title: Klebsiella pneumoniae meningitis in a 38-year-old Chinese traveller with impaired glucose tolerance: a new emerging syndrome?
abstract: Early diagnosis and appropriate empirical treatment of bacterial meningitis reduce morbidity and mortality. Prevalence rates of different causative pathogens associated with bacterial meningitis can depend on age, the underlying medical condition, way of infection and geographical distribution. Klebsiella pneumoniae represents an infrequent cause of community-acquired meningitis in South-East Asia and North-East Asia, where it accounts for 20% of all bacterial meningitis, frequently associated with septic metastatic complications. We describe a case of K. pneumoniae meningitis, diplopia and chemosis in a recently immigrated patient with impaired glucose tolerance. The reason for the high prevalence of metastatic septic infections caused by K. pneumoniae in Taiwan and South-East Asia remains unclear: high prevalence in this area of serotype K1 and K2 and the expression of a novel locus called magA conferring to bacterium an elevated phagocytosis resistance and an active proliferation ability have been suggested. A high degree of suspicion for this etiology must be taken into account in immigrants from China and Taiwan. Due to a very high lethality, guidelines on empiric treatment should be considered in the management of bacterial meningitis, with the patients geographical origin and the clinical syndrome (meningitis and endophtalmitis) as potential risk factors for K. pneumoniae infection.
authors.affiliation: Infectious and Tropical Diseases Unit A, Amedeo di Savoia Hospital, Turin, Corso Svizzera 164, 10149 Torino, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Boglione
authors.forename: Claudia
authors.initials: C
authors.lastname: Spezia
authors.forename: Filippo
authors.initials: F
authors.lastname: Lipani
authors.forename: Rosanna
authors.initials: R
authors.lastname: Balbiano
authors.forename: Francesca
authors.initials: F
authors.lastname: Canta
authors.forename: Rosalia
authors.initials: R
authors.lastname: Marrone
authors.forename: Maura
authors.initials: M
authors.lastname: De Agostini
authors.forename: Guido
authors.initials: G
authors.lastname: Calleri
authors.forename: Pietro
authors.initials: P
authors.lastname: Caramello
mesh_terms: D000328:Adult; D002681:China / Q000208:ethnology; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology; D009877:Endophthalmitis / Q000175:diagnosis* / Q000453:epidemiology; D018149:Glucose Intolerance / Q000150:complications; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis* / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity*; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors; D014195:Travel