Klebsiella pneumoniae liver abscess: a new invasive syndrome

Siu, L. Kristopher; Yeh, Kuo-Ming; Lin, Jung‐Chung; Fung, Chang-Phoné; Chang, Feng–Yee

doi:10.1016/s1473-3099(12)70205-0

Cited by 723 publications

(871 citation statements)

References 69 publications

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“…This problem is emphasized by a cr-hvKP isolate obtained from an elderly man receiving chemotherapy who was previously treated because of another systemic infection before developing a fatal cr-hvKP infection [31]. The bacterial capsule is an important virulence factor and serotypes K1 and K2 have been particularly linked to severe bacteraemia and liver abscess [32,33]. These findings have rarely been reported in fluids other than blood and /abscess.…”

Section: Discussionmentioning

confidence: 99%

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Xiao

Yao

Zhou

et al. 2017

J Infect Dev Ctries

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Introduction: Reports of hypermucoviscous Klebsiella pneumoniae (hvKP) isolated from fluids other than blood or abscess are rare. The aim of the study was to compare clinical and microbiological characteristics of hvKP found in blood or abscess fluid with those isolated from other loci. Methodology: A total of 24 non-repetitive hvKP isolates were collected from January 2013 to June 2014 from patients with hvKP infections. There were 15 in Group 1 (fluid other than blood or abscess) and 9 in Group 2 (blood or abscess fluid). Medical records of all patients were reviewed. Capsular polysaccharide (CPS) typing, virulence factor determination, and multilocus sequence typing (MLST) of hvKP isolates were performed. Results: Seventeen sequence types (STs) and 6 capsular serotypes were identified. Type K2 CC65 was most commonly identified in Group 1 and type K2 CC86 in Group 2. Deletion of pLVPK-derived loci were found in K2 and non-K1/K2 hvKP strains. Two virulent genes, fimH and ycfM, were identified more frequently in Group 2 than in Group 1. There was no difference in the frequency of other virulent genes or serotypes in the two groups. Two imipenem resistant hvKP isolates (cr-hvKP) were found in non-blood or abscess samples. Conclusions: hvKP isolated from different body fluids had similar clinical and microbiological characteristics. cr-hvKP identified in non-blood or abscess samples should raise our attention to the challenging situation and management of hvKP infection.

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Section: Discussionmentioning

confidence: 99%

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Xiao

Yao

Zhou

et al. 2017

J Infect Dev Ctries

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“…In times of modern surgery, transplantation and percutaneous techniques, PLA has essentially become a problem of biliary or iatrogenic origin, particularly in referral centers where these procedures are performed regularly. 3,4 Therefore, patients with PLA frequently exhibit: reconstructed biliary anatomy, recurrent hospitalizations, regular performance status and history of immunosuppression. In the current scenario, diagnostic approach, clinical behavior and therapeutic outcomes of PLA have not been profoundly studied.…”

Section: Introductionmentioning

confidence: 99%

Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes

Czerwonko

Huespe

Bertone

et al. 2016

HPB

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“…Serotype K1 Klebsiella pneumoniae has emerged as a major cause of pyogenic liver abscess in East Asia, and such infections frequently result in metastatic complications, including endophthalmitis, necrotizing fasciitis, meningitis, and cerebral and pul-monary abscesses (1, 3, 4). The striking emergence of this clinical syndrome has been reviewed in detail recently (5). The implicated K. pneumoniae strains are generally hypermucoviscous, and their virulence is dependent on the wzyAKpK1 (formerly called magA) gene, which is specific to the K1 serotype (6,7).…”

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confidence: 99%

“…Other important virulence factors in these Klebsiella strains include the rmpA gene, which regulates synthesis of the capsule, and aerobactin, a catecholate siderophore (9)(10)(11)(12). Despite numerous reports confirming the association of this distinctive clinical presentation with K. pneumoniae K1 in Asia, descriptions of K1-associated pyogenic abscesses with ophthalmologic complications originating outside this region are less frequent (5,13).…”

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confidence: 99%

Klebsiella pneumoniae K1 Liver Abscess and Septic Endophthalmitis in a U.S. Resident

et al. 2013

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Klebsiella pneumoniae K1 is a major agent of hepatic abscess with metastatic disease in East Asia, with sporadic reports originating elsewhere. We report a case of abscess complicated by septic endophthalmitis caused by a wzyAKpK1-positive Klebsiella strain in a U.S. resident, raising concern for global emergence. CASE REPORTA 58-year-old female resident of Bronx, New York, who was originally from the Dominican Republic presented with a chief complaint of 1 day of decreased vision in her right eye and concomitant symptoms, including weakness, myalgia, low-grade fever, and right upper quadrant pain for 1 week. She had a history of uncomplicated choledochal cyst resection and Roux-en-Y hepaticojejunostomy approximately 5 years prior to presentation but no history of ocular disease or prior intraocular surgery. She reported subsequent travel to the Dominican Republic but denied travel to Asia at any point before or after her surgery. On the initial ophthalmic examination, visual acuity was 20/60 in the affected eye. Slit-lamp examination revealed moderate conjunctival injection in the right eye, along with 4ϩ cells and hypopyon in the anterior chamber. The fundus view was hazy because of opacity in the anterior segment, but the retina was flat. She was diagnosed with presumed endogenous endophthalmitis. Her vision in the affected eye worsened over the next 24 h. Because of right upper quadrant tenderness on examination, further imaging was performed, revealing a hepatic abscess (7 by 7 by 7 cm) (Fig. 1). The patient reported no history of diabetes, and the serum glucose was normal. She was treated with intravenous levofloxacin, and the abscess was drained percutaneously. Cultures of liver aspirate, blood, and urine grew K. pneumoniae susceptible to expandedand broad-spectrum cephalosporins, ampicillin-sulbactam, levofloxacin, aminoglycosides, and trimethoprim-sulfamethoxazole. The isolate exhibited a hypermucoviscous phenotype, as exemplified by a positive string test (Fig. 2). On the seventh hospital day, her ophthalmologic exam deteriorated; she was found to have a subretinal abscess in the peripheral temporal retina, and retinal detachment was noted (Fig. 3). A sample of vitreous fluid was obtained, which revealed polymorphonuclear leukocytes on Gram stain but a negative culture, and intravitreal injection of ceftazidime was performed. Over the next several weeks, the vitreous debris cleared, and the retina more clearly assumed the configuration of a bullous rhegmatogenous detachment stemming from a break related to the retinal necrosis at the site of the subretinal abscess. The patient underwent a vitrectomy for retinal detachment 2 months after her initial presentation. The patient's subsequent course was complicated by a relapse of abdominal pain and an increase in size of the liver abscess following a transition to oral therapy. An abdominal CT scan conducted 2 months after the completion of an 8-week antibiotic course demonstrated resolution of her liver abscess.Because of the similarity of this case to rep...

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Klebsiella pneumoniae liver abscess: a new invasive syndrome

Cited by 723 publications

References 69 publications

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes

Klebsiella pneumoniae K1 Liver Abscess and Septic Endophthalmitis in a U.S. Resident

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