Metastatic Klebsiella Infection: A case report

Introduction@#A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae (K. pnuemoniae) had emerged. It has shown ability to cause serious infection in healthy ambulatory hosts as well as infect unusual sites. Though there have been numerous studies on severe infection by K. pneumoniae, little data has been documented on such infections involving Klebsiella oxytoca. (K. oxytoca). It is capable of causing metastatic spread of the infection even in healthy young individuals. This report was written to describe the clinical spectrum of a case of metastatic Klebsiella infection.@*Case presentation@#We illustrate a case of a 73-year-old diabetic and hypertensive female presenting with headache and eye discharge. She was initially managed as the case of conjunctivitis as out-patient. After three weeks of topical ophthalmic antibiotics, she developed decrease in sensorium leading to her eventual admission. Workup pointed towards a disseminated infection to the eye, brain, and urinary tract. The patient was placed on broad-spectrum antibiotics and a vitreous tap was done. However, the patient’s sensorium decreased further, and was eventually intubated and started on inotropes. The indolent course of the disease, which unfortunately led to the demise of the patient, directed the attending physicians to suspect a more virulent infection.@*Discussion@#Infection by hypervirulent variant of Klebsiella has been classically known to be nosocomial and opportunistic in nature. But cases have also been reported from the community setting. A common denominator in this population is that they are usually immunocompromised as in the case of our patient being elderly and diabetic. Unfortunately, there are no molecular or biochemical markers being used in the clinical setting to identify this strain. Hence, the attending physicians had to rely on the presentation of metastatic disease to diagnose our patient.@*Conclusion@#Early diagnosis, appropriate antibiotic treatment and drainage are keys in the management of these cases.

Distribution and antibiotic resistance of Klebsiella pneumoniae strains in terms of K1 and K2 serotypes / 中国感染与化疗杂志

Objective To investigate the distribution and antibiotic resistance of the K lebsiella pneumoniae strains isolated from clinical infections in terms of serotypes K1 ,K2 and virulence factor rmpA gene .Methods The hypermucoviscous phenotype of K .pneumoniae isolate was determined by string test .K1 and K2 serotypes and rmpA gene were detected using multiplex polymerase chain reaction .Results Of the 144 strains of K .pneumoniae ,the prevalence of hypermucoviscous phenotype ,K1 , K2 serotypes and rmpA gene was 62 .5% (90/144) ,52 .1% (75/144) and 65 .3% (94/144) ,respectively .The prevalence of K1 ,K2 and rmpA K .pneumoniae strains was 90 .7% (68/75) in K1 ,K2 serotypes .The prevalence of K1 ,K2 isolates and rmpA in hypermucoviscous or non‐hypermucoviscous phenoype was 63 .3% (57/90) ,85 .6% (77/90) and 33 .3% (18/54) , 31 .5% (17/54) ,respectively .The prevalence of serotype K1 ,K2 with or without rmpA gene was 72 .3% (68/94) and 14 .0% (7/50 ) respectively . Of the 42 K . pneumoniae strains isolated from liver abscess ,85 .7% (36/42) were hypermucoviscous phenotype and 88 .1% (37/42 ) were serotypes K1 , K2 . For the strains from other abscess , bacteremia ,community acquried pneumonia (CAP) ,urinary tract infection (UTI) and biliary tract infection ,the prevalence of hypermucoviscous phenotype was 81 .3% (13/16) ,40 .5%(15/37) ,85 .7% (12/14) ,52 .4% (11/21) and 21 .4% (3/14) ,respectively ,and the prevalence of serotypes K1 ,K2 was 56 .3% (9/16) ,29 .7% (11/37) ,64 .3% (9/14) ,38 .1% (8/21) and 7 .1% (1/14) ,respectively .K1 serotype isolate accounted for 61 .9% of the strains from liver abscess .The ratio between serotype K1 and K2 was similar in the isolates from other abscess ,CAP ,UTI or bacteremia .Non‐K1 ,K2 serotype isolates were common in biliary tract infection .The prevalence of extended‐spectrum beta‐lactamases (ESBLs ) was 5 .5% in hypermucoviscous phenotypes and 33 .3% in the non‐hypermucoviscous phenotypes .Conclusions rmpA gene is associated with the hypermucoviscous phenotype of K .pneumoniae strains and commonly identified in K1 ,K2 serotype isolates .Serotypes K1 ,K2 isolates are important pathogens in liver abscess and CAP ,and also common in other abscess ,UTI and bacteremia .K1 serotype isolate was most common in liver abscess .The prevalence of K1 or K2 serotype was similar in other infections . The prevalence of ESBLs is lower in hypermucoviscous strains than in non‐hypermucoviscous strains and is associated with lower resistance rate to most of the antibiotics tested .

Necrotizing fasciitis and psoas abscess caused by hypervirulent Klebsiella pneumoniae / 대한내과학회지

A 62-year-old diabetic female was admitted to the hospital with fever and pain in both legs. Computed tomography scans of the abdomen revealed necrotizing fasciitis of the right thigh extending into the abdominal wall, and abscesses on the right psoas muscle. Magnetic resonance imaging showed increased T2 signal intensity along the peroneus muscle and fascia of the lower left leg. The patient received antibiotics and underwent debridement of the infected and necrotic tissue. Intra-abdominal abscesses were drained. Blood and pus cultures showed growth of Klebsiella pneumoniae, as had been suspected due to string test results showing hypermucoviscosity. Free-skin grafts were performed to repair tissue loss and the patient was subsequently discharged 82 days after admission. This represents the first reported case of necrotizing fasciitis and psoas muscle abscess caused by a hypervirulent strain of K. pneumoniae in Korea.

Necrotizing fasciitis and psoas abscess caused by hypervirulent Klebsiella pneumoniae / 대한내과학회지

A 62-year-old diabetic female was admitted to the hospital with fever and pain in both legs. Computed tomography scans of the abdomen revealed necrotizing fasciitis of the right thigh extending into the abdominal wall, and abscesses on the right psoas muscle. Magnetic resonance imaging showed increased T2 signal intensity along the peroneus muscle and fascia of the lower left leg. The patient received antibiotics and underwent debridement of the infected and necrotic tissue. Intra-abdominal abscesses were drained. Blood and pus cultures showed growth of Klebsiella pneumoniae, as had been suspected due to string test results showing hypermucoviscosity. Free-skin grafts were performed to repair tissue loss and the patient was subsequently discharged 82 days after admission. This represents the first reported case of necrotizing fasciitis and psoas muscle abscess caused by a hypervirulent strain of K. pneumoniae in Korea.