Hirai Jun, Sakanashi Daisuke, Momose Masashi, Koga Tomomi, Kinjo Takeshi, Haranaga Shusaku, Motonaga Eiji, Fujita Jiro
Department of Internal Medicine, Okinawa Miyako Hospital, Okinawa 906-0012, Japan.
Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.
Infect Drug Resist. 2020 Jun 10;13:1691-1695. doi: 10.2147/IDR.S252251. eCollection 2020.
Hypervirulent (HV-KP) is typically associated with community-acquired liver abscess and bacteremia with metastatic infection; however, primary lung abscess (PLA) caused by HV-KP is rare, with only one such case report to date. A 69-year-old man with a history of diabetes mellitus (DM) was admitted to hospital complaining of slight bloody sputum. Chest imaging showed multiple consolidations with cavities in both lung fields. A culture of bronchoalveolar lavage fluid confirmed the presence of . Genetic analyses identified the isolate as serotype K2 and sequence type 375 (K2-ST375), and that it harbored the gene. The patient was an Asian middle-aged male with DM, all of which are risk factors for HV-KP infection. Although complicating DM and the presence of the gene are more likely to induce disseminated infection, metastatic infections were not found in this patient. The clinical and microbiological characteristics of our patient were different from those of a previous reported case, although in both cases the patient was from Asia and had DM. Therefore, DM appears to be one of the predisposing factors for HV-KP lung abscesses and physicians should pay attention to emerging HV-KP lung abscess infection, particularly in Asian countries. Previous studies have also revealed that K2-ST375 is one of the major clones causing HV-KP infection, and that it is mainly isolated from patients with liver abscess. Interestingly, including the present case, most of the infectious cases caused by K2-ST375 have been reported from Okinawa Prefecture in Japan. Therefore, the trend of the K2-ST375 strain should be carefully monitored, particularly in Okinawa, Japan. The serotype of HV-KP that causes PLA is still unknown and further study is needed to elucidate the etiology of PLA due to HV-KP and the relationship between the strain K2-ST375 and PLA.
高毒力（HV-KP）通常与社区获得性肝脓肿及伴有转移性感染的菌血症相关；然而，由HV-KP引起的原发性肺脓肿（PLA）较为罕见，迄今为止仅有一例病例报告。一名有糖尿病（DM）病史的69岁男性因主诉轻微咯血入院。胸部影像学显示双肺野多发实变伴空洞。支气管肺泡灌洗 fluid培养证实存在 。基因分析鉴定该分离株为血清型K2及序列型375（K2-ST375），且其携带 基因。该患者为患有DM的亚洲中年男性，所有这些都是HV-KP感染的危险因素。尽管合并DM及存在 基因更易诱发播散性感染，但该患者未发现转移性感染。我们患者的临床和微生物学特征与之前报道的病例不同，尽管两例患者均来自亚洲且患有DM。因此，DM似乎是HV-KP肺脓肿的易感因素之一，医生应关注新出现的HV-KP肺脓肿感染，尤其是在亚洲国家。既往研究还显示，K2-ST375是导致HV-KP感染的主要克隆之一，且主要从肝脓肿患者中分离得到。有趣的是，包括本病例在内，大多数由K2-ST375引起的感染病例均来自日本冲绳县。因此，应仔细监测K2-ST375菌株的流行趋势，尤其是在日本冲绳。引起PLA的HV-KP血清型仍不清楚，需要进一步研究以阐明HV-KP所致PLA的病因及菌株K2-ST375与PLA之间的关系。
