Hypermucoviscous Klebsiella Syndrome Without Liver Abscess in a Patient With Immunoglobulin G2 Immune Deficiency

Abstract

Background Hypermucoviscous Klebsiella pneumoniae (HMVKP) emerged as a cause of invasive infections in South-East (SE) Asia. It has become the most common cause of liver abscess in that region, and it is a significant causative organism in endogenous endophthalmitis and meningitis. During the past decade, cases of this uniquely virulent organism have been reported outside of SE Asia, with a propensity to affect individuals of SE Asian descent. Cases have been reported from North America including Canada.Methods We report a case of a patient of Filipino descent living in Canada who presented with recurrent HMVKP bacteremia in the absence of pyogenic liver abscess or other localized metastatic Klebsiella infection.Results Investigations identified an immunoglobulin (Ig)G2 deficiency and low IgM indicating potential common variable immunodeficiency, and administration of intravenous immunoglobulins was associated with prevention of further recurrences.Conclusions To our knowledge, this is the first report of HMVKP associated with predisposing antibody deficiency.

Prevalence of hypervirulent Klebsiella pneumoniae-associated genes rmpA and magA in two tertiary hospitals in Houston, TX, USA

“…Although there are multiple case reports and case series of hvKP in the USA and Canada (Alsaedi et al, 2014;Fierer et al, 2011;Frazee et al, 2009;Keynan et al, 2007;Lederman & Crum, 2005a, b;McCabe et al, 2010;Nadasy et al, 2007;Pastagia & Arumugam, 2008;Patel et al, 2014;Pomakova et al, 2012), none of these studies reported the prevalence of hvKP. The only surveillance study in North America was from Alberta, Canada; an estimated prevalence of 8.2 % hvKP was found (Peirano et al, 2013).…”

Antimicrobial Susceptibility, Virulence, and Genomic Features of a Hypervirulent Serotype K2, ST65 Klebsiella pneumoniae Causing Meningitis in Italy

“…We also conducted a literature search of cases of meningitis sustained by hmKp/hvKp ( Table 3 and Table 4 ) using the PubMed Database (only articles in English were taken into account) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The following terms and keywords were used for searching: Klebsiella hypervirulent cerebrospinal fluid; Klebsiella hypermucoviscous meningitis; hypervirulent Klebsiella pneumoniae meningitis.…”

HypermucoviscousKlebsiella pneumoniaeinvasive syndrome in a patient with diabetes without liver abscess

“…Although the classic HvKPS has liver abscesses, some cases have been described as an extrahepatic disease without liver abscesses, such as isolated muscle abscesses, necrotising fasciitis, osteomyelitis, septic arthritis, renal abscess, meningitis and prostate and bloodstream infections without abscesses 11–18. Further research is needed to unravel why some patients present with the typical phenotype while others do not.…”