Images of Infectious Diseases
2 months after visiting family and friends in Manila:
39M. No PMH. One week of fever, chills, cough, pleuritic chest pain, RUQ pain.
Now complains of blurred vision due to endophthalmitis.
Your DDx? #MayoIDQ and case details to follow…
2 months after visiting family and friends in Manila:
39M. No PMH. One week of fever, chills, cough, pleuritic chest pain, RUQ pain.
Now complains of blurred vision due to endophthalmitis.
Your DDx? #MayoIDQ and case details to follow…
2/
39M. No PMH. HIV-. No IDU.
PE: jaundice, endophthalmitis, no dental issues, b/l rales, new systolic murmur, tender RUQ
WBC 18.3 Alk phos 250.
CT chest / abdomen (photo)
TEE: mitral valve vegetation
Which of the following is the most likely pathogen? #MayoIDQ
39M. No PMH. HIV-. No IDU.
PE: jaundice, endophthalmitis, no dental issues, b/l rales, new systolic murmur, tender RUQ
WBC 18.3 Alk phos 250.
CT chest / abdomen (photo)
TEE: mitral valve vegetation
Which of the following is the most likely pathogen? #MayoIDQ
3/
Let us use this case to highlight clinical pearls about liver abscess:
Two major categories
1. Pyogenic liver abscess
2. Amoebic liver abscess
In this case, there are factors that favor pyogenic liver abscess: endocarditis, septic pulmonary emboli and endophthalmitis
Let us use this case to highlight clinical pearls about liver abscess:
Two major categories
1. Pyogenic liver abscess
2. Amoebic liver abscess
In this case, there are factors that favor pyogenic liver abscess: endocarditis, septic pulmonary emboli and endophthalmitis
4/
Pyogenic liver abscess
1. Almost always bacteria
- Klebsiella (esp. Asian), E. coli
- Streptococcus sp. (milleri group)
- Staphylococcus aureus (endovascular focus or procedure related)
- Anaerobes (polymicrobial cases)
2. Fungi rare (Candida, often in polymicrobial cases)
Pyogenic liver abscess
1. Almost always bacteria
- Klebsiella (esp. Asian), E. coli
- Streptococcus sp. (milleri group)
- Staphylococcus aureus (endovascular focus or procedure related)
- Anaerobes (polymicrobial cases)
2. Fungi rare (Candida, often in polymicrobial cases)
5/
Case diagnosis:
#Klebsiella pneumoniae liver abscess with endocarditis, septic pulmonary emboli, endophthalmitis
K. pneumoniae in liver abscess have a thick mucoid capsule which gives them a hypermucoviscosity phenotype
String test (photo)
doi.org/10.1128/JCM.01…
Case diagnosis:
#Klebsiella pneumoniae liver abscess with endocarditis, septic pulmonary emboli, endophthalmitis
K. pneumoniae in liver abscess have a thick mucoid capsule which gives them a hypermucoviscosity phenotype
String test (photo)
doi.org/10.1128/JCM.01…
6/
#Klebsiella pneumoniae Primary Liver Abscess
#IDDailyPearl
Common cause of pyogenic liver abscess in Asians (most series from Taiwan)
No underlying hepatobiliary disease (but higher association w/ colorectal Ca)
Community acquired
Often solitary and monomicrobial
#Klebsiella pneumoniae Primary Liver Abscess
#IDDailyPearl
Common cause of pyogenic liver abscess in Asians (most series from Taiwan)
No underlying hepatobiliary disease (but higher association w/ colorectal Ca)
Community acquired
Often solitary and monomicrobial
7/
#Klebsiella pneumoniae liver abscess
Complicated in up to 10%, metastatic lesions to organs: endophthalmitis, brain abscess, osteomyelitis / arthritis / psoas abscess / epidural spinal abscess, septic pulmonary embolism, and endocarditis!
doi.org/10.1128/JCM.01…
#Klebsiella pneumoniae liver abscess
Complicated in up to 10%, metastatic lesions to organs: endophthalmitis, brain abscess, osteomyelitis / arthritis / psoas abscess / epidural spinal abscess, septic pulmonary embolism, and endocarditis!
doi.org/10.1128/JCM.01…
8/
#Klebsiella pneumoniae Liver Abscess
Risk Factors
1. Asian
2. Diabetes
3. Prior antibiotics
Clinical:
1. Fever, NV, RUQ pain
2. Leukocytosis
3. Sepsis / metastatic focus
4. Drainage essential / culture guided antibiotic Rx
5. Screen for colorectal CA
10.7759/cureus.970
#Klebsiella pneumoniae Liver Abscess
Risk Factors
1. Asian
2. Diabetes
3. Prior antibiotics
Clinical:
1. Fever, NV, RUQ pain
2. Leukocytosis
3. Sepsis / metastatic focus
4. Drainage essential / culture guided antibiotic Rx
5. Screen for colorectal CA
10.7759/cureus.970
/9
Hypervirulent #Klebsiella pneumoniae
- community onset
- Asia Pacific / global
- metastatic - CNS, endophthalmitis
- hypervirulence plasmid - increase capsule and aerobactin production
- inc. resistance - acquisition of mobile resistance elements
cmr.asm.org/content/32/3/e…
Hypervirulent #Klebsiella pneumoniae
- community onset
- Asia Pacific / global
- metastatic - CNS, endophthalmitis
- hypervirulence plasmid - increase capsule and aerobactin production
- inc. resistance - acquisition of mobile resistance elements
cmr.asm.org/content/32/3/e…
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