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A k2A-positive Klebsiella pneumoniae causes liver and brain abscess in a Saint Kitt's man.

Doud MS, Grimes-Zeppegno R, Molina E, Miller N, Balachandar D, Schneper L, Poppiti R, Mathee K - Int J Med Sci (2009)

Bottom Line: Klebsiella pneumoniae isolated in community-acquired pneumonia is increasingly found in primary pyogenic liver abscesses.The K2 serotype has also been strongly associated with hypervirulence.We report the isolation of non-magA, K2 K. pneumoniae strain from a liver abscess of a Saint Kitt's man who survived the invasive syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Biological Sciences, College of Arts and Sciences, Florida International University, Miami, Florida 33199, USA.

ABSTRACT
Klebsiella pneumoniae isolated in community-acquired pneumonia is increasingly found in primary pyogenic liver abscesses. The presence of magA in K. pneumoniae has been implicated in hypermucoviscosity and virulence of liver abscess isolates. The K2 serotype has also been strongly associated with hypervirulence. We report the isolation of non-magA, K2 K. pneumoniae strain from a liver abscess of a Saint Kitt's man who survived the invasive syndrome.

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Related in: MedlinePlus

A and B are computed tomography (CT) scans of the abdomen. (a) Before treatment showing multiple liver abscesses with the largest measuring 3.9 cm. (b) After treatment showing improved resolution. C and D are CT scans of the brain. (c) Nine-days after arrival an additional lesion developed in the left parietal region. (d) After treatment showing improved resolution.
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Figure 1: A and B are computed tomography (CT) scans of the abdomen. (a) Before treatment showing multiple liver abscesses with the largest measuring 3.9 cm. (b) After treatment showing improved resolution. C and D are CT scans of the brain. (c) Nine-days after arrival an additional lesion developed in the left parietal region. (d) After treatment showing improved resolution.

Mentions: On day eight, he was airlifted to Mount Sinai Medical Center, a tertiary care facility in Miami Beach, Florida, for further management. Upon arrival, he was afebrile (T 98.0°F), bradycardic (38 beats per minute), intubated, and unresponsive. Physical examination revealed diffuse rhonchi bilaterally and right upper quadrant tenderness. Endopthalmitis was specifically sought and was not present in this patient. The remainder of the physical examination was unremarkable. Blood cultures drawn at this time were negative. The initial working diagnosis was dengue fever. Subsequently, a computed tomographic (CT) scan of the abdomen revealed multiple liver abscesses with possible necrosis with the largest measuring abscess (Figure 1a). Entamoeba titers were negative. Blood cultures drawn three days after admission grew K. pneumoniae. The susceptibility pattern for the K. pneumoniae was not unusual. It was resistant to ampicillin and intermediate to ampicillin/sulbactam. It was sensitive to the cephalosporins (cefazolin, cefotaxime, and cefepime), the fluoroquinolones (ciprofloxacin, levofloxacin), the aminoglycosides (amikacin, gentamicin, and tobramycin), meropenem, pipercillin/tazobactam and trimethoprim/sulfa. At this point, the patient was started on meropenem. The initial CT scan of the brain done on arrival to Mount Sinai was negative. However, follow-up CT of the brain seven days later showed a 2.7 cm abscess located in the frontal lobe. Two days later an additional lesion developed in the left parietal region (Figure 1c).


A k2A-positive Klebsiella pneumoniae causes liver and brain abscess in a Saint Kitt's man.

Doud MS, Grimes-Zeppegno R, Molina E, Miller N, Balachandar D, Schneper L, Poppiti R, Mathee K - Int J Med Sci (2009)

A and B are computed tomography (CT) scans of the abdomen. (a) Before treatment showing multiple liver abscesses with the largest measuring 3.9 cm. (b) After treatment showing improved resolution. C and D are CT scans of the brain. (c) Nine-days after arrival an additional lesion developed in the left parietal region. (d) After treatment showing improved resolution.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2748272&req=5

Figure 1: A and B are computed tomography (CT) scans of the abdomen. (a) Before treatment showing multiple liver abscesses with the largest measuring 3.9 cm. (b) After treatment showing improved resolution. C and D are CT scans of the brain. (c) Nine-days after arrival an additional lesion developed in the left parietal region. (d) After treatment showing improved resolution.
Mentions: On day eight, he was airlifted to Mount Sinai Medical Center, a tertiary care facility in Miami Beach, Florida, for further management. Upon arrival, he was afebrile (T 98.0°F), bradycardic (38 beats per minute), intubated, and unresponsive. Physical examination revealed diffuse rhonchi bilaterally and right upper quadrant tenderness. Endopthalmitis was specifically sought and was not present in this patient. The remainder of the physical examination was unremarkable. Blood cultures drawn at this time were negative. The initial working diagnosis was dengue fever. Subsequently, a computed tomographic (CT) scan of the abdomen revealed multiple liver abscesses with possible necrosis with the largest measuring abscess (Figure 1a). Entamoeba titers were negative. Blood cultures drawn three days after admission grew K. pneumoniae. The susceptibility pattern for the K. pneumoniae was not unusual. It was resistant to ampicillin and intermediate to ampicillin/sulbactam. It was sensitive to the cephalosporins (cefazolin, cefotaxime, and cefepime), the fluoroquinolones (ciprofloxacin, levofloxacin), the aminoglycosides (amikacin, gentamicin, and tobramycin), meropenem, pipercillin/tazobactam and trimethoprim/sulfa. At this point, the patient was started on meropenem. The initial CT scan of the brain done on arrival to Mount Sinai was negative. However, follow-up CT of the brain seven days later showed a 2.7 cm abscess located in the frontal lobe. Two days later an additional lesion developed in the left parietal region (Figure 1c).

Bottom Line: Klebsiella pneumoniae isolated in community-acquired pneumonia is increasingly found in primary pyogenic liver abscesses.The K2 serotype has also been strongly associated with hypervirulence.We report the isolation of non-magA, K2 K. pneumoniae strain from a liver abscess of a Saint Kitt's man who survived the invasive syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Biological Sciences, College of Arts and Sciences, Florida International University, Miami, Florida 33199, USA.

ABSTRACT
Klebsiella pneumoniae isolated in community-acquired pneumonia is increasingly found in primary pyogenic liver abscesses. The presence of magA in K. pneumoniae has been implicated in hypermucoviscosity and virulence of liver abscess isolates. The K2 serotype has also been strongly associated with hypervirulence. We report the isolation of non-magA, K2 K. pneumoniae strain from a liver abscess of a Saint Kitt's man who survived the invasive syndrome.

Show MeSH
Related in: MedlinePlus