Klebsiella pneumoniae necrotizing fasciitis and septic arthritis: an appearance in the Western hemisphere.
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.
Kohler
Jonathan E
JE
Department of Surgery, University of Washington, Seattle, WA, USA.
Hutchens
Michael P
MP
Sadow
Peter M
PM
Modi
Biren P
BP
Tavakkolizadeh
Ali
A
Gates
Jonathan D
JD
D000942:Antigens, Bacterial; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging / Q000382:microbiology*; D016470:Bacteremia / Q000382:microbiology*; D016667:Bacterial Capsules; D001900:Boston; D002160:Cambodia; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000382:microbiology*; D017809:Fatal Outcome; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000472:pathogenicity*; D008297:Male; D008875:Middle Aged; D011135:Polysaccharides, Bacterial; D011859:Radiography; D014195:Travel
D000942:Antigens, Bacterial; D011135:Polysaccharides, Bacterial; C036962:capsular polysaccharide K1