Yamamoto Hiroyuki, Iijima Anna, Kawamura Kumiko, Matsuzawa Yasuo, Suzuki Masahiro, Arakawa Yoshichika
Department of Cardiovascular medicine, Narita-Tomisato Tokushukai Hospital, Chiba.
Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Aichi.
Medicine (Baltimore). 2020 May 22;99(21):e20360. doi: 10.1097/MD.0000000000020360.
Invasive community-acquired infections, including pyogenic liver abscesses, caused by hypervirulent Klebsiella pneumoniae (hvKp) strains have been well recognized worldwide. Among these, sporadic hvKp-related community-acquired pneumonia (CAP) is an acute-onset, rapidly progressing disease that can likely turn fatal, if left untreated. However, the clinical diagnosis of hvKp infection remains challenging due to its non-specific symptoms, lack of awareness regarding this disease, and no consensus definition of hvKp.
A 39-year-old man presented with high-grade fever and sudden-onset chest pain. Laboratory testing revealed an elevated white blood cell count of 11,600 cells/μl and C-reactive protein level (>32 mg/dl). A chest X-ray and computed tomography revealed a focal consolidation in the left lower lung field.
Diagnosis of fulminant CAP caused by a hvKp K2-ST86 strain was made based upon multilocus sequencing typing (MLST).
The patient was treated with ampicillin/sulbactam.
The pneumonia became fulminant. Despite intensive care and treatment, he eventually died 15.5 hours after admission.
This is the first case of fatal fulminant CAP caused by a hvKp K2-ST86 strain reported in Japan. MLST was extremely useful for providing a definitive diagnosis for this infection. Thus, we propose that a biomarker-based approach should be considered even for an exploratory diagnosis of CAP related to hvKp infection.
由高毒力肺炎克雷伯菌（hvKp）菌株引起的侵袭性社区获得性感染，包括化脓性肝脓肿，在全球范围内已得到充分认识。其中，散发性hvKp相关社区获得性肺炎（CAP）是一种急性起病、进展迅速的疾病，如果不治疗可能会致命。然而，由于其非特异性症状、对该疾病缺乏认识以及对hvKp没有共识定义，hvKp感染的临床诊断仍然具有挑战性。
一名39岁男性出现高热和突发胸痛。实验室检查显示白细胞计数升高至11,600个/μl，C反应蛋白水平（>32mg/dl）。胸部X线和计算机断层扫描显示左下肺野有局灶性实变。
基于多位点测序分型（MLST）诊断为由hvKp K2-ST86菌株引起的暴发性CAP。
患者接受氨苄西林/舒巴坦治疗。
肺炎发展为暴发性。尽管进行了重症监护和治疗，但他最终在入院15.5小时后死亡。
这是日本报道的首例由hvKp K2-ST86菌株引起的致命性暴发性CAP病例。MLST对于明确诊断这种感染非常有用。因此，我们建议即使对于与hvKp感染相关的CAP的探索性诊断，也应考虑基于生物标志物的方法。
