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Microbes & Immunity

CASE SERIES
Rapid diagnosis of culture-negative Klebsiella

pneumoniae liver abscesses by next-generation
sequencing: A case series

Fanfan Xing 1 , Chaowen Deng 1 , Zhendong Luo 2 , Jing Chen , Simon K. F. Lo ,
2
1
3
Susanna K. P. Lau * , and Patrick C. Y. Woo 3,4,5 *
1 Department of Infectious Diseases and Microbiology, The University of Hong Kong–Shenzhen
Hospital, Shenzhen, Guangdong, China
2 Department of Medical Imaging, The University of Hong Kong–Shenzhen Hospital, Shenzhen,
Guangdong, China
3 Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The
University of Hong Kong, Pokfulam, Hong Kong SAR, China
4 Doctoral Program in Translational Medicine and Department of Life Sciences, National Chung
Hsing University, Taichung, Taiwan
5 The iEGG and Animal Biotechnology Research Center, National Chung Hsing University, Taichung,
Taiwan

Abstract

Diagnosis of Klebsiella pneumoniae (Kp) pyogenic liver abscesses is usually achieved
*Corresponding authors: by imaging and isolation of the bacterium. However, when blood and other
Patrick C. Y. Woo
(pcywoo@hku.hk) cultures were negative, laboratory diagnosis of Kp liver abscess may be challenging.
Susanna K. P. Lau Herein we report two patients with culture-negative Kp liver abscess with atypical
(skplau@hku.hk) presentations diagnosed by metagenomic next-generation sequencing (mNGS). For
Citation: Xing F, Deng C, Luo Z, the first non-diabetic patient, computed tomography examination of the abdomen
et al. Rapid diagnosis of culture- showed multiple round low-density foci with untidy margin in the liver, which
negative Klebsiella pneumoniae mimicked hydatid cysts; while the second patient presented with acute cholecystitis/
liver abscesses by next-generation
sequencing: A case series. cholangitis. mNGS analysis of the blood sample from the first patient revealed 144
Microbes & Immunity. sequence reads of Kp; and that of the second revealed 153 sequence reads of Kp
2024;1(2):94-99. as well as other latent or non-pathogenic microorganisms. Both patients responded
doi: 10.36922/mi.4636
promptly to antibiotics treatment. mNGS is a useful tool for laboratory diagnosis of
Received: August 23, 2024 culture-negative Kp liver abscess.
Accepted: October 23, 2024
Published Online: November 11, Keywords: Klebsiella pneumoniae; Pyogenic liver abscess; Next-generation sequencing;
2024 Rapid diagnosis
Copyright: © 2024 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution, 1. Introduction
and reproduction in any medium,
provided the original work is Traditionally, bacterial pathogens commonly associated with pyogenic liver abscesses
properly cited. include flora of the gastrointestinal tract, such as Escherichia coli and other members
Publisher’s Note: AccScience of the enterobacterales, Enterococcus species, and anaerobes. In the past few decades,
Publishing remains neutral with multiple studies have shown that Klebsiella pneumoniae (Kp) has emerged as the most
regard to jurisdictional claims in 1
published maps and institutional important cause of pyogenic liver abscesses. In Western countries, Kp accounted
2
affiliations. for about a quarter of all cases of pyogenic liver abscesses. In East Asians, such as

Volume 1 Issue 2 (2024) 94 doi: 10.36922/mi.4636