<i>Klebsiella pneumoniae</i>in Gastrointestinal Tract and Pyogenic Liver Abscess

Fung, Chang Phone; Lin, Yi Tsung; Lin, Jiunn Diann; Chen, Te Li; Yeh, Kuo Ming; Chang, Feng Yee; Chuang, Han-Chuan; Wu, Hau Shin; Tseng, Ching Jiunn; Siu, L. Kristopher

doi:10.3201/eid1808.111053

Cited by 128 publications

(129 citation statements)

References 15 publications

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“…Patients with pyogenic liver abscesses have been reported to have frequent intestinal (81.4%) and/or pharyngeal (39.5%) colonization with hvKP [29]. We found hvKP colonization in 16 patients.…”

Section: Discussionmentioning

confidence: 51%

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: 51%

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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“…It is unclear what role our patient's prior biliary surgery may have played in the pathogenesis of her disease, though it is conceivable that her altered anatomy may have been a predisposing factor. Gastrointestinal carriage of the K1 strain is likely a risk factor for development of K. pneumoniae liver abscess (24). Diabetes is a frequent underlying illness in reports of K. pneumoniae hepatic abscess (5, 25), but our patient lacked that putative risk factor as well.…”

mentioning

confidence: 77%

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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“…Although a report has shown that sequence type 14 (ST14) in serotype K2 isolates was not associated with virulence (16), this should not decrease the need to detect serotypes K1 and K2 in patients with clinical illness. Previous studies have shown that K. pneumoniae serotype K1 and/or K2 contamination can be detected in milk from cows with mastitis (8), and intestinal colonization of serotype K1/K2 isolates is a predisposing factor for the development of human disease as well (14,17). Therefore, the ability to specifically detect serotypes K1 and K2 may help to prevent future complications in infected patients (10).…”

Section: Resultsmentioning

confidence: 99%

Development of a Colloidal Gold-Based Immunochromatographic Strip for Rapid Detection of Klebsiella pneumoniae Serotypes K1 and K2

et al. 2016

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eIn this study, a novel colloidal gold-based immunochromatographic strip (ICS) containing anti-Klebsiella pneumoniae capsular polysaccharide polyclonal antibodies was developed to specifically detect K. pneumoniae serotypes K1 and K2. Capsular polysaccharide K1 and K2 antigens were first used to produce polyclonal anti-K1 and anti-K2 antibodies. Reference strains with different serotypes, nontypeable K. pneumoniae strains, and other bacterial species were then used to assess the sensitivity and specificity of these test strips. The detection limit was found to be 10 5 CFU, and the ICSs were stable for 6 months when stored at room temperature. No false-positive or false-negative results were observed, and equivalent results were obtained compared to those of more conventional test methods, such as PCR or serum agglutination. In conclusion, the ICS developed here requires no technical expertise and allows for the specific, rapid, and simultaneous detection of K. pneumoniae serotypes K1 and K2.K lebsiella pneumoniae is a Gram-negative, rod-shaped bacterium that is found in the normal flora of the mouth, skin, and intestines. Recently, a new type of invasive infection caused by K. pneumoniae has emerged as a global disease (1). There are 77 different serotypes of the capsular polysaccharides (CPSs) of K. pneumoniae (2), with K2 and K21 being the most prevalent in western countries (3). Recently, by genotyping capsular polysaccharide genes, 79 capsular types were distinguished (4, 5). In contrast, the K1 and K2 serotypes are most often associated with bacteremia, liver abscess, and community-acquired pneumonia in Asia (3). However, reports of this new invasive syndrome have recently been on the rise in western countries (6, 7). In addition to causing human disease, K. pneumoniae serotypes K1 and K2 have also been detected in contaminated animal milk (8). Capsular serotypes have typically been identified by using either a capsular swelling test or countercurrent immunoelectrophoresis (3, 9). However, these conventional methods are time-consuming, require extensive materials and manpower, and often produce falsepositive or false-negative results that are caused by cross-reactions. Another option is PCR, but this analysis requires a long time for preparation, expensive equipment, and skilled technicians, and previous studies have recommended that rapid detection is ideal for early clinical diagnosis and treatment (1).To address these concerns, this study involved the development of a colloidal gold-based immunochromatographic strip (ICS) that contained anti-K. pneumoniae capsular polysaccharide polyclonal antibodies (pAbs) and was able to detect K. pneumoniae serotypes K1 and K2. This testing kit provides a sensitive, rapid, and simultaneous method to detect K. pneumoniae serotypes K1 and K2. MATERIALS AND METHODSBacterial strains. The various serotypes of K. pneumoniae that were used here were obtained from our previous studies in Taiwan and at the Serum Institute in Denmark. The panel of bacterial strains contained al...

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Klebsiella pneumoniaein Gastrointestinal Tract and Pyogenic Liver Abscess

Cited by 128 publications

References 15 publications

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

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

Development of a Colloidal Gold-Based Immunochromatographic Strip for Rapid Detection of Klebsiella pneumoniae Serotypes K1 and K2

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