Identification and Management of the Hypervirulent Invasive Klebsiella pneumoniae Syndrome: A Unique and Distinct Clinical Entity

Abstract

In this article, we describe the case of a 61-year-old woman who presented with altered mental status and was found to have Klebsiella pneumoniae meningitis, bacteremia, and hepatic abscess. Despite intravenous antibiotic therapy and percutaneous drainage of the hepatic abscess, the patient developed worsening meningitis with ventriculitis, which led to her death. This invasive Klebsiella syndrome is characterized by metastatic infections with a hypervirulent strain and a poor clinical prognosis. Important elements of this patient’s case—including the widespread and highly aggressive course—and of those reported in the literature are reviewed. Although the invasive Klebsiella syndrome is an increasingly recognized clinical entity, most often in the Eastern hemisphere, it remains rare in the United States with approximately 20 cases reported in the literature, and given its high morbidity, it is vitally important for clinicians to recognize.

Ventriculitis Associated with Invasive <italic>Klebsiella Pneumoniae</italic> Syndrome: A Case Report

“…Ventriculitis caused by IKPS is rare and documented in few case reports. However, these case reports tend to show similar clinical course; initially presenting with nonspecific symptoms, rapid deterioration of mental status, equivocal brain CT results, diagnosis through diffusion-weighted MRI, and the need for CSF diversion 1,3,[7][8][9][10] . This is also shown in primary pyogenic ventriculitis caused by pathogens other than Klebsiella pneumoniae.…”

“…Its risk factors include diabetes mellitus and East-Asian descent 6,7) . Its etiology is yet poorly understood but is thought to be hematogenous through enterohepatic circulation8); and 75% of East-Asian are carriers of Klebsiella pneumoniae in contrast to 10%-19% in European 8) .…”

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Klebsiella pneumoniae is a gram-negative, anaerobic bacillus, a well-known nosocomial and community-acquired pathogen causing respiratory, urinary, and hepatobiliary infections 3,6,8) . Among them, hypervirulent strains have been reported to cause community-acquired liver abscesses and metastatic infections in lung, prostate, soft tissue, eye, and central nervous system (CNS) in non-immunocompromised individuals, defined as invasive Klebsiella pneumoniae syndrome (IKPS) 8) .

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“…We present a case of ventriculitis caused by invasive Klebsiella pneumoniae syndrome successfully treated with a timely diagnosis, immediate surgical intervention, and administration of antibiotics. Keywords: Drainage; Klebsiella pneumoniae; Magnetic resonance imaging; Ventriculitis tion shows a higher mortality rate 40% to 50% 7) than other metastatic infections 8) . It presents mostly as meningitis, encephalitis or cerebral abscess, and presenting primarily as ventriculitis or ventricular empyema is rare 7) .…”

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.…”