Hypervirulent Klebsiella pneumoniae - PubMed (original) (raw)

Review

. 2019 May 15;32(3):e00001-19.

doi: 10.1128/CMR.00001-19. Print 2019 Jun 19.

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Review

Hypervirulent Klebsiella pneumoniae

Thomas A Russo et al. Clin Microbiol Rev. 2019.

Abstract

Hypervirulent K. pneumoniae (hvKp) is an evolving pathotype that is more virulent than classical K. pneumoniae (cKp). hvKp usually infects individuals from the community, who are often healthy. Infections are more common in the Asian Pacific Rim but are occurring globally. hvKp infection frequently presents at multiple sites or subsequently metastatically spreads, often requiring source control. hvKp has an increased ability to cause central nervous system infection and endophthalmitis, which require rapid recognition and site-specific treatment. The genetic factors that confer hvKp's hypervirulent phenotype are present on a large virulence plasmid and perhaps integrative conjugal elements. Increased capsule production and aerobactin production are established hvKp-specific virulence factors. Similar to cKp, hvKp strains are becoming increasingly resistant to antimicrobials via acquisition of mobile elements carrying resistance determinants, and new hvKp strains emerge when extensively drug-resistant cKp strains acquire hvKp-specific virulence determinants, resulting in nosocomial infection. Presently, clinical laboratories are unable to differentiate cKp from hvKp, but recently, several biomarkers and quantitative siderophore production have been shown to accurately predict hvKp strains, which could lead to the development of a diagnostic test for use by clinical laboratories for optimal patient care and for use in epidemiologic surveillance and research studies.

Keywords: Friedlander’s bacillus; Klebsiella pneumoniae; abscess; aerobactin; colonization; hypervirulent; infection control; metastatic spread; virulence determinants; virulence plasmid.

Copyright © 2019 American Society for Microbiology.

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Figures

FIG 1

FIG 1

Schematic representation of the hvKp virulence plasmid pLVPK (red circle, 219,385 bp) (83) and pVir-CR-HvKp4 (blue circle, 178,154 bp) (22). The locations of various virulence genes and/or biomarkers are marked.

FIG 2

FIG 2

An image from an abdominal CT scan of a previously healthy 24-year-old Vietnamese man shows a primary liver abscess (red arrow) with metastatic spread to the spleen (black arrow). (Courtesy of Chiu-Bin Hsaio and Diana Pomakova; reprinted with permission from McGraw-Hill Education [353].)

FIG 3

FIG 3

A previously healthy 33-year-old Chinese male presented with endophthalmitis. (Courtesy of Chiu-Bin Hsaio; reprinted with permission from McGraw-Hill Education [353].)

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