A case report on rapid development of simultaneous liver and musculature calcifications in severe sepsis.

A 76-year-old Malay female presented with 2 days history of fever and vomiting. She was found to have Escherichia coli and Klebsiella pneumoniae bacteraemia with no clear intra-abdominal cause on the initial computed tomography of the abdomen and pelvis (CTAP). She clinically improved with 2 weeks duration of intravenous meropenem. She subsequently developed septic shock and a repeated CTAP demonstrated increased hepatic parenchymal density with extensive parenchymal calcifications. Curvilinear calcifications were seen in the paraspinal and pelvic musculature.

Thrombocytopenia in Klebsiella pneumoniae liver abscess: a retrospective study on its correlation with disease severity and potential causes.

Objective: Thrombocytopenia is commonly associated with infectious diseases and serves as an indicator of disease severity. However, reports on its manifestation in conjunction with Klebsiella pneumoniae liver abscess (KPLA) are scarce. The present study sought to elucidate the correlation between thrombocytopenia and KPLA severity and delve into the etiological factors contributing to the incidence of thrombocytopenia. Materials and methods: A retrospective analysis of the clinical data from patients with KPLA admitted between June 2012 and June 2023 was performed. Baseline characteristics, biochemical assessments, therapeutic interventions, complications, and clinical outcomes were compared between patients with and without thrombocytopenia. To investigate the potential etiologies underlying thrombocytopenia, the association between platelet count reduction and thrombophlebitis was examined, with a particular focus on platelet consumption. Furthermore, bone marrow aspiration results were evaluated to assess platelet production anomalies. Results: A total of 361 KPLA patients were included in the study, among whom 60 (17%) had concurrent thrombocytopenia. Those in the thrombocytopenia group exhibited significantly higher rates of thrombophlebitis (p = 0.042), extrahepatic metastatic infection (p = 0.01), septic shock (p = 0.024), admissions to the intensive care unit (p = 0.002), and in-hospital mortality (p = 0.045). Multivariate analysis revealed that thrombocytopenia (odds ratio, 2.125; 95% confidence interval, 1.114-4.056; p = 0.022) was independently associated with thrombophlebitis. Among the thrombocytopenic patients, eight underwent bone marrow aspiration, and six (75%) had impaired medullar platelet production. After treatment, 88.6% of thrombocytopenic patients (n = 47) demonstrated recovery in their platelet counts with a median recovery time of five days (interquartile range, 3-6 days). Conclusions: Thrombocytopenia in patients with KPLA is indicative of increased disease severity. The underlying etiologies for thrombocytopenia may include impaired platelet production within the bone marrow and augmented peripheral platelet consumption as evidenced by the presence of thrombophlebitis.

Case report: A case of high virulence and multidrug resistant Klebsiella pneumoniae liver abscess in Ningxia, China.

RATIONALE: Highly virulent multidrug-resistant Klebsiella pneumoniae (KP) is becoming more and more common in clinical practice, especially the rise of carbapenem-resistant KP in clinical practice, resulting in the emergence of KP liver abscess in Ningxia, China. For the prognosis of liver abscess patients, it is particularly important to identify the types of pathogens and identify antibiotics that are sensitive to the pathogens. PATIENT CONCERNS: A 73-year-old man from China presents to our hospital with abdominal pain, jaundice and fever. Patients have no obvious cause of abdominal pain, abdominal distension, and abdominal pain is persistent. Abdominal examination showed hepatomegaly, no tenderness 2 cm from the right costal margin, abdominal distension and other general examinations did not have obvious abnormalities. He had no history of hypertension and diabetes, ERCP was performed for cholangiocarcinoma 1 year before the current visit, and no significant complications occurred. DIAGNOSES: His initial diagnosis was obstructive cholangitis, and computed tomographic images and liver drainage fluid bacterial culture and genetic polymerase chain reaction tests later determined that the patient had KP liver abscess. INTERVENTIONS: Drainage by liver catheter and antibiotic treatment for 7 weeks. OUTCOMES: The patient liver abscess is basically gone. LESSION: It is particularly important to optimize the diagnosis of liver abscess pathogens for timely and effective treatment of patients.

