Letter to the Editor
Ann Lab Med 2021; 41(2): 250-254
Published online March 1, 2021 https://doi.org/10.3343/alm.2021.41.2.250
Copyright © Korean Journal of Laboratory Medicine.
Osteomyelitis Caused by Hypervirulent Klebsiella pneumoniae: The First Korean Case With Family Spread
Departments of 1Orthopaedic Surgery, Hanyang University College of Medicine, 2Laboratory Medicine, and 3Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea; 4Department of Laboratory Medicine, Seegene Medical Foundation, Seoul, Korea; 5Department of Laboratory Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
Correspondence to: Jeong Don Chae, M.D.
Department of Laboratory Medicine Nowon Eulji Medical Center, Eulji University, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea
Tel: +82-2-970-8324, Fax: +82-2-970-8534
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
In February 2019, a previously healthy, 60-year-old Korean woman was admitted to a hospital with a three-week history of severe pain in her right thigh. On admission, she was afebrile (37.2°C) but had mild leukocytosis (white blood cell count, 16.9 × 109/L) with elevated C-reactive protein (3.37 mg/L) and procalcitonin (8.3 μg/L) levels. On the second day of admission, magnetic resonance imaging of her right thigh showed increased signal intensity in the quadriceps muscle and femur, with bone edema and fluid collection. On the third day of admission, she had fever of 38.9°C, accompanied by general weakness. After blood and urine cultures were obtained, empirical antibiotic therapy with intravenous tazobactam/piperacillin and vancomycin was initiated. Systemic inflammatory response syndrome (SIRS) was confirmed with leukocytosis (white blood cell count, 30.9 × 109/L; segmented neutrophils, 89.0%), and her respiration rate was 43 breaths/minute. She underwent urgent surgical debridement, and a small abscess with periosteal thickening due to osteomyelitis was observed. Her blood pressure (72/41 mmHg) and oxygen saturation (87%) decreased in the evening. The patient did not recover from SIRS and expired on the fifth day of admission. The urine culture result was found to be positive a day after her death, while two blood culture sets and intraoperative pus culture gave positive results two days after her death. The pathogen was identified as hypermucoviscous
Osteomyelitis in long bones caused by
We characterized the antimicrobial susceptibility of two isolates from the patient’s blood samples and her husband’s stool sample using the VITEK-2 system (BioMérieux, Marcy-l′Étoile, France) and genetic relatedness using capsular typing and multilocus sequence typing. Both isolates were susceptible to all antibiotics except ampicillin, similar to susceptibility patterns reported in China  and the USA . The
Whole-genome sequencing using the MiSeq (Illumina Inc., San Diego, CA, USA) platform and comparative genomic analysis of the two
Figure 1. Characterization of the two
Klebsiella pneumoniaeisolates from the present case. (A) Phylogenetic tree analysis based on tetra-nu-cleotide analysis. (B) Venn diagram of the six clinically associated hypervirulent Klebsiella pneumoniae(hvKp) isolates. Abbreviations: EMC-hvKp-1, blood isolate from the patient; EMC-hvKp-2, stool isolate from the patient’s husband; NTUH-K2044, liver abscess isolate from Taiwan; UTSW Atlanta 01, femoral bone isolate from the USA; ATCC 13883, K. pneumoniaetype strain; 1088, carbapenem-resistant hvKP strain from China; SH-1, carbapenem-resistant K. pneumoniaestrain from China; 5, carbapenem-resistant hvKP strain from China.
In conclusion, HvKp can be a member of the gut microbiome, which likely contributes to its dissemination in communities and hospitals. Microbiologists and clinicians should be more aware of the possible severity of infections caused by this strain of
CHL and HYL obtained clinical background data of the patient and her husband. YHS and JHJ analyzed the data and wrote the manuscript. JDC, WC, and CHL wrote the manuscript. JDC and WC contributed to manuscript revision. All authors have read and approved the final manuscript.
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