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Community-acquired meningitis caused by a CG86 hypervirulent Klebsiella pneumoniae strain: first case report in the Caribbean.

ABSTRACT: Community-acquired bacterial meningitis due to Klebsiella pneumoniae has mainly been described in Southeast Asia and has a poor prognosis. Severe invasive infections caused by K. pneumoniae, including meningitis, are often due to hypervirulent strains (hvKP), which are characterized by capsular serotypes K1 and K2, a gene responsible for hypermucoviscosity, and the cluster for synthesis of the siderophore aerobactin.A 55 year old man with a history of essential hypertension, benign prostate hyperplasia, hyperlipidemia, obstructive sleep apnea, and chronic alcoholism was admitted for meningitis due to Klebsiella pneumoniae with a wild-type susceptibility profile. Its genomic features were consistent with a capsular K2 strain belonging to clonal group 86 (CG86) displaying the large virulence of Klebsiella plasmid (pLVPK) with heavy metal resistance gene clusters, aerobactin, rmpA.This is the first case of community-acquired meningitis caused by a hypervirulent strain of hvKP ever reported in the Caribbean.

SUBMITTER: Melot B

PROVIDER: S-EPMC5142283 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Community-acquired meningitis caused by a CG86 hypervirulent Klebsiella pneumoniae strain: first case report in the Caribbean.

Melot Bénédicte B Brisse Sylvain S Breurec Sébastien S Passet Virginie V Malpote Edith E Lamaury Isabelle I Thiery Guillaume G Hoen Bruno B

BMC infectious diseases 20161207 1

<h4>Background</h4>Community-acquired bacterial meningitis due to Klebsiella pneumoniae has mainly been described in Southeast Asia and has a poor prognosis. Severe invasive infections caused by K. pneumoniae, including meningitis, are often due to hypervirulent strains (hvKP), which are characterized by capsular serotypes K1 and K2, a gene responsible for hypermucoviscosity, and the cluster for synthesis of the siderophore aerobactin.<h4>Case presentation</h4>A 55 year old man with a history of ...[more]

PMID: 27923372

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Project description:BackgroundKlebsiella pneumoniae is a conditional pathogen related to several infectious diseases. Few studies reported Klebsiella pneumoniae meningitis in the Chinese population, guidelines on diagnosis and treatment of Klebsiella pneumoniae meningitis should be considered due to its high lethality. Here, we report a case of adult intracranial infection caused by extended-spectrum-beta-lactamase (ESBL)-producing hypervirulent Klebsiella pneumoniae (hvKP) in a 65-year-old female, providing new insight for clinical awareness and epidemiological surveillance for ESBL-producing hvKP infection.Case descriptionA 65-year-old female who had a recurrent fever for more than 1 month, and vomiting for 1 week was admitted to our hospital. The computed tomography (CT) results and laboratory results indicated systematic infection, and the blood culture confirmed the infection of Klebsiella pneumoniae. A combination of antibiotics including vancomycin, caspofungin, dexamethasone, and posaconazole oral suspension was given to the patient. Further, she exhibited a convulsion with unconsciousness, the CT revealed lacunar infarction and encephalomalacia. The following physical examination showed slight neck resistance, a weak light response of the eye, low muscle tension, suspicious left Babinski sign (+), and right Babinski sign (-). The CT and cerebrospinal fluid (CSF) analyses confirmed the diagnosis of intracranial infection caused by Klebsiella pneumoniae. We employed CSF microbial metagenomic next-generation sequencing (mNGS) was employed and the results suggested the high sequence of Klebsiella pneumoniae with drug-resistant gene SHV-type beta-lactamases (blaSHV). Subsequently, 2 g meropenem every 8 hours (q8h) prolonged for 3 hours was applied to treat intracranial infection, and her body temperature and infectious manifestations were gradually relieved. The CT results represented that pulmonary edema and pleural effusion were gradually dissipated and absorbed. Based on the improvement of clinical manifestations, the patient was discharged from the hospital and a close follow-up was conducted.ConclusionsAn ESBL-producing strain of hvKP could lead to invasive infection such as severe intracranial infection, with a relatively favorable prognosis. The outcome of the disease caused by Klebsiella pneumoniae infection is firmly related to the phenotypic features, for instance, virulence factors and antibiotic susceptibility. Due to its high lethality, timely empiric anti-infection therapy and close surveillance are necessary for patients with Klebsiella pneumoniae infection in the clinic.

Project description:Distinguishing hypervirulent (hvKp) from classical Klebsiella pneumoniae (cKp) strains is important for clinical care, surveillance, and research. Some combinations of iucA, iroB, peg-344, rmpA, and rmpA2 are most commonly used, but it is unclear what combination of genotypic or phenotypic markers (e.g., siderophore concentration, mucoviscosity) most accurately predicts the hypervirulent phenotype. Furthermore, acquisition of antimicrobial resistance may affect virulence and confound identification. Therefore, 49 K. pneumoniae strains that possessed some combinations of iucA, iroB, peg-344, rmpA, and rmpA2 and had acquired resistance were assembled and categorized as hypervirulent hvKp (hvKp) (N = 16) or cKp (N = 33) via a murine infection model. Biomarker number, siderophore production, mucoviscosity, virulence plasmid's Mash/Jaccard distances to the canonical pLVPK, and Kleborate virulence score were measured and evaluated to accurately differentiate these pathotypes. Both stepwise logistic regression and a CART model were used to determine which variable was most predictive of the strain cohorts. The biomarker count alone was the strongest predictor for both analyses. For logistic regression, the area under the curve for biomarker count was 0.962 (P = 0.004). The CART model generated the classification rule that a biomarker count = 5 would classify the strain as hvKP, resulting in a sensitivity for predicting hvKP of 94% (15/16), a specificity of 94% (31/33), and an overall accuracy of 94% (46/49). Although a count of ≥4 was 100% (16/16) sensitive for predicting hvKP, the specificity and accuracy decreased to 76% (25/33) and 84% (41/49), respectively. These findings can be used to inform the identification of hvKp.IMPORTANCEHypervirulent Klebsiella pneumoniae (hvKp) is a concerning pathogen that can cause life-threatening infections in otherwise healthy individuals. Importantly, although strains of hvKp have been acquiring antimicrobial resistance, the effect on virulence is unclear. Therefore, it is of critical importance to determine whether a given antimicrobial resistant K. pneumoniae isolate is hypervirulent. This report determined which combination of genotypic and phenotypic markers could most accurately identify hvKp strains with acquired resistance. Both logistic regression and a machine-learning prediction model demonstrated that biomarker count alone was the strongest predictor. The presence of all five of the biomarkers iucA, iroB, peg-344, rmpA, and rmpA2 was most accurate (94%); the presence of ≥4 of these biomarkers was most sensitive (100%). Accurately identifying hvKp is vital for surveillance and research, and the availability of biomarker data could alert the clinician that hvKp is a consideration, which, in turn, would assist in optimizing patient care.

Dataset Information

Community-acquired meningitis caused by a CG86 hypervirulent Klebsiella pneumoniae strain: first case report in the Caribbean.

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Community-acquired meningitis caused by a CG86 hypervirulent Klebsiella pneumoniae strain: first case report in the Caribbean.

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