Abstract
BackgroundHypervirulent strains of Klebsiella pneumoniae are a recognized cause of a distinct invasive syndrome that results in pyogenic liver abscesses and metastatic complications, particularly in the Asia Pacific region. Reports of hypervirulent K.pneumoniae in Europe, the Americas and Australia indicate worldwide spread. We present a case of multi-focal osteomyelitis, a rarely described complication of hypervirulent K.pneumoniae in the medical literature. The prevalence of this condition in countries outside Asia may be expected to rise with increasing travel.Case presentationA 20-year-old Chinese man residing in Australia for 2 years presented with a 2-week history of gradually worsening leg pain preceded by 2 weeks of constitutional symptoms. Imaging with computerized axial tomography (CT) and other modalities revealed bilateral tibial lesions described as lattice-like linear lucencies involving the cortices with scalloping of the outer involved cortex. Cultures of tissue from a left tibial bone biopsy were positive cultures for K.pneumoniae. Whole-genome sequencing identified the isolate as K1 serotype ST23, a well-recognized hyper virulent strain capable of causing invasive disease. An abdominal CT revealed a 27x22mm liver abscess. The patient had no other metastatic manifestations of the disease, and responded to 6 weeks of intravenous ceftriaxone followed by 3 months of oral Ciprofloxacin.ConclusionsIncreased awareness of the manifestations and subsequent management of hyper virulent strains of K.pneumoniae by clinicians is important to assist early recognition and help minimize serious sequelae. Cases with overseas links, such as previous residence in the Asia Pacific area, are at higher risk for infection with the hyper virulent strain. This case highlights the need for clinicians to be able to recognize this important disease, especially in patients with the right epidemiological links, and to investigate and treat appropriately to prevent severe metastatic complications.
Highlights
Hypervirulent strains of Klebsiella pneumoniae are a recognized cause of a distinct invasive syndrome that results in pyogenic liver abscesses and metastatic complications, in the Asia Pacific region
Hyper virulent strains are a distinct population of K.pneumoniae, causing the well-recognized “invasive syndrome” that results in pyogenic liver abscesses, as well as extrahepatic metastatic infectious manifestations resulting from bacteraemic dissemination [1]
We describe a rare case of bilateral tibial osteomyelitis and liver abscess resulting from infection with hypervirulent K.pneumoniae in a previously healthy Chinese student at our Australian health service
Summary
In an increasingly globalised world, our study highlights the importance of clinician awareness of the manifestations and management of K.pneumoniae hypervirulent strains, even in areas with few described cases. Further testing and prompt evaluation for the hyper virulent strain in the right clinical context is important to reduce the morbidity and mortality This is even more crucial with the emergence of carbapenem resistant strains of hyper virulent K.pneumoniae. Our case contributes to the growing awareness of the unusual manifestations of this serious disease Authors’ contributions BL, JK and BH were involved in microbiological analysis of the initial isolate, antibiotic susceptibility analysis and subsequent genome sequencing of the bacterial strain. Author details 1Department of Infectious Diseases, Barwon Health, Bellarine Street, Geelong, VIC 3220, Australia.
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