Liver Abscess Combined with Endogenous Endophthalmitis Caused by Genotype ST25 Serotype K2 Hypervirulent Klebsiella pneumoniae: A Case Report

Abstract

At present, invasive syndrome caused by hypervirulent Klebsiella pneumoniae (HvKp) is a widespread concern, and HvKp strains of different genotypes have been isolated. Here, we report a case of community-acquired liver abscess and endogenous endophthalmitis caused by a genotype ST25 serotype K2 (ST25-K2) HvKp strain in China. A 51-year-old man with diabetes was transferred to our hospital from a local community hospital with persistent fever for > 20 days and blurred vision in his left eye. A detailed examination revealed a liver abscess, endogenous endophthalmitis, and pneumonia. Bacterial cultures of pus from the liver abscess and the vitreous abscess of the left eye yielded Klebsiella pneumoniae (Kp), which was sensitive to the recommended drugs. In addition to positive string tests, a genetic analysis showed that the strain belonged to sequence type 25 (ST25) and serotype K2, and carried already-reported virulence genes, including iucA, rmpA2, rmpA, aerobactin , and entB . The pathogenic agent isolated from this patient was identified as HvKp. The patient’s general condition improved after a combination of treatments, including antimicrobial therapy, abscess drainage, and nutritional support. Unfortunately, the patient lost the vision in his left eye and developed secondary glaucoma, resulting in inevitable enucleation. Sequence 25 serotype K2 HvKp strains have been previously associated with nosocomial infections, but none associated with community-acquired liver abscess combined with endogenous endophthalmitis has yet been reported. Clinicians must be alert to the possibility of genotype ST25-K2 HvKp infection in patients with community-acquired liver abscess combined with an invasive infection, such as ocular discomfort.

Pyogenic liver abscess caused by extended-spectrum β-lactamase-producing hypervirulent Klebsiella pneumoniae diagnosed by third-generation sequencing: a case report and literature review

“…PLA caused by multidrug-resistant hvKp has rarely been reported (Table 4). [19][20][21][22][23][24][25][26] The strain in our case showed a trend of multidrug resistance. There needs to be awareness of infection caused by hypervirulent strains with drug resistance.…”

Performance of next-generation sequencing for diagnosis of blood infections by Klebsiella pneumoniae

“…Kp is a threat to public health and can cause a range of severe infections, such as pneumonia, BSI, meningitis, urinary tract infection, and bacterial abscesses (Dong et al, 2019;Lai and Yu, 2021), which can result in high mortality rates of hospitalized patients (Shapaka et al, 2023). Based on virulence factors, Kp is commonly classified as classic or hypervirulent (Liu and Guo, 2018;Zhu et al, 2021;Lin et al, 2022). Routine culture methods for detection of Kp BSIs have relatively low positivity rates (10% to 30%) and are time-consuming (Zhou et al, 2023).…”

Oral Administration of Lacticaseibacillus rhamnosus CRL1505 Modulates Lung Innate Immune Response against Klebsiella pneumoniae ST25

“…LABACER 01 and LABACER 27, hypermucoviscous carbapenem resistant K. pneumoniae ST25 strains, were isolated at the “Angel Cruz Padilla” hospital (San Miguel de Tucuman, Tucuman, Argentina). ST25 K. pneumoniae strains were identified by MALDI-TOF (matrix-assisted laser desorption/ionization) (Microflex LT; Bruker Daltonik GmbH, Bremen, Germany) and kept in the Culture Collection of the Certified Bacteriology Laboratory (LABACER, National University of Tucuman, Tucuman, Argentina) [ 4 , 5 , 6 ].…”

“…In recent years, an increase in the prevalence of hypermucoviscous carbapenem-resistant K. pneumoniae of the sequence type (ST) 25 was detected in patients hospitalized in Northwest Argentina. This hypermucoviscous phenotype has been associated with hypervirulent strains, leading this bacterium to cause different infectious diseases including liver abscesses, meningitis, endophthalmitis, prostate abscesses and respiratory infections [ 4 , 5 ]. In this sense, our previous studies have shown that K. pneumoniae carbapenemase-2 (KPC-2)-producing ST25 strains are endemic in hospitals in the province of Tucuman (Argentina) and are associated with respiratory and systemic infections [ 5 , 6 , 7 ].…”