Nonresolving Pneumonia Due to Klebsiella oxytoca: An Unusual Presentation

Abstract

and second lymph-node aspirates, respectively, and all show a Missouri fragment of identical size. Lane 2 represents the patient's whole blood obtained at admission and is negative. The nucleic acid sequence of the fragment was identical to the published sequence References over 350 bp.PCR has been used to detect F. tularensis DNA in blood samples Before referral to our institution, the patient had completed a the basis of biochemical reactions. The species Klebsiella oxytoca 1-week course of clarithromycin, 500 mg twice daily. Because she has been identified by use of DNA hybridization assays and can did not respond to this antimicrobial regimen, flexible fiberoptic be differentiated from Klebsiella pneumoniae by its inability to bronchoscopy (FFB) was performed and showed a welling up of produce indole from tryptophan [1]. We describe an unusual case yellowish sticky purulent secretions from the LLL and RLL in the of nonresolving pneumonia caused by K. oxytoca.absence of an endobronchial lesion. Culture of the bronchoalveolar An 82-year-old previously healthy woman was referred for inlavage (BAL) specimen obtained from the LLL yielded K. oxytoca. vestigation of a 9-month history of fever, weight loss, and coughThe organism was identified by use of the VITEK GNI card (bioproductive of copious yellowish sputum. She denied any hemoptyMérieux Vitek, Hazelwood, MO). Susceptibility testing, performed sis, night sweats, or history of tuberculosis. She had a 30 packby use of disk diffusion according to the approved standard of the year history of tobacco use. On examination, auscultation revealed National Committee for Clinical Laboratory Standards [2], showed dullness over the left lung base with decreased breath sounds; that the organism was resistant to ampicillin and susceptible to there were no added sounds. Other than for a low-grade fever, the cefazolin, cefuroxime, and gentamicin. Examination of the BAL findings of the remainder of her examination were unremarkable. and bronchial brushing specimens did not show any malignant A complete blood count showed the following values: hemoglocells, and cultures were negative for mycobacteria and fungi. bin, 120 g/L; WBC count, 7.1 1 10 9 /L; and platelet count, 317 1 The patient was treated initially with parenteral cefuroxime, 10 9 /L. A sputum culture yielded normal upper respiratory tract 750 mg q8h for 10 days, followed by, oral cefuroxime axetil, flora. Serology for antibodies to HIV was negative, and serum Ig 500 mg q12h for 3 weeks. Four weeks later, her symptoms relevels were normal. A chest radiograph showed extensive consolicurred, and repeated chest radiography, HRCT of the lungs, and dation of the left lower lobe (LLL) of the lung with volume loss.FFB did not reveal significant changes. Culture of a BAL specimen again yielded K. oxytoca, which was susceptible to tobramycin and ciprofloxacin and intermediately resistant to cefazolin and ce-

Chronic Pneumonia Due to Klebsiella oxytoca Mimicking Pulmonary Tuberculosis

“…Radiologically, the patient had an extensive consolidation of the left lower lobe with volume loss, which was confirmed on HRCT along with emphysematous changes. The diagnosis was established with the culture of the organism from bronchoalveolar lavage [14]. In our patient too, non-resolving pneumonia along with a history of smoking and emphysematous changes were present.…”

“…This was highlighted by a study from Switzerland which reported 12 (12.4%) patients with CAP requiring hospitalisation due to Klebsiella species which included two caused by K. oxytoca [5]. The chronic form of the disease caused by K. oxytoca has been documented only once previously in an 82-year-old female from Canada who presented with a non--resolving pneumonia of 9 months duration [14].…”