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A Particularly Severe Diarrhea in Young Infants With Klebsiella spp. Cultured From the Stool: A Case Series
Joanna Mańdziuk1, Dominika Rykowska1, Barbara Saniewska2
1From the Department of Pediatrics With Clinical Assessment Unit.
Insights
Klebsiella bacteria can cause severe diarrhea in infants, challenging the view of them as harmless gut commensals. This study suggests Klebsiella may be a significant pathogen in infantile gastroenteritis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Klebsiella spp. are common gastrointestinal commensals in infants.
- Their role in severe infantile diarrhea is often overlooked, with infections typically dismissed as colonization.
Purpose of the Study:
- To investigate the potential role of Klebsiella spp. as a cause of severe diarrhea in previously healthy infants.
- To highlight a potentially underrecognized pathogen in infantile gastroenteritis.
Main Methods:
- Retrospective analysis of 4 cases of infants under 3 months with severe diarrhea and Klebsiella spp. as the sole identified pathogen.
- Review of additional hospital records to identify similar cases.
- Evaluation of clinical, laboratory features, and treatment outcomes.
Main Results:
- All 4 infants presented with severe watery diarrhea, lethargy, and required intensive care.
- Klebsiella pneumoniae or Klebsiella oxytoca were isolated as the sole pathogens.
- Patients showed elevated inflammatory markers and methemoglobinemia, with symptom improvement after antibiotic treatment.
Conclusions:
- Klebsiella spp. may play a pathogenic role in severe infantile gastroenteritis, particularly in young infants with no other identifiable cause.
- Further research is needed to understand the clinical significance and optimal management of Klebsiella-associated infantile diarrhea.
Background:
Klebsiella spp. are frequently found as commensals of the gastrointestinal tract in infants, and their presence in stool cultures is often dismissed as colonization. However, their role in causing severe diarrhea in previously healthy infants remains unclear.
Methods:
We retrospectively analyzed 4 cases of previously healthy term infants under 3 months of age hospitalized between 2016 and 2024 with unusually severe diarrhea. All had Klebsiella spp. isolated in stool cultures as the sole pathogen. Clinical and laboratory features were evaluated. Additional hospital records from 2020 to 2024 were reviewed to identify other infants with Klebsiella spp. in stool.
Results:
All 4 infants presented with profound watery diarrhea, lethargy and poor general condition, requiring intensive fluid resuscitation. Stool cultures revealed monoculture or abundant growth of Klebsiella pneumoniae (n = 3) or Klebsiella oxytoca (n = 1). No viral or bacterial co-pathogens were identified. All patients had elevated inflammatory markers and methemoglobinemia. Symptoms improved following antibiotic therapy, and hospital stays ranged from 11 to 24 days.
Conclusions:
This case series highlights a potentially underrecognized role of Klebsiella spp. in severe infantile gastroenteritis. In young infants with unusually severe diarrhea and no other identifiable cause, Klebsiella may be pathogenic. These findings support the need for further investigation into its clinical significance and management strategies.
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