Community-acquired meningitis caused by a CG86 hypervirulent Klebsiella pneumoniae strain: first case report in the Caribbean

Abstract

BackgroundCommunity-acquired bacterial meningitis due to Klebsiella pneumoniae has mainly been described in Southeast Asia and has a poor prognosis. Severe invasive infections caused by K. pneumoniae, including meningitis, are often due to hypervirulent strains (hvKP), which are characterized by capsular serotypes K1 and K2, a gene responsible for hypermucoviscosity, and the cluster for synthesis of the siderophore aerobactin.Case presentationA 55 year old man with a history of essential hypertension, benign prostate hyperplasia, hyperlipidemia, obstructive sleep apnea, and chronic alcoholism was admitted for meningitis due to Klebsiella pneumoniae with a wild-type susceptibility profile. Its genomic features were consistent with a capsular K2 strain belonging to clonal group 86 (CG86) displaying the large virulence of Klebsiella plasmid (pLVPK) with heavy metal resistance gene clusters, aerobactin, rmpA. ConclusionThis is the first case of community-acquired meningitis caused by a hypervirulent strain of hvKP ever reported in the Caribbean.

Caribbean multi-centre study of Klebsiella pneumoniae: whole genome sequencing, antimicrobial resistance and virulence factors

“…In addition to the main high-risk clones, with respect to antimicrobial resistances, we also noticed isolates belonging to hypervirulent lineages: an ST23 isolate, two isolates belonging to ST65 (AMR0288 and AMR0296), and ST86 [22][23][24][25][26]. Whilst the ST23 isolate was submitted as urine isolate (AMR0157), one of the ST86 isolate (17-02612) encoding a high number of virulence factors is derived from a fatal meningitis case, and the lineage is closely related to the previously reported strain from a case in Guadeloupe [26], whilst a second ST86 isolate (AMR0062) seems to miss/have lost the virulence plasmid (Figure 4).…”

“…Descriptions of infections caused by hypervirulent K. pneumoniae strains in the Caribbean are so far rare [26][27], but given the lack of surveillance, these observations might only represent the tip of the ice berg. The presence of high-risk multidrug resistant and hypervirulent strains, most of which are carried on mobile elements, also bears the further threat of the convergence to a multidrug resistant hypervirulent strain, as reported for e.g.…”

Detection of hypermucoviscousKlebsiella pneumoniaesequence type 86 capsular type K2 in South America as an unexpected cause of a fatal outbreak in captivity marmosets

“…All of them isolated from humans, and predominantly from Europe (12/26) and Asia (10/26) (10,47–49). Only two isolates were previously identified in America, one recovered from the blood of a patient with liver abscess in Buffalo, USA, in 2013 (50) and another one recovered from the cerebrospinal fluid of a patient with meningitis in Pointe-a-Pitre, Guadeloupe, in 2014 (51). Therefore, to the best of our knowledge, this is the first description of hvKp ST86 K2 K. pneumoniae from South America.…”

Community-acquired Klebsiella pneumoniae central nervous infection with acute suppurative otitis and bacteremia: a case report in mainland China

“…Communityacquired infection caused by K. pneumoniae mainly reported in cases of invasive liver abscess syndrome (ILAS) of liver abscess, meningitis, or endophthalmitis in Taiwan [2]. Although sporadic cases occur otherwhere in the world recently, community-acquired K. pneumoniae central nervous infection without liver abscess are rarely seen worldwide [3][4][5][6][7][8][9][10][11]. Here, we reported our experience with a failed case of an adult with community-acquired K. pneumoniae meningitis associated with acute suppurative otitis, bacteremia and suspicious multiple brain abscesses.…”