RESEARCH ARTICLE


Appearance of Klebsiella Pneumoniae Liver Abscess Syndrome in Argentina: Case Report and Review of Molecular Mechanisms of Pathogenesis



Andrea Vila 1, *, Andrea Cassata 1, Hugo Pagella 1, Claudio Amadio 2, Kuo-Ming Yeh 3, Feng-Yee Chang 3, L. Kristopher Siu 4
1 Department of Infectious Diseases, Hospital Italiano de Mendoza, Avenida Acceso Este 1070, Guaymallén, Mendoza, Argentina
2 Department of Internal Medicine, Hospital Italiano de Mendoza, Avenida Acceso Este 1070, Guaymallén, Mendoza, Argentina
3 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Sec. 2, Cheng-Kung Rd., Neihu 114, Taipei, Taiwan
4 Division of Infectious Diseases, National Health Research Institute, 35, Keyan Rd., Zhunan, Miaoli County, Taipei, Taiwan


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© Vila et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Barrio Dalvian, manzana 36, casa 10. Mendoza, Argentina (5500); Tel: 54 261 4444470; Fax: 54 261 4444640; E-mail: santander@arlink.net.ar


Abstract

Klebsiella pneumoniae liver abscess syndrome (KLAS) is an emerging invasive infection caused by highly virulent community-acquired strains of K. pneumoniae displaying hypermucoviscosity. The salient features of this syndrome include the presence of bacteremia, primary monomicrobial liver abscess, and metastatic complications. A previously healthy Argentinean man presented with fever and found to have liver abscess caused by K. pneumoniae with metastatic seeding of gastric wall. Cultures from blood and liver abscess grew hypermucoviscous K1 K. pneumoniae with sequence type (ST) 23 by multilocus sequence typing (MLST), positive for rmpA (regulator of mucoid phenotype A), wzyKpK1 (capsular polymerase) and aerobactin genes. The hypermucoviscous phenotype of this K. pneumoniae isolate was readily identified by the "string test" (colonies formed a long string when touched with a loop). The patient responded favourably to percutaneous drainage of the abscess and antibiotics. This is the first documented report of KLAS described in Argentina, and may signal the emergence of this syndrome in South America.

Keywords: Liver abscess Hipermucoviscous Klebsiella pneumoniae, RmpA, MagA.