Acute Crit Care.  2021 Nov;36(4):390-394. 10.4266/acc.2021.00010.

The first case of abdominal mycotic aneurysm caused by K1 hypervirulent Klebsiella pneumoniae in a healthy adult

Affiliations
  • 1Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
  • 2Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
  • 3Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea
  • 4Department of Microbiology, Hanyang University College of Medicine, Seoul, Korea

Abstract

Incidence of hypervirulent Klebsiella pneumoniae (hvKp) infection has been steadily increasing in the Asia-Pacific rim. The characteristic of hvKp infection is its ability to cause multiple site infections and unpredictable metastatic spread in the community. We describe the first case of mycotic aneurysm caused by hvKp serotype K1 in a previously healthy man and review the literature. Of a total of 13 cases, including our case, three cases were related to hvKp. Among patients with hvKp, the level of mycotic aneurysm in most patients was the infrarenal aorta, and they underwent an aortic graft or coil embolization. All strains were susceptible to most antimicrobial agents, except ampicillin. Early detection of hvKp can help to prevent the metastatic spread of pathogens and be useful for optimal patient care and epidemiologic research.

Keyword

hypervirulent; liver abscess; metastatic infection; mycotic aneurysm

Figure

  • Figure 1. (A) Low-density lesion in the liver (black arrow) and (B) new aneurysmal dilatation with thrombosis, wall enhancement, and periarterial fatty infiltration in left common iliac artery (white arrow) are observed using enhanced abdominal computed tomography.

  • Figure 2. String test is used to confirm the hypermucoviscosity of Klebsiella pneumoniae isolates recovered from the blood culture. A positive result was defined as the formation of a viscous rope of length >5 mm when a bacterial colony was touched with a loop on the agar plate.


Reference

1. Choby JE, Howard-Anderson J, Weiss DS. Hypervirulent Klebsiella pneumoniae: clinical and molecular perspectives. J Intern Med. 2020; 287:283–300.
2. Harada S, Ishii Y, Saga T, Aoki K, Tateda K. Molecular epidemiology of Klebsiella pneumoniae K1 and K2 isolates in Japan. Diagn Microbiol Infect Dis. 2018; 91:354–9.
Article
3. Hsu PJ, Lee CH, Lee FY, Liu JW. Clinical and microbiological characteristics of mycotic aneurysms in a medical center in southern Taiwan. J Microbiol Immunol Infect. 2008; 41:318–24.
4. Lam MM, Wyres KL, Duchêne S, Wick RR, Judd LM, Gan YH, et al. Population genomics of hypervirulent Klebsiella pneumoniae clonal-group 23 reveals early emergence and rapid global dissemination. Nat Commun. 2018; 9:2703.
Article
5. Russo TA, Marr CM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev. 2019; 15. 3:e00001–19.
Article
6. Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012; 12:881–7.
Article
7. Martin RM, Bachman MA. Colonization, infection, and the accessory genome of Klebsiella pneumoniae. Front Cell Infect Microbiol. 2018; 8:4.
Article
8. Cubero M, Marti S, Domínguez MÁ, González-Díaz A, Berbel D, Ardanuy C. Hypervirulent Klebsiella pneumoniae serotype K1 clinical isolates form robust biofilms at the air-liquid interface. PLoS One. 2019; 14:e0222628.
Article
9. Namikawa H, Yamada K, Fujimoto H, Oinuma KI, Tochino Y, Takemoto Y, et al. Two unusual cases of successful treatment of hypermucoviscous Klebsiella pneumoniae invasive syndrome. BMC Infect Dis. 2016; 16:680.
Article
10. Chen YJ, Chen SY, Wang JT, Hsueh PR. Mycotic aneurysm caused by gas-forming serotype K5 Klebsiella pneumoniae. Int J Infect Dis. 2009; 13:e47–8.
Article
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