Endogenous endophthalmitis caused by urinary tract infection: A case report.

RATIONALE: Endogenous endophthalmitis is a vision-threatening intraocular infection caused by hematogenous spread of infectious organisms from distant sites. PATIENT CONCERNS: A 71-year-old man with a history of fever and dysuria 5 days prior to presentation presented with sudden loss of vision in his left eye. The patient had no history of ocular surgery or trauma, and ocular examination revealed a large amount of exudative plaque covering the pupil. Therefore, fundus examination was not feasible. B-scan ultrasonography revealed a dome-shaped subretinal mass with an exudative retinal detachment. DIAGNOSIS: Endogenous endophthalmitis was diagnosed on the basis of these findings. INTERVENTIONS: The patient underwent pars plana vitrectomy and the early postoperative course was favorable. OUTCOMES: Vitreous cultures grew gram-negative bacilli, identified as Klebsiella pneumonia. Urinalysis revealed white blood cells (++) and urinary tract infection was the only identifiable risk factor for endogenous endophthalmitis. LESSONS: Urinary tract infection is an independent risk factor for endogenous endophthalmitis.

Giant Klebsiella pneumoniae pyogenic liver abscess in the left liver lobe presenting with dyspepsia and vaginal discharge.

Pyogenic liver abscess (PLA) commonly occurs in the right liver lobe, causing the typical symptoms of fever and right upper quadrant pain. Less than one-third of cases occur in the left lobe. We describe an unusual presentation of a giant left-sided PLA that was compressing the stomach and surrounding venous vasculature, causing the respective symptoms of gastro-oesophageal reflux and vaginal discharge from secondary pelvic congestion syndrome. CT revealed a solitary 14 cm×10 cm×10 cm multiloculated lesion, replacing most of the left liver lobe. It was successfully treated with intravenous antibiotics and percutaneous drainage, resulting in complete resolution at 1-year follow-up. This case explores the predisposing risk factor of diabetes in PLA and its association with Klebsiella pneumoniae, which was the offending pathogen in our patient. We also discuss the phenomenon of secondary pelvic venous congestion syndrome and compare similar cases of left-sided PLA, highlighting the different modes of presentation and treatment options.

Cryptogenic Hypervirulent Klebsiella pneumoniae Pyogenic Liver Abscess: A Case Report.

BACKGROUND Klebsiella pneumoniae is a gram-negative organism known to cause pyogenic liver abscesses. It is most often caused by one of the hypervirulent strains, which are capable of causing metastatic infection. This occurs most commonly in Asia in patients without hepatobiliary disease; however, it is becoming increasingly recognized in North America. CASE REPORT We report a previously healthy man in his 50s who presented to hospital with 3 weeks of fever, chills, and mild abdominal pain following a minor motor vehicle collision. Ultrasound and computed tomography of his abdomen revealed a large multi-loculated liver abscess. This was drained percutaneously and grew a hypervirulent strain of Klebsiella pneumoniae known to cause metastatic infection. His blood cultures were negative. In addition to percutaneous drainage, he was treated with 8 weeks of antimicrobial therapy. Fortunately, he did not develop evidence of metastatic infection despite the hypervirulent strain. Etiology of the abscess was not clearly identified; however, it was speculated that the motor vehicle collision could have led to its development through gut translocation. CONCLUSIONS Presentation of Klebsiella pneumoniae liver abscesses is often nonspecific, and clinicians must have a high index of suspicion in order to ensure rapid diagnosis and treatment. Delay in diagnosis is associated with increased morbidity and mortality, and thus it is an important entity for clinicians to be aware of, especially as it becomes more prevalent in North American populations. Additionally, it is important that physicians are aware of the hypervirulent strains and screen patients clinically for evidence of metastatic infection.

First Italian report of a liver abscess and metastatic endogenous endophthalmitis caused by ST-23 hypervirulent Klebsiella pneumoniae in an immunocompetent individual.

