Invasive Klebsiella pneumoniae Syndrome in North America

Nadasy, Krisztina A.; Domiati‐Saad, Rana; Tribble, Marc

doi:10.1086/519424

Cited by 146 publications

(114 citation statements)

References 28 publications

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“…[1][2][3][4] Its emergence in western countries has also been reported. [5][6][7] Previous studies in Taiwan, Singapore and Korea found a high prevalence of the capsular polysaccharide (CPS) K antigen serotypes K1 (54.5-63.4%) and K2 (5-21.2%) of K. pneumoniae in liver abscess isolates. 1,[8][9][10] Apart from the capsular serotypes, other virulence determinants have also been reported for K. pneumoniae liver abscesses, including the presence of hypermucoviscosity, aerobactin, magA (mucoviscosity-associated gene A), rmpA (regulator of mucoid phenotype), kfu (responsible for an iron uptake system) and allS (associated with allantoin metabolism) genes.…”

mentioning

confidence: 99%

Immune response and pathophysiological features of Klebsiella pneumoniae liver abscesses in an animal model

Fung

Chang

Lin

et al. 2011

Laboratory Investigation

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Capsular serotypes K1 and K2, the rmpA gene (a regulator of the mucoid phenotype) and aerobactin from Klebsiella pneumoniae have been identified as the major virulence factors for pyogenic liver abscesses with high morbidity, mortality and severe complications. The pathological mechanisms remain unclear. In this study, we compared liver immune responses and pathological changes in response to different serotypes of K. pneumoniae infections. A mouse model was used to investigate cytokine and chemokine production, histopathology findings, phagocytic uptake and mortality induced by serotypespneumoniae serotypes K1 and K2 showed lower 50% lethal dose values and more phagocytic resistance to neutrophils than K62 and the DK1 mutant. In sequential liver samples, viable bacteria counts increased 3 h to 3 days after low-dose inoculation (o10 1 colony-forming unit (cfu)) with K1 and K2, while K62 and DK1 cleared rapidly and became undetectable even with high-dose inoculation (B2.9 Â 10 5 cfu). Time-dependent increases in cytokines and chemokines, including tumor necrosis factor-a, interleukin (IL)-1b, IL-6, IL-10, keratinocyte-derived chemokines and macrophage inflammatory protein-2, were observed in the serum and liver tissue of K1-and K2-infected mice, and severe disease progression manifesting as microabscesses was also identified. K62 and DK1 inoculation did not result in similar immune responses and histological changes. These findings illustrate the critical role of phagocytic resistance against innate immunological defense mechanisms as well as its contribution to the development of liver abscesses.

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confidence: 99%

Immune response and pathophysiological features of Klebsiella pneumoniae liver abscesses in an animal model

Fung

Chang

Lin

et al. 2011

Laboratory Investigation

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“…Recent studies have shown that the mucoviscosity-associated gene A (magA) and regulator of mucoid phenotype A (rmpA) are associated with this syndrome [9,[12][13][14]17]. However, we could not ascertain which phenotype and genotype produced invasive K. pneumoniae syndrome in our case.…”

Section: Discussionmentioning

confidence: 67%

“…pneumoniae has been reported to be the most common pathogen causing liver abscess in Korea [6,7]. The incidence of K. pneumoniae infection increases in immunocompromised conditions, such as diabetes mellitus, alcoholism, malignancy, hepatobiliary disease, chronic obstructive pulmonary disease, glucocorticoid therapy and renal failure [6][7][8][9][10][11][12][13][14]. In our case, the In a few cases, K. pneumoniae liver abscess has been associated with metastatic infection at other sites [7,8,[10][11][12][13][14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Emphysematous prostatitis combined with a liver abscess caused byKlebsiella pneumoniae

et al. 2011

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Emphysematous prostatitis combined with a liver ab scess caused by Klebsiella pneumoniae Emphysematous prostatitis is a rare condition that is characterized by gas and abscess accumulation in the prostate. This uncommon but serious disease requires special attention because of its nonspecific presentation such as dysuria, frequency, urgency, fever, acute urinary retension and/or perineal pain. We report here on a case of emphysematous prostatitis that was combined with a liver abscess caused by Klebsiella pneumoniae. A 55yearold man was admitted due to a 3day history of urinary retention with a febrile sensation. He had histories of liver cirrhosis and uncontrolled diabetes mellitus. After blood and urine cultures, levofloxacin 500 mg was started intravenously. On the third hospital day, he displayed septic shock.The kidneysureters bladder (KUB) Xray showed pockets of airaccumulation in the lower pelvic cavity, and abdominopelvic computed tomography (CT) with contrast enhancement taken on the third day showed a 5cm liver abscess with an emphysematous prostate. Intravenous antibiotics was changed to metronidazole 500 mg q.i.d. and cefotaxime 2 g t.i.d. On the sixth day, transurethral resection and drainage were performed under spinal anesthesia. However, the postoperative bleeding continued and hypovolemic shock persisted, which then provoked multiorgan failure. The patient died on the 11th hospital day. K. pneumoniae was cultured from the liver abscess aspirate, blood and prostatic tissue, and the bacteria were sensitive to both levofloxacin and cefotaxime. Emphysematous prostatitis is a difficult to diagnose because of its rarity and nonspecific symptoms. A delayed diagnosis can cause high mortality and morbidity, so making a prompt clinical diagnosis of this condition is essential. Appropriate antibiotics with early adequate incision and drainage are also needed.

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“…2 Clinicians in the United States are just becoming aware of this syndrome, even though several articles about the Taiwanese experience have appeared in English language journals. [6][7][8] More recently there have been case reports of Kp liver abscesses in Asians living in the United States and Europe, [9][10][11][12] and even cases in non-Asian who have never traveled to Asia, 13 indicating that the spread of virulent Kp to the United States has occurred. The US strains carry many of the virulence-associated genes that have been identified in Taiwan.…”

mentioning

confidence: 99%

Biofilm formation and Klebsiella pneumoniae liver abscess

Fierer

2012

Virulence

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Invasive Klebsiella pneumoniae Syndrome in North America

Cited by 146 publications

References 28 publications

Immune response and pathophysiological features of Klebsiella pneumoniae liver abscesses in an animal model

Immune response and pathophysiological features of Klebsiella pneumoniae liver abscesses in an animal model

Emphysematous prostatitis combined with a liver abscess caused byKlebsiella pneumoniae

Biofilm formation and Klebsiella pneumoniae liver abscess

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