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Microbes & Immunity Rare multi-site Klebsiella pneumoniae infections

A B our reports, four of the patients had untreated diabetes
mellitus. In the case involving endophthalmitis, the patient
underwent enucleation of the left eye due to irreversible
vision loss. Unfortunately, the individual with purulent
meningitis succumbed to the condition (Table 1).
For three of the patients, the involvement of unusual
infection sites (the spleen, the psoas major, and
subcutaneous soft tissue/muscle) added complexity to
C D the diagnostic process. Although historically rare, splenic
abscesses have been noted to occur with greater frequency.
A variety of conditions can contribute to splenic abscess or
necrosis, such as endocarditis, advanced syphilis, acquired
immunodeficiency syndrome, typhoid fever, cat scratch
disease, splenic trauma, or undergoing chemotherapy. 18-22
No prior cases of splenic abscess due to KP have been
reported, and in our case, the patient’s history of radiation
Figure 6. Medical presentations of Case 6. (A) Brain magnetic resonance therapy and transcatheter arterial embolization of the
imaging (MRI) findings indicating a brain abscess, (B) brain MRI findings spleen in Case 3 might have played a role in the abscess
indicating endophthalmitis, (C) abdominal computed tomography scan formation. Psoas abscess formation due to KP, particularly
exhibiting a liver abscess, and (D) photograph of the left eye indicating with gas production, is rare but poses a serious threat to
endophthalmitis.
life. Symptoms often include persistent fever with daily
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The administration of meropenem 1 g every 8 h was fluctuations and lower back pain, making timely diagnosis
maintained for 12 days, after which the regimen was difficult due to atypical presentations. Necrotizing fasciitis
switched to moxifloxacin 0.4 g once daily and ceftazidime caused by KP is particularly severe and associated with high
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1 g every 8 h for an additional 10 days. Following a 22-day mortality. The first report of KP as a causative agent of
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hospitalization, the patient was discharged. A telephone necrotizing fasciitis emerged in 1998, sparking significant
follow-up confirmed the patient’s good condition. interest in the medical community. Recent studies have
shown that KP accounts for 16% of necrotizing fasciitis
3. Discussion cases, with a mortality rate of 60% and a diabetes prevalence
of 76% among affected individuals. 26,27 Despite aggressive
The incidence of serious metastatic infections due to treatment, the patient in our study with necrotizing fasciitis
KP is on the rise, particularly among individuals with succumbed rapidly. Elevated blood sugar levels can weaken
compromised immune systems, such as diabetic patients. immune defenses while simultaneously enhancing the
In 1999, Saccente documented a landmark case involving metastatic capabilities of hvKP.
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a diabetic patient with meningitis, a liver abscess, and
endophthalmitis, marking the beginning of increased The adverse outcomes in these patients were primarily
scientific attention toward the metastatic risks posed by attributed to delayed diagnosis and suboptimal treatment.
KP. By 2012, the term “invasive syndrome” was coined While imaging techniques such as CT/enhanced CT and
to describe this phenomenon. Diabetes mellitus has ultrasound are valuable for detecting infections, they lack
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been identified as a significant risk factor for this invasive specificity and cannot provide a definitive diagnosis of the
syndrome, 12,13 with hyperglycemia exacerbating visual pathogen. The traditional gold standard of blood culture for
prognosis in endophthalmitis cases. KP meningitis bloodstream infections is increasingly questioned due to its
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is increasingly recognized as a lethal threat among lengthy process. Metagenomic next-generation sequencing
patients with traumatic brain injuries, those undergoing (mNGS) offers a rapid alternative by identifying nucleic
neurosurgical procedures, and those with weakened acids from a wide array of microorganisms, including
immune defenses. The cognitive impairments and Mycobacterium, bacteria, and fungi, in blood, other bodily
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neurological damage following infection are often severe fluids, and tissues. 28,29 mNGS analyzes microorganisms in
and lasting. Some case reports have demonstrated that the patient samples along with host genetic material (DNA and
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development of KP meningitis and brain abscess may be RNA), removing the host genetic material through specific
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associated with poorly controlled Type 2 diabetes, typically methods to determine pathogenic microorganisms.
occurring in community settings; yet, further validation However, it requires specialized equipment and highly
through randomized controlled trials is lacking. In trained personnel. A combination of diagnostic
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Volume 1 Issue 1 (2024) 116 doi: 10.36922/mi.2600