BACKGROUND: Klebsiella pneumoniae is a common species in the gut of mammals and is widely distributed in the environment. However, the environmental source of hvKp that precedes gut colonization is unclear, but once that it reaches the gut there is a possible generalized spread y fecal-oral transmission especially in endemic areas. Liver abscess might develop when the bacteria, using its virulence factors, cross the intestinal barrier and invade the liver by the portal circulation. This syndrome, prevalent mostly in Asian countries, is increasingly reported in Western Countries and leaves open questions about the source of infection. CASE: Here we describe for the first time in Italy, a case of pyogenic liver abscess caused by a hypervirulent Klebsiella pneumoniae (HvKp) complicated by endophthalmitis and other metastatic infections in lung and prostate in an immunocompetent Chinese healthy individual with no recent travel in Asia. CONCLUSION: This case underlines the need for increased awareness of hypervirulent K. pneumoniae, even in settings where it occurs infrequently and where there are not evident epidemiological links.

Invasive Hypervirulent Klebsiella pneumoniae Syndrome Originating from an Anorectal Abscess as Opposed to a Pyogenic Liver Abscess.

An immunocompetent 49-year-old man presented with swelling and pain in the lower region of his left leg that had lasted for 4 weeks. The diagnosis was severe pyomyositis and osteomyelitis in the lower left leg caused by hypervirulent Klebsiella pneumoniae (hvKP) along with multiple metastatic infections in the kidneys, lungs, and brain originating from an anorectal abscess. A virulence-gene analysis revealed that the isolated K. pneumoniae harbored rmpA, entB, ybtS, kfu, iutA, mrkD, and allS-virulence genes and belonged to the K1 capsular serotype. After repeated abscess drainage procedures, intravenous ceftriaxone was administered for more than 10 weeks, and the patient's infection was controlled. We focused on the clinical features of hvKP originating from an anorectal abscess without a pyogenic liver abscess. We suggest that hvKP be considered a causative pathogen of pyomyositis and osteomyelitis resulting in multiple metastatic infections in an immunocompetent patient, and more information on the unexpected multiple metastatic infections should be obtained from a virulence analysis of K. pneumoniae.

Hypervirulent Klebsiella pneumoniae infection presenting as endocarditis and liver abscess.

Hypervirulent Klebsiella pneumoniae infection, reported commonly from South-east Asia, is predominantly community-acquired and affects young healthy adults. Although abscesses of liver, brain and muscles, endophthalmitis or osteomyelitis have been reported, Infective endocarditis is a rare manifestation. This report illustrates a patient with uncontrolled diabetes mellitus who presented with clinical features of liver abscess with an incidental finding of infective endocarditis. Hypervirulent K. pneumoniae, which was isolated from blood culture of the patient carried the plasmid borne key virulence markers-rmpA and rmpA2 with enterobactin (entB), type 3 fimbriae (mrkD) and was of K1 type and ST3321, an uncommon clone of Hypervirulent K. pneumoniae. Transthoracic Echocardiography showed multiple mobile vegetations attached to mitral valve and posterior wall of left ventricle. With appropriate antibiotics blood cultures turned sterile, liver abscess and cardiac vegetations reduced in size. Mitral Valve replacement surgery was proposed. He declined treatment and succumbed to the infection subsequently.

Klebsiella invasive liver abscess syndrome presenting with a central nervous system manifestation secondary to latent cholecystitis: a case report.

