Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Microbiol Immunol Infect. 2012 Apr;45(2):141-6. doi: 10.1016/j.jmii.2011.12.006. Epub 2012 Mar 21.
Klebsiella pneumoniae liver abscess (KLA) is an emerging infectious disease caused by the virulent K pneumoniae strains of capsular serotype K1 and commonly associated with diabetes mellitus. Recurrent KLA is rarely reported and the mechanism of recurrence is uncertain. In this study we evaluated both phagocytosis by neutrophils and serum killing ability of serum from recurrent K1 KLA patients compared to normal healthy subjects (NHS).
This prospective study included six cases of recurrent K1 KLA consisting of three male and three female patients with a mean age of 67.2 years (range, 56-88 years). The different serotypes of K pneumoniae were reacted with serum from patients with recurrent KLA and NHS. Subsequent phagocytosis by neutrophils was determined using flow cytometry and serum killing assays were performed.
The most common underlying disease in patients with recurrent KLA was diabetes mellitus, occurring in about 83.3% (5/6) of patients. The antibiogram of the strains associated with recurrent KLA remained uniquely resistant to ampicillin. The average percentage derived from the serum killing assays showed serotype K1 and K2 resistance to serum from NHS (1281% and 621%, respectively); however, serum susceptibly was observed in the serum of patients with recurrent K1 KLA (0.3% and 1.1%, respectively). A significant increase in neutrophil phagocytosis of serotype K1 was observed following opsonisation with serum from patients with recurrent KLA compared with serum from NHS (p = 0.008). No significant difference in the phagocytic rate of non-K1/K2 or K2 serotypes was observed between NHS and patients with recurrent KLA (p = 0.76 and p = 0.132, respectively).
These preliminary results showed possible immunologic protection in patients with recurrent KLA due to increasing opsonization and serum killing.
肺炎克雷伯菌肝脓肿（KLA）是一种由荚膜血清型 K1 的毒力肺炎克雷伯菌引起的新兴传染病，通常与糖尿病有关。复发性 KLA 很少见，其复发机制尚不清楚。在这项研究中，我们评估了复发性 K1 KLA 患者的中性粒细胞吞噬作用和血清杀菌能力，并与正常健康受试者（NHS）进行了比较。
这是一项前瞻性研究，共纳入 6 例复发性 K1 KLA 患者，其中男 3 例，女 3 例，平均年龄 67.2 岁（56-88 岁）。不同血清型的肺炎克雷伯菌与复发性 KLA 患者和 NHS 的血清反应。随后通过流式细胞术测定中性粒细胞的吞噬作用，并进行血清杀菌试验。
复发性 KLA 患者最常见的基础疾病是糖尿病，约占 83.3%（5/6）。与复发性 KLA 相关的菌株的抗生素谱仍然对氨苄西林具有独特的耐药性。血清杀菌试验的平均百分比显示，血清型 K1 和 K2 对 NHS 血清具有耐药性（分别为 1281%和 621%）；然而，在复发性 K1 KLA 患者的血清中观察到血清敏感性（分别为 0.3%和 1.1%）。与 NHS 血清相比，经复发性 K1 KLA 患者血清调理后，K1 型中性粒细胞吞噬作用显著增加（p = 0.008）。NHS 和复发性 K1 KLA 患者之间非 K1/K2 或 K2 血清型的吞噬率无显著差异（p = 0.76 和 p = 0.132，分别）。
这些初步结果表明，复发性 KLA 患者可能由于调理和血清杀菌作用增强而产生免疫保护。
