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      Pyogenic Liver Abscess and Endogenous Endophthalmitis Due to K64-ST1764 Hypervirulent Klebsiella pneumoniae: A Case Report

      case-report

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          Abstract

          Rationale

          Klebsiella pneumoniae ( K. pneumoniae, KP) are divided into two types: classic K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP). hvKP causes liver abscess and metastatic infection. Here, we report one case with pyogenic liver abscess (PLA) and endogenous endophthalmitis (EE) due to a relatively rarely reported serotype of K. pneumoniae in China.

          Patient Concerns

          An 80-year old man presented with nausea, vomiting, and epigastric discomfort for 2 weeks.

          Diagnoses

          PLA was identified by CT scan and abdominal ultrasound. Urgent ophthalmologic consultation was performed. B-scan ocular ultrasound was done and he was diagnosed as EE.

          Interventions

          Antibiotic treatment, intravitreal injection of eyes and eye drops were given. Percutaneous needle aspiration, evisceration, and drainage of the right eye were performed.

          Outcomes

          Cultures of the blood, the aspirated pus from the liver abscess, and the contents of the eyeball all yielded K. pneumoniae with a positive string test. The capsular serotype was K64. According to the existence of multiple virulence genes and the severe invasive clinical manifestation, this strain is regarded as a hvKp strain. Multilocus sequence typing (MLST) revealed the sequence type (ST) of this strain was K64-ST1764. Antimicrobial resistance genes, bla NDM-1 and bla KPC-2, were not detected in the genome. The patient lost his eyesight but his symptoms subsided. During 15 months follow-up, the result was satisfactory.

          Lessons

          Here, we report one case with PLA due to a relatively rarely reported serotype of K. pneumoniae in China. This K64 K. pneumoniae strain is confirmed as hvKp by multiple methods. It is noteworthy that the sequence type is K64-ST1764 instead of the commonest ST11. Moreover, this strain is not considered a K. pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) or a carbapenem-resistant K. pneumoniae (CRKP) as it is usually. Further follow-up and research are required to investigate this strain.

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          Hypervirulent (hypermucoviscous) Klebsiella pneumoniae

          Alyssa S. Shon, Rajinder Bajwa, Thomas Russo (2013)
          A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae has emerged. First described in the Asian Pacific Rim, it now increasingly recognized in Western countries. Defining clinical features are the ability to cause serious, life-threatening community-acquired infection in younger healthy hosts, including liver abscess, pneumonia, meningitis and endophthalmitis and the ability to metastatically spread, an unusual feature for enteric Gram-negative bacilli in the non-immunocompromised. Despite infecting a healthier population, significant morbidity and mortality occurs. Although epidemiologic features are still being defined, colonization, particularly intestinal colonization, appears to be a critical step leading to infection. However the route of entry remains unclear. The majority of cases described to date are in Asians, raising the issue of a genetic predisposition vs. geospecific strain acquisition. The traits that enhance its virulence when compared with “classical” K. pneumoniae are the ability to more efficiently acquire iron and perhaps an increase in capsule production, which confers the hypermucoviscous phenotype. An objective diagnostic test suitable for routine use in the clinical microbiology laboratory is needed. If/when these strains become increasingly resistant to antimicrobials, we will be faced with a frightening clinical scenario.
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            Multiplex PCR for detection of acquired carbapenemase genes.

            Laurent Poirel, Timothy R. Walsh, Vincent Cuvillier … (2011)
            A rapid and reliable PCR-based technique was developed for detection of genes encoding carbapenemases belonging to different classes. Primers were designed to amplify the following 11 genes: bla(IMP), bla(VIM), bla(NDM), bla(SPM), bla(AIM), bla(DIM), bla(GIM), bla(SIM)bla(KPC), bla(BIC), and bla(OXA-48). Three different multiplex reaction mixtures were defined and evaluated for the detection of all these 11 genes. Using optimized conditions, each reaction mixture allowed to identify the respective genes, with PCR giving distinct amplicon sizes corresponding to the different genes for each mixture. We reported here a rapid and reliable technique for screening all clinically relevant carbapenemase genes. Copyright © 2011 Elsevier Inc. All rights reserved.
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              A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study.

              Danxia Gu, Ning Dong, Zhiwei Zheng … (2018)
              Hypervirulent Klebsiella pneumoniae strains often cause life-threatening community-acquired infections in young and healthy hosts, but are usually sensitive to antibiotics. In this study, we investigated a fatal outbreak of ventilator-associated pneumonia caused by a new emerging hypervirulent K pneumoniae strain.
              Article 0 comments Cited 334 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Drug Resist
                Journal ID (iso-abbrev): Infect Drug Resist
                Journal ID (publisher-id): idr
                Journal ID (pmc): idr
                Title: Infection and Drug Resistance
                Publisher: Dove
                ISSN (Electronic): 1178-6973
                Publication date (Electronic): 12 January 2021
                Publication date Collection: 2021
                Volume: 14
                Pages: 71-77
                Affiliations
                [1 ]Department of Gastroenterology, The Affiliated Wuxi Second People’s Hospital of Nanjing Medical University , Wuxi, People’s Republic of China
                [2 ]Department of Clinical Laboratory, The Affiliated Wuxi Second People’s Hospital of Nanjing Medical University , Wuxi, People’s Republic of China
                Author notes
                Correspondence: Xiaoyun Wang Department of Gastroenterology, The Affiliated Wuxi Second People’s Hospital of Nanjing Medical University , Wuxi, People’s Republic of ChinaTel +86 15061857125Fax +86 510 685662052 Email xiaoyunwang68@aliyun.com
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0000-0001-6631-1643
                Article
                Publisher ID: 289088
                DOI: 10.2147/IDR.S289088
                PMC ID: 7811456
                PubMed ID: 33469321
                SO-VID: 95a88bf4-42ce-4e54-b1b7-ac54b7acb2d5
                Copyright © © 2021 Zhao et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 28 October 2020
                Date accepted : 09 December 2020
                Page count
                Figures: 4, Tables: 3, References: 39, Pages: 7
                Funding
                Funded by: the National Natural Science Foundation of China;
                Funded by: Foundation for Key Medical Talents in Jiangsu Province;
                Funded by: Six Talent Peaks Project of Jiangsu Province;
                Funded by: Six One Top-notch Talent Project of Jiangsu Province;
                This work was supported by the National Natural Science Foundation of China No.81500467, Foundation for Key Medical Talents in Jiangsu Province No.QNRC2016151, Six Talent Peaks Project of Jiangsu Province No.WSN-220, Six One Top-notch Talent Project of Jiangsu Province No.LGY201701. The funders had no role in the study design, conduct, analysis, interpretation of study results, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: case report,hypervirulent klebsiella pneumoniae,pyogenic liver abscess,antibiotic resistance,ultrasonography guided puncture aspiration
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: case report, hypervirulent klebsiella pneumoniae, pyogenic liver abscess, antibiotic resistance, ultrasonography guided puncture aspiration

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