Primary osteomyelitis caused by hypervirulent Klebsiella pneumoniae

Summary Klebsiella pneumoniae is the most clinically relevant species of this genus, known to cause both community-acquired and nosocomial infections worldwide. In the past two decades, a distinct hypervirulent strain of K pneumoniae , characterised by its hypermucoviscous phenotype, has emerged as...

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Bibliographic Details
Published in:The Lancet infectious diseases 2016-09, Vol.16 (9), p.e190-e195
Main Authors: Prokesch, Bonnie C, Dr, TeKippe, Michael, MD, Kim, Jiwoong, MS, Raj, Prithvi, PhD, TeKippe, Erin McElvania, PhD, Greenberg, David E, MD
Format: Article
Language:English
Subjects:
Abdomen
Alzheimer's disease
Anti-Bacterial Agents - therapeutic use
Antibiotics
Asian Continental Ancestry Group
Diabetes
Genomes
Genotype & phenotype
Hospitals
Humans
Hypertension
Infectious Disease
Infectious diseases
Klebsiella Infections - complications
Klebsiella Infections - drug therapy
Klebsiella pneumoniae
Klebsiella pneumoniae - genetics
Klebsiella pneumoniae - isolation & purification
Klebsiella pneumoniae - pathogenicity
Laboratories
Liver
Male
Medical imaging
Middle Aged
Nosocomial infection
Nosocomial infections
Osteomyelitis - etiology
Pain
Pathogens
Serogroup
Urine
Virulence - genetics
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Summary:Summary Klebsiella pneumoniae is the most clinically relevant species of this genus, known to cause both community-acquired and nosocomial infections worldwide. In the past two decades, a distinct hypervirulent strain of K pneumoniae , characterised by its hypermucoviscous phenotype, has emerged as a clinically significant pathogen responsible for highly invasive infections. We present a case of osteomyelitis due to hypervirulent K pneumoniae reported in the USA. Genomic testing of the K pneumoniae isolate was performed due to the striking clinical presentation of the infection as well as the hypermucoid nature of the isolates, raising the suspicion for possible infection with the hypervirulent strain. Whole-genome sequencing and additional PCR testing demonstrated the isolate to be a K1 serotype, sequence type 23 strain expressing rmpA and rmpA2 . Given the multiple reports of this pathogen causing invasive infections, clinicians should be aware of the possible presentation of metastatic and severe infection, including osteomyelitis, due to the hypervirulent strain of K pneumoniae not typical of classic K pneumoniae variants. In this Grand Round, we review the clinical features of hypervirulent K pneumoniae and its link to invasive infections, and discuss the need for improved awareness and identification of the pathogen.
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(16)30021-4