Premathilake P N S, Kularatne W K S, Jayathilake J P K, Senadhira S D N
Department of Medicine, Teaching Hospital Kandy, Kandy, Sri Lanka.
J Med Case Rep. 2018 Dec 13;12(1):367. doi: 10.1186/s13256-018-1924-4.
Liver abscess has formerly been a polymicrobial infection. Currently, liver abscess due to Klebsiella pneumoniae is increasingly reported, predominantly in Southeast Asia for unknown reasons. Liver abscess due to Klebsiella pneumonia has never been previously reported in Sri Lanka.
A 63-year-old Sinhalese man with diabetes mellitus and a poor glycemic control presented with fever, loose stools, and loss of appetite of 1 week's duration. An examination was unremarkable apart from a mild non-tender hepatomegaly. Investigations indicated a septic process with neutrophil leukocytosis, thrombocytopenia, and raised inflammatory markers with acute kidney injury. Sonography of his abdomen revealed a large liver abscess with two blood cultures positive for Klebsiella pneumoniae. He made a complete recovery following aspiration of the abscess and treatment with intravenously administered ceftriaxone.
Liver abscess due to Klebsiella pneumoniae is an emerging infection and most commonly reported from Southeast Asia. In Sri Lanka, further studies are necessary to understand the epidemiology and modes of spread. Furthermore, a high index of suspicion is essential as early detection is the key to successful treatment and prevention of complications.
肝脓肿既往为多微生物感染。目前,肺炎克雷伯菌所致肝脓肿的报道日益增多,主要在东南亚地区,原因不明。斯里兰卡此前从未有过肺炎克雷伯菌所致肝脓肿的报道。
一名63岁的僧伽罗男性,患有糖尿病且血糖控制不佳,出现发热、腹泻和食欲减退1周。检查除轻度无压痛性肝肿大外无异常。检查显示为脓毒症过程,伴有中性粒细胞增多、血小板减少以及炎症标志物升高和急性肾损伤。腹部超声检查发现一个大的肝脓肿,两次血培养肺炎克雷伯菌呈阳性。经脓肿穿刺抽吸及静脉注射头孢曲松治疗后,他完全康复。
肺炎克雷伯菌所致肝脓肿是一种新发感染,最常见于东南亚地区。在斯里兰卡,有必要开展进一步研究以了解其流行病学和传播方式。此外,高度的怀疑指数至关重要,因为早期发现是成功治疗和预防并发症的关键。