BACKGROUND: Brain abscess is a life-threatening event. Moreover, when Klebsiella pneumoniae is the cause, rapid diagnosis and appropriate treatment are required. Klebsiella invasive liver abscess syndrome, a bloodstream metastatic infection of potentially aggressive nature, has been recognized to cause infection in the central nervous system, and concern for Klebsiella liver abscess syndrome is increasing globally. CASE PRESENTATION: A 73-year-old Japanese woman was admitted to the institution complaining of aggravated dysarthria and weakness in the right upper extremities with onset 5 days earlier. Magnetic resonance imaging revealed a brain abscess in the left basal ganglia, and abdominal computed tomography revealed a liver abscess in liver segment 7. The patient's dysarthria symptoms became increasingly worse over the next few days, so surgical drainage via frontotemporal craniotomy was performed on admission day 3, and subsequent culture from the brain abscess showed growth of Klebsiella pneumoniae. On admission day 9, percutaneous transhepatic drainage of the liver segment 7 abscess was undertaken. The pus culture also showed growth of Klebsiella pneumoniae, thus associating the liver abscess with the brain abscess. Following long-term conservative treatment with antibiotics and abscess drainage, the liver abscess disappeared. However, the patient continuously presented with right upper quadrant pain, and abdominal computed tomography showed swelling of the gallbladder. Consequently, percutaneous transhepatic gallbladder drainage was initially administered, and the bile culture was also positive for Klebsiella pneumoniae. For radical treatment, a laparoscopic cholecystectomy was performed on admission day 99. The postoperative period was complicated by an intraabdominal abscess; however, conservative therapy was successful. She was subsequently discharged, and 12-month follow-up revealed no further sequelae. CONCLUSIONS: We describe a rare case of Klebsiella liver abscess syndrome, which first presented with a central nervous system manifestation. Our patient was successfully treated via an early surgical intervention and subsequent antibiotic therapy. Although surgical drainage remains the cornerstone treatment for brain abscess, when a brain abscess is found, and there is a high index of suspicion for the existence of a liver abscess, Klebsiella liver abscess syndrome should be considered as a possible diagnosis.

Characteristics of Pyogenic Liver Abscess: Experience of a single centre in Oman.

Objectives: This study aimed to analyse the epidemiological, aetiological and clinical characteristics of pyogenic liver abscess (PLA) occurring in Oman. The intention was to obtain the information needed for the adequate liver abscess (LA) empirical treatment. LA can develop as a complication of hepatobiliary disease or other intraabdominal infections, but more recently, it is associated with primary and secondary liver malignancies and their treatment. Methods: This retrospective study took place in the Royal Hospital, Muscat, Oman. Consecutive patients treated for LA from January 2013 to December 2017 were enrolled. Their demographic and clinical data were used to study the characteristics of PLA occurring in Oman. Results: A total of 53 patients with PLA were enrolled in the study. They were predominantly male and younger than 60 years. Klebsiella pneumoniae was found to be the most common bacteria causing LA. Clinical presentation was non-specific, and abdominal pain and high fever were the most common symptoms. Conclusion: The majority of PLAs are caused by K. pneumoniae, so the empirical treatment should begin with antibiotic directed against it. Further studies are needed to establish the local role of anaerobic bacteria in PLA and monitor the presence of hypervirulent K. pneumoniae in Oman.

Klebsiella pneumoniae Bacteremia is Associated with Higher Mortality in Acute Calculous Cholangitis as Compared to Escherichia coli Bacteremia.

BACKGROUND: Acute cholangitis (AC) is a potentially life-threatening infection involving the biliary system. The two commonest bacteria involved are Escherichia coli (EC) followed by Klebsiella pneumoniae (KP). Microbiology is a prognostic factor for several pathologies but not for AC. We aim to investigate clinical outcomes between KP bacteremia vs. EC bacteremia in AC. METHODS: This is a retrospective cohort study of patients diagnosed with calculous AC (January-December 2016). Study outcomes include the length of hospitalization stay, in-hospital mortality, 30-day, and 90-day mortality. Univariate and multivariate logistic regression was used to establish correlations. RESULTS: We included 141 patients (KP (n = 29), EC (n = 112)) with overall median age of 82.2 and similar gender distribution. Most patients had Grade II AC (n = 59, 41.8%). Patient demographics were comparable. KP bacteremia had lower median platelet count (KP:168 × 109/L vs. EC:200 × 109/L; p = 0.025). Overall 30-day and 90-day mortality were 9.2 and 10.6%, respectively. Multivariate analysis showed KP bacteremia had higher 30-day (Odds ratio (OR) 6.09, (95% Confidence Interval (CI):1.27-29.10), p = 0.024) and 90-day mortality (OR 6.10, 95% CI: 1.39-26.76, p = 0.017). The length of hospitalization stay was comparable. Subgroup analysis of endoscopic retrograde cholangiopancreatogram patients showed comparable outcomes. CONCLUSION: KP bacteremia is associated with lower platelet count and higher 30-day and 90-day mortality than EC. More studies are required to establish if inferior outcomes of KP bacteremia are associated with antimicrobial resistance.

