Document Detail

Klebsiella pneumoniae necrotizing fasciitis and septic arthritis: an appearance in the Western hemisphere.
MedLine Citation:
PMID:  17437368     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Necrotizing fasciitis caused by Klebsiella pneumoniae is rare, with 11 documented cases in the literature, all occurring in Asia and the Middle East. These reports have become more frequent in recent years in association with the emergence of the highly virulent K1 capsular serotype of Klebsiella. We report a case of Klebsiella necrotizing fasciitis and con-current septic arthritis in the Western hemisphere. METHODS: Case report and review of the literature. RESULTS: Our patient, a 50-year-old Cambodian man with advanced hepatitis B-associated cirrhosis, who had last visited an endemic area six months prior to presentation, was hospitalized after several days of left knee and thigh pain. He was hypotensive, tachycardic, and bacteremic with K. pneumoniae. A computed tomography scan showed gas in the tissues of the thigh and left knee joint. Despite aggressive surgical debridement and antibiotic therapy, the patient died on day three. Serotyping of blood, wound, and synovial cultures revealed K1-type K. pneumoniae. CONCLUSIONS: Although K. pneumoniae is common, monomicrobial necrotizing fasciitis and septic arthritis caused by this pathogen has not been reported previously outside Asia, where it is rare. The appearance of this infection in the Western hemisphere may reflect geographic spread of the aggressive K1 phenotype. Physicians treating patients with symptoms and signs of necrotizing fasciitis or septic arthritis, particularly in the setting of underlying chronic illness or recent travel to Asia, should consider K. pneumoniae as a potential cause and treat accordingly.
Jonathan E Kohler; Michael P Hutchens; Peter M Sadow; Biren P Modi; Ali Tavakkolizadeh; Jonathan D Gates
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Surgical infections     Volume:  8     ISSN:  1096-2964     ISO Abbreviation:  Surg Infect (Larchmt)     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-17     Completed Date:  2007-05-24     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  9815642     Medline TA:  Surg Infect (Larchmt)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  227-32     Citation Subset:  IM    
Department of Surgery, University of Washington, Seattle, WA, USA.
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MeSH Terms
Antigens, Bacterial*
Arthritis, Infectious / microbiology*,  radiography
Bacteremia / microbiology*
Bacterial Capsules
Fasciitis, Necrotizing / microbiology*,  radiography
Fatal Outcome
Klebsiella Infections / epidemiology,  mortality*,  physiopathology
Klebsiella pneumoniae / classification,  pathogenicity*
Middle Aged
Polysaccharides, Bacterial*
Reg. No./Substance:
0/Antigens, Bacterial; 0/Bacterial Capsules; 0/Polysaccharides, Bacterial; 0/capsular polysaccharide K1

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