title: 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.
authors.affiliation: Food Biosciences Department, Teagasc Food Research Centre, Moorepark, Co Cork, Ireland; School of Microbiology, APC Microbiome Institute.
authors.forename: Kiera
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Department of Haematology, Mercy University Hospital, Cork, Ireland; and.
authors.forename: Clodagh
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland INFANT Centre, and.
authors.forename: Eugene M
authors.initials: EM
authors.lastname: Dempsey
authors.affiliation: School of Microbiology, APC Microbiome Institute.
authors.forename: Paul W
authors.initials: PW
authors.lastname: O'Toole
authors.affiliation: APC Microbiome Institute, College of Science, Engineering and Food Science, University College Cork, Cork, Ireland;
authors.forename: R Paul
authors.initials: RP
authors.lastname: Ross
authors.affiliation: Food Biosciences Department, Teagasc Food Research Centre, Moorepark, Co Cork, Ireland; APC Microbiome Institute.
authors.forename: Catherine
authors.initials: C
authors.lastname: Stanton
authors.affiliation: APC Microbiome Institute, Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland tony.ryan@ucc.ie.
authors.forename: C Anthony
authors.initials: CA
authors.lastname: Ryan
mesh_terms: D000743:Anemia, Hemolytic / Q000150:complications* / Q000628:therapy; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D005243:Feces / Q000382:microbiology; D005260:Female; D000069196:Gastrointestinal Microbiome; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D020613:Morganella morganii; D013436:Sulfhemoglobinemia / Q000150:complications* / Q000628:therapy