title: Pyogenic liver abscess caused by Klebsiella pneumoniae genetic serotype K1 in Japan.
abstract: Pyogenic liver abscess caused by Klebsiella pneumoniae is an emerging disease worldwide, and we know the serotype K1 strain to be the most virulent strain. We report a Japanese case of septic pyogenic liver abscess caused by K. pneumoniae genetic serotype K1. A 60-year old man presented at our hospital in a state of cardiopulmonary arrest. From the patient's chief complaint of chest pain, we suspected acute coronary syndrome, i.e., acute myocardial infarction. We used extracorporeal circulation and checked coronary angiography, but the 75% stenosis by itself could not adequately account for the patient's critical condition. The patient's laboratory data indicated multiple organ failure. The patient's condition did not improve while in intensive care and he died 20 h after the onset of the cardiopulmonary arrest. Pathological autopsy later showed colliquative necrosis in the deltoid and left greater pectoral muscles, as well as liver abscesses. The patient's blood, gastric juice, and stool cultures all grew a Gram-negative bacillus identified as Klebsiella pneumoniae. We also performed capsular polysaccharide synthesis (cps) genotyping by polymerase chain reaction for the detection of K serotype-specific alleles at the wzx and wzy loci. The result indicated that wzx_K1 and wzy_K1 were positive. This is the first reported Japanese case of septic pyogenic liver abscess caused by K. pneumoniae genetic serotype K1.
authors.affiliation: Department of Critical Care and Emergency Medicine, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan. kahedon@spch.izumo.shimane.jp
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kohayagawa
authors.forename: Keiko
authors.initials: K
authors.lastname: Nakao
authors.forename: Misuzu
authors.initials: M
authors.lastname: Ushita
authors.forename: Norio
authors.initials: N
authors.lastname: Niino
authors.forename: Masayuki
authors.initials: M
authors.lastname: Koshizaki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamori
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tokuyasu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukushima
mesh_terms: D016470:Bacteremia / Q000150:complications; D017809:Fatal Outcome; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012703:Serotyping