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Clinical and phenotypic differences between classic and hypervirulent Klebsiella pneumonia: an emerging and under-recognized pathogenic variant

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Abstract

The purpose of this study was to increase awareness, gain insight into acquisition, and assess the virulence of the hypervirulent (hypermucoviscous) clinical variant (hvKP) that is entrenched in the Pacific Rim but emerging in Western countries. A case of community-acquired liver abscess with metastatic spread to the spleen is described. Comparative in vitro and in vivo virulence studies on this isolate (hvKP1) and four randomly chosen blood isolates of “classic” K. pneumonia strains (cKP1-4) were performed. Cases of hvKP infection are occurring in Western countries and are under-recognized. A hypermucoviscous phenotype is a surrogate laboratory marker for this variant. The propensity of hvKP strains for metastatic spread in non-compromised hosts is both a defining and unusual trait. The mode of acquisition in the described case was unclear but potential means are discussed. hvKP1 was more resistant to complement and neutrophil-mediated bactericidal activity and was more virulent in a rat subcutaneous abscess model than cKP1-4. Recognition of the hypermucoviscous phenotype, defined by a positive “string-test”, will alert the microbiologist or clinician that the infecting strain may be a hvKP, which is hypervirulent compared to cKP. This will improve our understanding of the epidemiology and clinical spectrum of infection, which may be more extensive than appreciated.

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Acknowledgements

We thank the Clinical Microbiology laboratories at Erie County Medical Center and the Veterans Administration Western New York Healthcare System for their sage advice and support. This work was supported in part by the National Institutes of Health grant 1RZ1 AI 088318-01 AI (TAR) and by a Merit Review grant from the Department of Veterans Affairs (TAR).

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Authors and Affiliations

  1. Veterans Administration Western New York Healthcare System, Buffalo, NY, USA

    D. K. Pomakova & T. A. Russo

  2. Department of Medicine, University at Buffalo-State University of New York, Buffalo, NY, USA

    D. K. Pomakova, J. M. Beanan, R. Olson, U. MacDonald & T. A. Russo

  3. Erie County Medical Center, Erie, NY, USA

    C-B. Hsiao

  4. Department of Microbiology and Immunology, University at Buffalo-State University of New York, Buffalo, NY, USA

    C-B. Hsiao & T. A. Russo

  5. The Witebsky Center for Microbial Pathogenesis, University at Buffalo-State University of New York, Buffalo, NY, USA

    J. M. Beanan, R. Olson, U. MacDonald & T. A. Russo

  6. Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada

    Y. Keynan

  7. Department of Medicine, Division of Infectious Diseases, University at Buffalo-State University of New York, 3435 Main St., Biomedical Research Building (Room 141), Buffalo, NY, 14214, USA

    T. A. Russo

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  1. D. K. Pomakova
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  2. C-B. Hsiao
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  7. T. A. Russo
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Correspondence to T. A. Russo.

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Pomakova, D.K., Hsiao, CB., Beanan, J.M. et al. Clinical and phenotypic differences between classic and hypervirulent Klebsiella pneumonia: an emerging and under-recognized pathogenic variant. Eur J Clin Microbiol Infect Dis 31, 981–989 (2012). https://doi.org/10.1007/s10096-011-1396-6

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  • DOI: https://doi.org/10.1007/s10096-011-1396-6

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