Left eye enucleation caused by multi-systemic Klebsiella pneumoniae invasive syndrome.

Klebsiella pneumoniae is generally considered the most common pathogenic bacterium causing community-acquired pneumonia. In recent years, cases of liver abscess caused by the bacterium and its spread have been reported in Asia and other parts of the world. This clinical symptom of liver abscess caused by hypervirulent K. pneumoniae and its migrating infection is also called invasive K. pneumoniae liver abscess syndrome (IKPLAS). This study explored the clinical characteristics, diagnosis, and treatment of an elderly patient with IKPLAS who experienced multi-organ failure caused by the infection. The treatment of the patient was difficult, and despite our efforts, the invasive infection led to eye enucleation. This paper is expected to improve our understanding and awareness of this disease in the clinic.

Klebsiella pneumoniae-related brain abscess and meningitis in adults: Case report.

INTRODUCTION: Klebsiella pneumoniae is once thought to be a less common cause of brain abscess in adults and is mainly hospital-acquired. Community-acquired CNS infection (brain abscess and meningitis) caused by K pneumoniae without other metastatic septic abscesses is exceedingly rare. Therefore, we present a rare adult patient with invasive cerebral abscess and meningitis without other invasive abscesses related to K pneumoniae. PATIENT CONCERNS: A 64-year-old woman experienced a sudden onset of severe continuous headache accompanied by intermittent nausea, vomiting, and fever. Meanwhile, she experienced tinnitus and had a feeling of swelling in the right ear. DIAGNOSIS: Cranial magnetic resonance imaging revealed abnormal hyperintensity signals in the left head of the caudate nucleus. The next generation sequencing of cerebral spinal fluid showed infection with K pneumoniae. The patient was diagnosed with K pneumoniae-related brain abscesses and meningitis. INTERVENTIONS: Antibacterial treatment was carried out for 2 months. OUTCOMES: The patient recovered well. CONCLUSION: Despite the progress of modern neurosurgical techniques, new antibiotics, and modern imaging techniques, brain abscesses are still a potentially fatal infection. Streptococci are common organisms that result in brain abscesses. Nevertheless, Klebsiella species, once thought to be a less common cause of brain abscess in adults, has become an increasingly important cause of brain abscess, especially in Asia.

Risk Factors of Septic Metastatic Infection among Patients with Klebsiella pneumoniae Liver Abscess in Singapore: A Case-Control Study.

Metastatic infection resulting from Klebsiella pneumoniae liver abscess (KPLA) results in high mortality and morbidity. This study aimed to determine the risk factors associated with metastatic infection among patients with KPLA in Singapore. A retrospective case-control analysis among adult patients admitted to the National University Hospital with KPLA between 2013 and 2017 was conducted. Univariate and multivariate regression analysis was conducted. Of the 116 KPLA patients, 38.8% had pulmonary metastatic infection. Length of hospital stay (P = 0.001) and intensive care unit admissions (P = 0.044) were significantly longer and greater, respectively, among the patients with metastatic infection. Sepsis-induced hypotension (adjusted odds ratio [AOR], 4.88; 95% CI, 1.1-21.69), breathlessness (AOR, 5.10; 95% CI, 1.42-18.27), and abscess size (AOR, 1.02; 95% CI, 1.01-1.03) were associated independently with septic metastatic infection. Patients with KPLA who had breathlessness and larger abscess size are at a greater risk of septic metastatic infection.

Diet-induced obesity in mice impairs host defense against Klebsiella pneumonia in vivo and glucose transport and bactericidal functions in neutrophils in vitro.

