BACKGROUND Klebsiella pneumoniae(K.pneumoniae)used to affect mainly people with compromised immunity or weakened by other infections,but recent emergence of hypervirulent strains has increased infections even in healt...BACKGROUND Klebsiella pneumoniae(K.pneumoniae)used to affect mainly people with compromised immunity or weakened by other infections,but recent emergence of hypervirulent strains has increased infections even in healthy individuals.These infections include liver abscess,pneumonia,bacteremia,meningitis,necrotizing fasciitis,and endophthalmitis.Although metastatic infection by hypervirulent K.pneumoniae(hvKP)is increasingly recognized,co-infection with Cryptococcus neoformans(C.neoformans)meningitis in immunocompetent hosts is rare but fatal.So,it is necessary to determine the risk factors,complications,and comorbidity of this disease.CASE SUMMARY This report describes a 58-year-old man with hvKP pulmonary abscess,bacteremia,and meningitis,accompanied by fatal Cryptococcus meningitis.This patient presented with fever for 1 wk and drowsiness for 3 d.Laboratory findings revealed pulmonary abscess and bacteremia of K.pneumoniae.He was given intravenous antibiotic therapy,and the infection was under control for about 1 wk.However,his condition deteriorated rapidly because of metastatic purulent meningitis.Although hvKP and C.neoformans were isolated and confirmed,the patient died of spontaneous respiratory and cardiac arrest caused by cerebral hernia.CONCLUSION HvKP has emerged as a cause of metastatic infections in immunocompetent hosts.polymicrobial co-infections should be taken into consideration when metastatic infection is present.展开更多
The emergence of hypervirulence(hv)and carbapenem resistance(CR)as distinct evolutionary directions for Klebsiella pneumoniae presents a significant threat in clinical settings.However,in recent years,there has been a...The emergence of hypervirulence(hv)and carbapenem resistance(CR)as distinct evolutionary directions for Klebsiella pneumoniae presents a significant threat in clinical settings.However,in recent years,there has been a growing identification of K.pneumoniae strains that integrate both phenotypes,resulting in severe clinical outcomes.Carbapenemresistant hypervirulent K.pneumoniae(CRhvKP)typically emerges through the acquisition of plasmids carrying either virulence or CR-encoded genes by carbapenem-resistant K.pneumoniae or hypervirulent K.pneumoniae.Furthermore,the acquisition of a hybrid plasmid can confer a combination of CR and hv.CRhvKP can cause a variety of infections,including pneumonia,urinary tract infections,bloodstream infections,liver abscesses,and other related conditions.While the sequence type 11(ST11)dominates the majority of CRhvKP strains in China,the molecular factors responsible for the success of ST11 CRhvKP largely remain unknown.Here,we provide an overview of the current understanding of the variation and distribution of crucial virulence determinants,the mechanisms driving the merging of hv and CR,and the potential molecular factors influencing the epidemiological success of ST11 CRhvKP.This research aims to contribute to a comprehensive understanding of the complexities surrounding CRhvKP.It is imperative to underscore the development of combination therapies,precision medicine,and vaccine strategies as pivotal approaches in effectively combating CRhvKP.Considering the widespread prevalence of CRhvKP,a prioritized,multifaceted approach encompassing infection control,active surveillance,and the development of innovative therapeutics is essential.展开更多
基金Supported by Science and Technology Planning Project of Guangdong Province of China,No.2017A020215177
文摘BACKGROUND Klebsiella pneumoniae(K.pneumoniae)used to affect mainly people with compromised immunity or weakened by other infections,but recent emergence of hypervirulent strains has increased infections even in healthy individuals.These infections include liver abscess,pneumonia,bacteremia,meningitis,necrotizing fasciitis,and endophthalmitis.Although metastatic infection by hypervirulent K.pneumoniae(hvKP)is increasingly recognized,co-infection with Cryptococcus neoformans(C.neoformans)meningitis in immunocompetent hosts is rare but fatal.So,it is necessary to determine the risk factors,complications,and comorbidity of this disease.CASE SUMMARY This report describes a 58-year-old man with hvKP pulmonary abscess,bacteremia,and meningitis,accompanied by fatal Cryptococcus meningitis.This patient presented with fever for 1 wk and drowsiness for 3 d.Laboratory findings revealed pulmonary abscess and bacteremia of K.pneumoniae.He was given intravenous antibiotic therapy,and the infection was under control for about 1 wk.However,his condition deteriorated rapidly because of metastatic purulent meningitis.Although hvKP and C.neoformans were isolated and confirmed,the patient died of spontaneous respiratory and cardiac arrest caused by cerebral hernia.CONCLUSION HvKP has emerged as a cause of metastatic infections in immunocompetent hosts.polymicrobial co-infections should be taken into consideration when metastatic infection is present.
基金supported by the National Key Research and Development Program of China(2021YFC2300300)Key Research and Development Program of Zhejiang Province(2021C03068)+1 种基金National Natural Science Foundation of China(81971984 and 82202588)Shandong Provincial Laboratory Project(SYS202202).
文摘The emergence of hypervirulence(hv)and carbapenem resistance(CR)as distinct evolutionary directions for Klebsiella pneumoniae presents a significant threat in clinical settings.However,in recent years,there has been a growing identification of K.pneumoniae strains that integrate both phenotypes,resulting in severe clinical outcomes.Carbapenemresistant hypervirulent K.pneumoniae(CRhvKP)typically emerges through the acquisition of plasmids carrying either virulence or CR-encoded genes by carbapenem-resistant K.pneumoniae or hypervirulent K.pneumoniae.Furthermore,the acquisition of a hybrid plasmid can confer a combination of CR and hv.CRhvKP can cause a variety of infections,including pneumonia,urinary tract infections,bloodstream infections,liver abscesses,and other related conditions.While the sequence type 11(ST11)dominates the majority of CRhvKP strains in China,the molecular factors responsible for the success of ST11 CRhvKP largely remain unknown.Here,we provide an overview of the current understanding of the variation and distribution of crucial virulence determinants,the mechanisms driving the merging of hv and CR,and the potential molecular factors influencing the epidemiological success of ST11 CRhvKP.This research aims to contribute to a comprehensive understanding of the complexities surrounding CRhvKP.It is imperative to underscore the development of combination therapies,precision medicine,and vaccine strategies as pivotal approaches in effectively combating CRhvKP.Considering the widespread prevalence of CRhvKP,a prioritized,multifaceted approach encompassing infection control,active surveillance,and the development of innovative therapeutics is essential.
