Necrotizing Fasciitis Caused by Hypermucoviscous Klebsiella pneumoniae in a Filipino Female in North America

Abstract

Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America.

Structural and functional delineation of aerobactin biosynthesis in hypervirulent Klebsiella pneumoniae

“…In 1986, a seminal report was published linking KP to severe life-threatening infections in ambulatory individuals from the community (10). In the decades that followed, numerous reports from around the globe of KP-associated infections, including hepatic abscesses, endopthalmitis, meningitis, osteomyelitis, and necrotizing fasciitis, in otherwise healthy individuals, illustrated the emergence of this new hypervirulent pathotype (11)(12)(13)(14)(15)(16)(17)(18). Amid recent reports suggesting the confluence of both drug-resistance and hypervirulence determinants in clinical isolates of KP, medical professionals fear a true "super bug" may be evolving (19,20).…”

Mass spectrometry and associated technologies delineate the advantageously biomedical capacity of siderophores in different pathogenic contexts

“…A line of studies showed that aerobactin assembly will help form potential anti-virulence strategies and advance our understanding of siderophore biosynthesis. Aerobactin plays a key role to mediate the enhanced virulence of a hypervirulent pathotype of Klebsiella pneumoniae, a causative agent of hepatic abscesses, endophthalmitis, meningitis, osteomyelitis, pneumonia, and necrotizing fasciitis (Kashani & Eliott, 2013;Kwon et al, 2013;Vandevelde & Stepanovic, 2014;Ng & Frazee, 2015;Takahashi et al, 2015;Prokesch et al, 2016;Iwasaki et al, 2017;Bailey et al, 2018). Siderophores and substrate-binding proteins (SBPs) are employed by gramnegative bacteria to transport transition metals such as iron.…”

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

“…It is a recognised causative agent in South-East Asia for hepatic abscesses and necrotising fasciitis 1. In recent years, literature on Klebsiella has focused on the carbapenem-resistant Enterobacteriaceae (CRE) strains 2. On one hand, the CRE species represent a class of multidrug-resistant strains that are common in the hospital setting and long-term care facilities.…”

“…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…”

“…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.…”