Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report)
Abstract Background Hypervirulent 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...
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-018-3277-4 |
| _version_ | 1818855424373293056 |
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| author | Emma Sturm Alex Tai Belinda Lin Jason Kwong Eugene Athan Benjamin P. Howden Richard D. Angliss Rafik Asaid James Pollard |
| author_facet | Emma Sturm Alex Tai Belinda Lin Jason Kwong Eugene Athan Benjamin P. Howden Richard D. Angliss Rafik Asaid James Pollard |
| author_sort | Emma Sturm |
| collection | DOAJ |
| description | Abstract Background Hypervirulent 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 presentation A 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. Conclusions Increased 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. |
| first_indexed | 2024-12-19T08:08:23Z |
| format | Article |
| id | doaj.art-31a2a075f64a4069a4a2b5fa3f5a0d24 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-19T08:08:23Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-31a2a075f64a4069a4a2b5fa3f5a0d242022-12-21T20:29:42ZengBMCBMC Infectious Diseases1471-23342018-08-011811510.1186/s12879-018-3277-4Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report)Emma Sturm0Alex Tai1Belinda Lin2Jason Kwong3Eugene Athan4Benjamin P. Howden5Richard D. Angliss6Rafik Asaid7James Pollard8Department of Infectious Diseases, Barwon HealthDepartment of Infectious Diseases, Barwon HealthDepartment of Infectious Diseases, Barwon HealthDoherty Applied Microbial Genomics and Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at The Peter Doherty Institute for Infection & ImmunityDepartment of Infectious Diseases, Barwon HealthDoherty Applied Microbial Genomics and Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at The Peter Doherty Institute for Infection & ImmunityDepartment of Orthopaedics, Barwon HealthDepartment of Orthopaedics, Barwon HealthDepartment of Infectious Diseases, Barwon HealthAbstract Background Hypervirulent 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 presentation A 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. Conclusions Increased 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.http://link.springer.com/article/10.1186/s12879-018-3277-4Klebsiella pneumoniaeHypervirulentOsteomyelitisPyogenic liver abscess |
| spellingShingle | Emma Sturm Alex Tai Belinda Lin Jason Kwong Eugene Athan Benjamin P. Howden Richard D. Angliss Rafik Asaid James Pollard Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report) BMC Infectious Diseases Klebsiella pneumoniae Hypervirulent Osteomyelitis Pyogenic liver abscess |
| title | Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report) |
| title_full | Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report) |
| title_fullStr | Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report) |
| title_full_unstemmed | Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report) |
| title_short | Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report) |
| title_sort | bilateral osteomyelitis and liver abscess caused by hypervirulent klebsiella pneumoniae a rare clinical manifestation case report |
| topic | Klebsiella pneumoniae Hypervirulent Osteomyelitis Pyogenic liver abscess |
| url | http://link.springer.com/article/10.1186/s12879-018-3277-4 |
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