Klebsiella pneumoniae-related invasive liver abscess syndrome complicated by purulent meningitis: a review of the literature and description of three cases

Abstract

Background Klebsiella pneumoniae (K. pneumoniae) invasive liver abscess syndrome (ILAS) with purulent meningitis was rarely identified the mainland of China. Last winter, we received 3 cases of K. pneumoniae meningitis and all of them died in a short time. We report these cases in order to find the reason of high mortality and discuss effective effort to improve these patients’ prognosis. Case presentation Three patients with uncontrolled diabetes developed live abscess and purulent meningitis. Upon admission, the clinical manifestations, laboratory result of blood and cerebrospinal fluid (CSF) and imaging examinations were compatible with K. pneumoniae ILAS which had metastasis infection of meningitis. Even with timely adequate antibiotic therapy and strict glycemic control, all of the patients’ condition deteriorated rapidly and died in a short time. Conclusion The reason of patients’ poor prognosis might be the absence of liver abscess drainage, high level of CSF protein which indicates severe inflammation and unknown special but stronger virulence factors of K. pneumoniae the patients’ living place Zhangjiakou. Strict glycemic control, early drainage of liver abscess and appropriate antibiotic application are recommended for treating this condition, further progress on the pathogenesis and treatment of K. pneumoniae meningitis may help patients gain a better prognosis.

Klebsiella pneumoniae invasion syndrome: a case of liver abscess combined with lung abscess, endophthalmitis, and brain abscess

“…Kp infection can cause a combination of liver abscessation and metastatic infections, in the form of meningitis, brain abscessation, lung abscessation, endophthalmitis and/or necrotising fasciitis, and this is collectively referred to as Klebsiella pneumoniae invasive syndrome (KPIS). 1 – 3 KPIS was first reported in Taiwan in the 1980s and usually occurs in Asian individuals with weakened immune systems. The associated mortality rate has been estimated as 3% to 42%, but in the presence of intracranial infection it can be as high as 38% to 91%.…”

“…The associated mortality rate has been estimated as 3% to 42%, but in the presence of intracranial infection it can be as high as 38% to 91%. 2 – 4 However, there is a lack of published guidelines for the diagnosis and treatment of Kp.…”

Case Report: Diagnosis of Klebsiella pneumoniae Invasive Liver Abscess Syndrome With Purulent Meningitis in a Patient From Pathogen to Lesions

“…Rapid pathogen diagnosis facilitated further lesion detection, proper treatment, and full recovery of the patient. Until now, few KLA cases with metastatic meningitis were reported, fewer patients achieved a good prognosis (8). Our case suggested the importance of early pathogen diagnosis.…”

“…She presented with purulent meningitis at the time of onset and was demonstrated as KLAS on the fourth day after admission. After consulting the literature, we found that adult community-acquired K. pneumoniae meningitis has been less recorded (8,13). Unfortunately, few patients have survived this disease.…”

Metagenome Analysis of the Bacterial Characteristics in Invasive Klebsiella Pneumoniae Liver Abscesses

“…EMI is a condition wherein K. pneumoniae in the liver abscess metastasize to distant sites, most commonly to the eyes, lungs, and central nervous system (Chung et al, 2007;Siu et al, 2012;Shin et al, 2013;Guo et al, 2017). During the past two decades, KPLA has been increasingly reported in Asia, and this invasive syndrome is emerging as a global concern (Chung et al, 2007;Siu et al, 2012;Guo et al, 2017;Sun et al, 2021). Catastrophic disability caused by ocular or neurological complications arising from IKPLA can lead to a poor long-term prognosis (Lin et al, 2012).…”