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[Klebsiella pneumoniae meningitis associated with liver abscess: a case report]
T Yanagawa1, H Nakamura, I Takei
1Department of Internal Medicine, School of Medicine, Keio University.
Abstract:
We report a rare case of Klebsiella pneumoniae meningitis associated with liver abscess, which was successfully treated with cefotaxime (CTX), one of the third-generation cephalosporins. A 53-year-old man was admitted to Keio University Hospital on June 13, 1988, because of a fever and a headache. On June 3, he suddenly started shivering and his temperature rose to 39 degrees C. He then began to complain of polydipsia, polyuria, and a weight loss of 4 kg a week. On June 11, he developed a severe headache. Four years prior to this incident, he had been diagnosed as having diabetes after a routine medical examination, but had neglected to undergo medical treatment. On admission, laboratory data showed leukocytosis, hyperglycemia (394 mg/dl) and ketonuria (4+). A lumbar puncture yielded cloudy cerebrospinal fluid (CSF) containing 500/3 cells/mm8, of which about 70% were neutrophils. A diagnosis of diabetic ketoacidosis and purulent meningitis was made. A treatment with ampicillin (ABPC) and CTX, (12 g/day, each) was begun. On the third day, cultures of a blood specimen and CSF yielded both K. pneumoniae. The MICs of CTX to K. pneumoniae isolated from blood and CSF were both 0.05 microgram/ml. ABPC was discontinued, gentamicin was administered for 2 days, CTX was continued at the same dosage level and an administration of prednisolone 40 mg daily was begun.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
This case study highlights a rare instance of Klebsiella pneumoniae meningitis and liver abscess successfully treated with cefotaxime (CTX). The patient, a diabetic with ketoacidosis, recovered following antibiotic therapy.
Area of Science:
- Infectious Diseases
- Neurology
- Hepatology
Background:
- Klebsiella pneumoniae meningitis is a rare but serious infection, often associated with other comorbidities.
- Diabetes mellitus is a known risk factor for invasive bacterial infections, including K. pneumoniae.
Observation:
- A 53-year-old male with undiagnosed diabetes presented with fever, headache, and symptoms of diabetic ketoacidosis.
- Cerebrospinal fluid analysis revealed purulent meningitis, and blood and CSF cultures identified K. pneumoniae.
Findings:
- The patient was successfully treated with cefotaxime (CTX), a third-generation cephalosporin, demonstrating its efficacy against K. pneumoniae.
- The minimum inhibitory concentration (MIC) of CTX for the isolated K. pneumoniae was low (0.05 microgram/ml).
Implications:
- This case underscores the importance of considering K. pneumoniae in patients with meningitis, especially those with underlying conditions like diabetes.
- Effective management with cefotaxime offers a viable treatment option for this rare but severe infection.