Hypermucoviscous capsular 1 (K1) serotypeKlebsiella pneumoniaenecrotising fasciitis and metastatic endophthalmitis

Abstract

A 48-year-old man presented with a non-healing wound on his left foot after stepping on a nail. He self-medicated with amoxicillin, but the wound progressed prompting consult. On examination, his left foot was diffusely swollen with surrounding erythema, areas of gangrene, foul-smelling purulent discharge and subcutaneous emphysema. He was managed as a case of necrotising fasciitis and underwent emergent amputation. Three days after amputation, he developed a sudden and progressive blurring of vision, swelling and conjunctival erythema, with purulent discharge and the presence of hypopyon on the left eye. He was then managed as a case of endophthalmitis of the left eye and underwent pars plana vitrectomy. All cultures (blood, tissue and vitreous fluid) grew pan-susceptible hypermucoviscous Klebsiella pneumoniae, with positive string tests and confirmed by multilocus gene sequencing and sequence type analysis. He gradually improved with intravenous antibiotics, but only regained light perception in the left eye.

Klebsiella pneumoniae-induced multiple invasive abscesses

“…The K1 serotype of K pneumoniae is the major serotype that induces deep abscesses. [4,11,12] Invasive infection caused by K pneumoniae is common in immunosuppressed patients, but it could also be observed in some immunocompetent patients. It was reported that prevalence of K pneumoniae in healthy adults was 75%, with a high prevalence (23%) of serotype K1 or K2 isolates in Taiwan.…”

Left eye enucleation caused by multi-systemic Klebsiella pneumoniae invasive syndrome

“…5 Thus, K. pneumoniae is more virulent and aggressive in Asia, and Asian populations are more likely to develop IKPLAS. Chiu et al 6 reported a clinical case of K. pneumoniae invasive syndrome caused by a non-healing wound after foot trauma. The middle-aged male patient was treated with antibiotics (piperacillin/tazobactam 4.5 g q8h, vancomycin 1 g q12h) and emergency double-calf amputation to control the infectious foci of necrotizing fasciitis after admission.…”

Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: A Case Report and Literature Review

“…Exogenous endophthalmitis occurs when the infecting organisms directly enter the eye, while endogenous endophthalmitis results from infectious agent hematogenous seeding of the eye. In the literature, septic metastatic endophthalmitis may develop from distant NF of a lower extremity infected by Klebsiella pneumoniae [ 9 ]. Severe infections, such as liver abscesses and bacteremia, can also cause endogenous endophthalmitis concurrent with orbital cellulitis or NF of the leg [ 10 , 11 , 12 , 13 ].…”