Kohler Jonathan E, Hutchens Michael P, Sadow Peter M, Modi Biren P, Tavakkolizadeh Ali, Gates Jonathan D
Department of Surgery, University of Washington, Seattle, WA, USA.
Surg Infect (Larchmt). 2007 Apr;8(2):227-32. doi: 10.1089/sur.2006.007.
Necrotizing fasciitis caused by Klebsiella pneumoniae is rare, with 11 documented cases in the literature, all occurring in Asia and the Middle East. These reports have become more frequent in recent years in association with the emergence of the highly virulent K1 capsular serotype of Klebsiella. We report a case of Klebsiella necrotizing fasciitis and con-current septic arthritis in the Western hemisphere.
Case report and review of the literature.
Our patient, a 50-year-old Cambodian man with advanced hepatitis B-associated cirrhosis, who had last visited an endemic area six months prior to presentation, was hospitalized after several days of left knee and thigh pain. He was hypotensive, tachycardic, and bacteremic with K. pneumoniae. A computed tomography scan showed gas in the tissues of the thigh and left knee joint. Despite aggressive surgical debridement and antibiotic therapy, the patient died on day three. Serotyping of blood, wound, and synovial cultures revealed K1-type K. pneumoniae.
Although K. pneumoniae is common, monomicrobial necrotizing fasciitis and septic arthritis caused by this pathogen has not been reported previously outside Asia, where it is rare. The appearance of this infection in the Western hemisphere may reflect geographic spread of the aggressive K1 phenotype. Physicians treating patients with symptoms and signs of necrotizing fasciitis or septic arthritis, particularly in the setting of underlying chronic illness or recent travel to Asia, should consider K. pneumoniae as a potential cause and treat accordingly.
肺炎克雷伯菌引起的坏死性筋膜炎较为罕见，文献记载的病例有11例，均发生在亚洲和中东地区。近年来，随着高毒力肺炎克雷伯菌K1荚膜血清型的出现，此类报道愈发频繁。我们报告了西半球1例肺炎克雷伯菌坏死性筋膜炎合并脓毒性关节炎的病例。
病例报告及文献复习。
我们的患者是一名50岁的柬埔寨男子，患有晚期乙型肝炎相关性肝硬化，在发病前6个月曾去过流行地区，在出现左膝和大腿疼痛数天后入院。他血压低、心动过速，血培养显示肺炎克雷伯菌阳性。计算机断层扫描显示大腿和左膝关节组织中有气体。尽管积极进行了手术清创和抗生素治疗，患者在第3天死亡。血液、伤口和滑膜培养的血清分型显示为K1型肺炎克雷伯菌。
尽管肺炎克雷伯菌很常见，但此前在亚洲以外地区尚未报道过由该病原体引起的单微生物坏死性筋膜炎和脓毒性关节炎，而在亚洲这种情况也很罕见。这种感染在西半球的出现可能反映了具有侵袭性的K1表型的地理传播。治疗有坏死性筋膜炎或脓毒性关节炎症状和体征的患者时，尤其是在有潜在慢性疾病或近期去过亚洲的情况下，医生应考虑肺炎克雷伯菌作为潜在病因并相应进行治疗。