Obesity impairs host defense against Klebsiella pneumoniae, but responsible mechanisms are incompletely understood. To determine the impact of diet-induced obesity on pulmonary host defense against K. pneumoniae, we fed 6-wk-old male C57BL/6j mice a normal diet (ND) or high-fat diet (HFD) (13% vs. 60% fat, respectively) for 16 wk. Mice were intratracheally infected with Klebsiella, assayed at 24 or 48 h for bacterial colony-forming units, lung cytokines, and leukocytes from alveolar spaces, lung parenchyma, and gonadal adipose tissue were assessed using flow cytometry. Neutrophils from uninfected mice were cultured with and without 2-deoxy-d-glucose (2-DG) and assessed for phagocytosis, killing, reactive oxygen intermediates (ROI), transport of 2-DG, and glucose transporter (GLUT1-4) transcripts, and protein expression of GLUT1 and GLUT3. HFD mice had higher lung and splenic bacterial burdens. In HFD mice, baseline lung homogenate concentrations of IL-1ß, IL-6, IL-17, IFN-γ, CXCL2, and TNF-α were reduced relative to ND mice, but following infection were greater for IL-6, CCL2, CXCL2, and IL-1ß (24 h only). Despite equivalent lung homogenate leukocytes, HFD mice had fewer intraalveolar neutrophils. HFD neutrophils exhibited decreased Klebsiella phagocytosis and killing and reduced ROI to heat-killed Klebsiella in vitro. 2-DG transport was lower in HFD neutrophils, with reduced GLUT1 and GLUT3 transcripts and protein (GLUT3 only). Blocking glycolysis with 2-DG impaired bacterial killing and ROI production in neutrophils from mice fed ND but not HFD. Diet-induced obesity impairs pulmonary Klebsiella clearance and augments blood dissemination by reducing neutrophil killing and ROI due to impaired glucose transport.

Report of Four Cases of Endogenous Klebsiella Pneumoniae Endophthalmitis Originated from Liver Abscess with Eye Complaints as the Initial Presentations.

PURPOSE: To report four cases of endogenous endophthalmitis (EE) secondary to Klebsiella pneumoniae liver abscess, and discuss their clinic features and outcomes. METHODS: Clinical data were collected by reviewing the medical records of four patients diagnosed with endogenous Klebsiella Pneumoniae endophthalmitis (EKPE) secondary to liver abscess. RESULTS: Four patients were diagnosed with EE. Two males and two females, with ages ranging from 33 to 63 years old. All patients presented with ocular symptoms initially. Liver abscesses were diagnosed during hospitalization. All cases were caused by Klebsiella Pneumoniae confirmed by blood or tissue cultures. All patients were treated with intravitreal antibiotic injection, and two of the patients had vitrectomy. At the end, all affected eyes underwent evisceration. One patient died of septic shock with multiple organ failures. CONCLUSION: EE secondary to liver abscess with metastatic spread is a severe sight-threatening condition. The delayed discovery of liver abscess may hinder the diagnosis and treatment of the disease, which may be related to poor prognosis.

Second-trimester miscarriage caused by recurrent Klebsiella pneumoniae infection: a case report.

BACKGROUND: Klebsiella pneumoniae (K. pneumoniae) can cause hospital- and community-acquired pneumonia, and urinary tract, wound, and blood infections. As there are few reports on K. pneumoniae infections in pregnancy and no treatment guidelines, diagnosis and treatment are difficult. The diagnosis and treatment require a bacterial culture to confirm the diagnosis. Therefore, the condition is often exacerbated due to a lack of timely medication. CASE DESCRIPTION: We report a case of a pregnant woman with recurrent K. pneumoniae infection during pregnancy. The 40-year-old woman was admitted to hospital at 14 weeks gestation due to fever of unknown origin. She was treated with empiric antibiotics, and her fever resolved within 1 day. A blood culture showed K. pneumoniae infection. She was discharged after 11 days of treatment. However, 10 days later, she was re-hospitalized due to fever, and treated with cefoperazone sodium and sulbactam sodium. Her fever resolved within 1 day. A blood culture again showed K. pneumoniae infection. On day 5, she experienced chills and a miscarriage. Cervical secretions showed K. pneumoniae, and a placental examination revealed chorioamnionitis. The treatment was changed to meropenem, and the patient recovered within 2 weeks. CONCLUSIONS: When a fever of unknown origin occurs during pregnancy, one should be wary of K. pneumoniae recurrence or secondary infection, and use sensitive antibiotics early. When K. pneumoniae is cultivated, the course of treatment must be sufficient, and the source of infection must be actively searched to prevent secondary infections, such as kidney cysts, liver cysts, lung cysts, and community infections. Finding the cause and taking appropriate treatment can prevent the occurrence of adverse pregnancy and childbirth history.