Fatal fulminant community-acquired pneumonia caused by hypervirulent Klebsiella pneumoniae K2-ST86
Fatal fulminant community-acquired pneumonia caused by hypervirulent Klebsiella pneumoniae K2-ST86
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DOI：
10.1097/md.0000000000020360
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发表时间：
2020-05
期刊：
影响因子：
1.6
通讯作者：
Hiroyuki Yamamoto;Anna Iijima;K. Kawamura;Y. Matsuzawa;Masahiro Suzuki;Y. Arakawa
中科院分区：
文献类型：
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作者：
Hiroyuki Yamamoto;Anna Iijima;K. Kawamura;Y. Matsuzawa;Masahiro Suzuki;Y. Arakawa
摘要依据：由高毒力肺炎克雷伯菌（hvKp）菌株引起的侵袭性社区获得性感染，包括化脓性肝脓肿，已在全球范围内得到广泛认可。其中，散发性hvKp相关社区获得性肺炎（CAP）是一种急性发作、进展迅速的疾病，如果不及时治疗，可能会致命。然而，hvKp感染的临床诊断仍然具有挑战性，由于其非特异性症状，缺乏对这种疾病的认识，并且没有对hvKp的共识定义。患者问题：一名39岁的男性出现高热和突发性胸痛。实验室检查显示白色血细胞计数升高至11，600个细胞/μl，C反应蛋白水平升高（>32 mg/dl）。胸部X线和计算机断层扫描显示左下肺野局灶性实变。诊断：根据多位点测序分型（MLST）诊断由hvKp K2-ST 86菌株引起的暴发性CAP。干预：患者接受氨苄西林/舒巴坦治疗。结果：肺炎暴发。尽管接受了重症监护和治疗，但他最终在入院后15.5小时死亡。教训：这是日本报告的首例由hvKp K2-ST 86菌株引起的致命暴发性CAP病例。MLST是非常有用的，为这种感染提供了明确的诊断。因此，我们建议，一个生物标志物为基础的方法应考虑即使是探索性诊断CAP相关的hvKp感染。
Abstract Rationale: Invasive community-acquired infections, including pyogenic liver abscesses, caused by hypervirulent Klebsiella pneumoniae (hvKp) strains have been well recognized worldwide. Among these, sporadic hvKp-related community-acquired pneumonia (CAP) is an acute-onset, rapidly progressing disease that can likely turn fatal, if left untreated. However, the clinical diagnosis of hvKp infection remains challenging due to its non-specific symptoms, lack of awareness regarding this disease, and no consensus definition of hvKp. Patient concerns: A 39-year-old man presented with high-grade fever and sudden-onset chest pain. Laboratory testing revealed an elevated white blood cell count of 11,600 cells/μl and C-reactive protein level (>32 mg/dl). A chest X-ray and computed tomography revealed a focal consolidation in the left lower lung field. Diagnosis: Diagnosis of fulminant CAP caused by a hvKp K2-ST86 strain was made based upon multilocus sequencing typing (MLST). Interventions: The patient was treated with ampicillin/sulbactam. Outcomes: The pneumonia became fulminant. Despite intensive care and treatment, he eventually died 15.5 hours after admission. Lessons: This is the first case of fatal fulminant CAP caused by a hvKp K2-ST86 strain reported in Japan. MLST was extremely useful for providing a definitive diagnosis for this infection. Thus, we propose that a biomarker-based approach should be considered even for an exploratory diagnosis of CAP related to hvKp infection.