Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2019; 7(22): 3812-3820
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3812
Metastatic infection caused by hypervirulent Klebsiella pneumonia and co-infection with Cryptococcus meningitis: A case report
Yun-Feng Shi, Yu-Kai Wang, Yan-Hong Wang, Hui Liu, Xiao-Han Shi, Xiao-Jie Li, Ben-Quan Wu
Yun-Feng Shi, Yu-Kai Wang, Yan-Hong Wang, Hui Liu, Xiao-Han Shi, Ben-Quan Wu, Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Yun-Feng Shi, Yu-Kai Wang, Yan-Hong Wang, Hui Liu, Xiao-Han Shi, Ben-Quan Wu, Institute of Respiratory Diseases, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Xiao-Jie Li, Department of Laboratory Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Shi YF and Wu BQ analyzed the data, designed the report, and drafted the manuscript; Wang YK collected the data, reviewed the literature, and contributed to manuscript drafting; Wang YH and Liu H made contributions to collect the patient’s clinical data; Shi XH collected the data and revised the manuscript; Li XJ performed the microbiological analyses; Wu BQ was responsible for the revision of the manuscript for important content; All authors approved the final version.
Supported by Science and Technology Planning Project of Guangdong Province of China, No. 2017A020215177.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ben-Quan Wu, PhD, Professor, Director, Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tian He Road, Guangzhou 510630, Guangdong Province, China. zswbq@163.com
Telephone: +86-20-85253479 Fax: +86-20-85252092
Received: May 17, 2019
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
Abstract
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.

Keywords: Hypervirulent Klebsiella pneumoniae; Metastatic infection; Cryptococcus neoformans meningitis; Comorbidity; Case report

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.