Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3812
Peer-review started: May 23, 2019
First decision: September 9, 2019
Revised: September 30, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: November 26, 2019
Processing time: 193 Days and 23.9 Hours
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.
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.
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.
Core tip: Hypervirulent Klebsiella pneumoniae (hvKP) has emerged as a cause of metastatic infections in immunocompetent hosts and presents mainly as a monomicrobial infection. We present a rare case of metastatic infection caused by hvKP and co-infection with Cryptococcus neoformans meningitis. The patient received antibiotics that were sensitive to pathogens in time, and the infection was under control for 1 wk. However, his condition deteriorated rapidly because of metastatic purulent meningitis, and he died of spontaneous respiratory and cardiac arrest caused by cerebral hernia. This case highlights the risk of complications and polymicrobial co-infections in hvKP infected patients. Timely ventricle drainage is strongly recommended for polymicrobial co-infected meningitis.