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Peculiar purulence: Hypervirulent Klebsiella pneumoniae causing pyomyositis
Okechukwu Mgbemena1, David P Serota2, Sonali Kumar2
1Providence Hospital of North Houston, Houston, TX, United States.
Abstract:
This report describes the first confirmed case of isolated pyomyositis caused by a hypervirulent strain of Klebsiella pneumoniae. Pyomyositis is almost universally caused by gram-positive organisms and while the recent emergence of invasive disease due to hypervirulent K. pneumoniae has been well documented, the most common clinical manifestation reported is liver abscess. The K. pneumoniae isolate in our case had a hypermucousviscous phenotype as demonstrated by a positive string test and was confirmed to be hypervirulent with molecular testing. Documenting the extrahepatic manifestations of hypervirulent Klebsiella pneumoniae strains is important to increase clinical awareness and in guiding empiric antibiotic regimens.
Insights
This study reports the first case of pyomyositis caused by hypervirulent Klebsiella pneumoniae. This finding expands the known clinical manifestations of this dangerous bacterial strain beyond liver abscesses.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Pyomyositis, a bacterial infection of muscle, is typically caused by Gram-positive bacteria.
- Invasive infections due to hypervirulent Klebsiella pneumoniae (hvKP) have emerged, commonly presenting as liver abscesses.
- The spectrum of extrahepatic manifestations of hvKP remains incompletely understood.
Observation:
- This report details the first confirmed case of isolated pyomyositis caused by a hypervirulent Klebsiella pneumoniae strain.
- The identified K. pneumoniae isolate exhibited a hypermucoviscous phenotype, confirmed by a positive string test and molecular analysis.
- The patient presented with pyomyositis, an unusual manifestation for hvKP infections.
Findings:
- Hypervirulent Klebsiella pneumoniae can cause pyomyositis, challenging the traditional understanding of its clinical presentations.
- The hypermucoviscous phenotype is associated with invasive potential beyond hepatic sites.
- This case highlights the need to consider hvKP in the differential diagnosis of pyomyositis.
Implications:
- Increased clinical awareness of hvKP's broader pathogenic potential is crucial.
- Recognition of pyomyositis as an extrahepatic manifestation aids in timely diagnosis and treatment.
- Understanding the diverse clinical presentations informs empiric antibiotic selection for severe Klebsiella pneumoniae infections.