Invasive liver abscess syndrome caused by Klebsiella pneumoniae with definite K2 serotyping in Japan: a case report

Abstract

BackgroundKlebsiella pneumonia is a well-known human pathogen, and recently, a distinct invasive syndrome caused by K. pneumoniae serotypes K1 and K2 has been recognized in Southeast Asia. This syndrome is characterized by primary liver abscess and extrahepatic complications resulting from bacteremic dissemination. We report the first adult case of primary liver abscess caused by the definite K2 serotyped pathogen, with endogenous endophthalmitis in Japan.Case presentationA 64-year-old woman was admitted to a nearby hospital for a high fever and diarrhea. She had visual loss of her right eye, renal dysfunction, and thrombocytopenia within 24 h from admission. She was transferred to our institution. On admission, she had no alteration of mental status and normal vital signs; however, she had almost complete ablepsia of the right eye. Laboratory data showed severe inflammation, liver dysfunction, thrombocytopenia, an increased serum creatinine level, and coagulopathy. Computed tomography showed a low density area in the right lobe of the liver. Invasive liver abscess syndrome probably caused by K. pneumonia was highly suspected and immediately administered broad-spectrum antibiotics for severe sepsis. Concurrently, endogenous endophthalmitis was diagnosed, and we performed vitrectomy on the day of admission. The blood culture showed K. pneumoniae infection. Percutaneous drainage of the liver abscess was also performed. Although she was discharged in a good general condition on day 22, she had complete ablepsia of the right eye. The K2A gene was detected by polymerase chain reaction (PCR), which is consistent with the K2 serotype. PCR was also positive for the virulence-associated gene rmpA. Final diagnosis was invasive liver abscess syndrome caused by K2 serotype K. pneumonia.ConclusionsAlthough the primary liver abscess caused by K. pneumoniae with a hypermucoviscous phenotype is infrequently reported outside Southeast Asia, physicians should recognize this syndrome, and appropriate diagnosis and treatment is essential for saving patients’ lives and preserving organ function, especially for visual acuity.

Genotypic Characterization of Klebsiella pneumoniae Isolated from Human and Sheep in Al-Qadisiyah Province, Iraq

“…In a study performed in Taiwan, the serotype K1 was revealed in a higher occurrence rate, 63.4%,that that for the case of K2, 14.2%, of K. pneumonia isolates from liver abscess 23 . In Japan, it has been detected that the rate for the K1 serotype occurrence was lower than that regarding the K2 serotype of K. pneumonia isolates from liver abscesses 24 which shows similar to the current study results. These serotypes were Fig.…”

Occurrence and characterization of hyperviscous K1 and K2 serotype in Klebsiella pneumoniael

“…[ 19 ] A publication from Japan in 2016, described K1 serotype in one and K2 serotype in two liver abscess patients. [ 20 ] The presence of K1 or K2 serotypes are also being reported from North America, Europe, Australia, Africa, and the Middle East. [ 6 ] Although K1/K2 serotypes are frequently associated with liver abscess, they have been isolated from extrahepatic abscess also.…”

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

“…The syndrome of metastatic infections from hv K. pneumoniae infections, to a large extent, has been restricted geographically in Asia. Although a few established reports in North America and Europe were documented, interestingly majority of cases have occurred disproportionately in persons of Asian descent 1–10. The hv strains, especially K1 and K2 capsular serotypes, are highly associated with a wide range of highly complicated and invasive diseases,8–10 including soft tissue infections such as necrotising fasciitis 1…”

“…Its incidence is less common than exogenous endophthalmitis, which commonly results from trauma or cataract surgery. Primary liver abscesses are the most common primary site, accounting for metastatic spread with an approximate risk as high as 11% of developing endophthalmitis vs 4.8% in patients with bacteraemia 7 8. Bilateral involvement occurs in 13%–25% 10.…”

“…Monomicrobial necrotising fasciitis due to hypermucoviscous (hv) Klebsiella pneumoniae has strong association with diabetes mellitus and a strong propensity to disseminate to multiple sites including the eye, causing endogenous endophthalmitis 1–5. Endophthalmitis is a rare but severe ocular inflammation due to an infection of the vitreous cavity, which may lead to irreversible vision loss when not treated promptly 6–10. We report the first documented case in the Philippines on monomicrobial necrotising fasciitis with metastatic endophthalmitis.…”