Abstract
Pyogenic liver abscess caused by Klebsiella pneumoniae is an emerging disease worldwide, and we know the serotype K1 strain to be the most virulent strain. We report a Japanese case of septic pyogenic liver abscess caused by K. pneumoniae genetic serotype K1. A 60-year old man presented at our hospital in a state of cardiopulmonary arrest. From the patient’s chief complaint of chest pain, we suspected acute coronary syndrome, i.e., acute myocardial infarction. We used extracorporeal circulation and checked coronary angiography, but the 75% stenosis by itself could not adequately account for the patient’s critical condition. The patient’s laboratory data indicated multiple organ failure. The patient’s condition did not improve while in intensive care and he died 20 h after the onset of the cardiopulmonary arrest. Pathological autopsy later showed colliquative necrosis in the deltoid and left greater pectoral muscles, as well as liver abscesses. The patient’s blood, gastric juice, and stool cultures all grew a Gram-negative bacillus identified as Klebsiella pneumoniae. We also performed capsular polysaccharide synthesis (cps) genotyping by polymerase chain reaction for the detection of K serotype-specific alleles at the wzx and wzy loci. The result indicated that wzx-K1 and wzy-K1 were positive. This is the first reported Japanese case of septic pyogenic liver abscess caused by K. pneumoniae genetic serotype K1.
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References
Michel SD. Enterobacteriaceae (chapter 215). In: Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia, Pennsylvania: Elsevier; 2005. p. 2567–2586.
Chang SC, Fang CT, Hsueh PR, Chen YC, Luh KT. Klebsiella pneumoniae isolates causing liver abscess in Taiwan. Diagn Microbiol Infect Dis 2000;37:279–284.
Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med 1991;151:1557–1559.
Fang CT, Chuang YP, Shun CT, Chang SC, Wang JT. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med 2004;199:697–705.
Fang FC, Sandler N, Libby SJ. Liver abscess caused by magA+ Klebsiella pneumoniae in North America. J Clin Microbiol 2005;43:991–992.
Ko WC, Paterson DL, Sagnimeni AJ, Hansen DS, Von Gottberg A, Mohapatra S, et al. Community-acquired Klebsiella pneumoniae bacteremia: global differences in clinical patterns. Emerg Infect Dis 2002;8:160–166.
Lee SS, Chen YS, Tsai HC, Wann SR, Lin HH, Huang CK, et al. Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess. Clin Infect Dis 2008;47:642–650.
Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis 1998:26:1434–1438.
Yang CC, Yen CH, Ho MW, Wang JH. Comparison of pyogenic liver abscess caused by non-Klebsiella pneumoniae and Klebsiella pneumoniae. J Microbiol Immunol Infect 2004;37:176–184.
Chen W, Chen CH, Chiu KL, Lai HC, Liao KF, Ho YJ, et al. Clinical outcome and prognostic factors of patients with pyogenic liver abscess requiring intensive care. Crit Care Med 2008;36:1184–1188.
Chuang YP, Fang CT, Lai SY, Chang SC, Wang JT. Genetic determinants of capsular serotype K1 of Klebsiella pneumoniae causing primary pyogenic liver abscess. J Infect Dis 2006;193:645–654.
Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis 2007;45:284–293.
Fung CP, Chang FY, Lee SC, Hu BS, Kuo BI, Liu CY, et al. A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis? Gut 2002;50:420–424.
Sahly H, Podschun R, Ullmann U. Klebsiella infections in the immunocompromised host. Adv Exp Med Biol 2000;479:237–249.
Dong C, Beis K, Nesper J, Brunkan-Lamontagne AL, Clarke BR, Whitfield C, et al. Wza the translocon for E. coli capsular polysaccharides defines a new class of membrane protein. Nature 2006;444:226–229.
Rahn A, Drummelsmith J, Whitfield C. Conserved organization in the cps gene clusters for expression of Escherichia coli group 1 K antigens: relationship to the colanic acid biosynthesis locus and the cps genes from Klebsiella pneumoniae. J Bacteriol 1999;181:307–313.
Whitfield C. Biosynthesis and assembly of capsular polysaccharides in Escherichia coli. Annu Rev Biochem 2006;75:39–68.
Lin JC, Siu LK, Fung CP, Tsou HH, Wang JJ, Chen CT, et al. Impaired phagocytosis of capsular serotypes K1 or K2 Klebsiella pneumoniae in type 2 diabetes mellitus patients with poor glycemic control. J Clin Endocrinol Metab 2006;91:3084–3087.
Wu MF, Yang CY, Lin TL, Wang JT, Yang FL, Wu SH, et al. Humoral immunity against capsule polysaccharide protects the host from magA+ Klebsiella pneumoniae-induced lethal disease by evading Toll-like receptor 4 signaling. Infect Immun 2009;77:615–621.
Poltrak A, He X, Smirnova I, Liu MY, Van HC, Du X, et al. Defective LPS signaling in C3H/HeJ and C57BL/10ScCr mice: mutations in Tlr4 gene. Science. 1998;282:2085–2088.
Hawkey PM. Prevalence and clonality of extended-spectrum betalactamases in Asia. Clin Microbiol Infect 2008;14Suppl 1:159–165.
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Kohayagawa, Y., Nakao, K., Ushita, M. et al. Pyogenic liver abscess caused by Klebsiella pneumoniae genetic serotype K1 in Japan. J Infect Chemother 15, 248–251 (2009). https://doi.org/10.1007/s10156-009-0695-7
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DOI: https://doi.org/10.1007/s10156-009-0695-7