethal condition.
AuthorsKiera Murphy, Clodagh Ryan, Eugene M Dempsey, Paul W O'Toole, R Paul Ross, Catherine Stanton, C Anthony Ryan
JournalPediatrics (Pediatrics) Vol. 136 Issue 6 Pg. e1641-5 (Dec 2015) ISSN: 1098-4275 [Electronic] United States
PMID26553186 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2015 by the American Academy of Pediatrics.
Topics
  • Anemia, Hemolytic (complications, therapy)
  • Enterobacteriaceae Infections (complications, microbiology, therapy)
  • Feces (microbiology)
  • Female
  • Gastrointestinal Microbiome
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Morganella morganii
  • Sulfhemoglobinemia (complications, therapy)

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