Klebsiella pneumoniae-related brain abscess and meningitis in adults

Abstract Background: Patients with primary brain abscess often present with atypical symptoms, and the outcome is varied. We investigated the demographic, laboratory, and neuroimaging features of patients with brain abscess at our hospital and identified factors associated with their outcome.Methods: We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. Their clinical characteristics, predisposing factors, laboratory and neuroimaging findings, treatment, and outcome were analyzed. Results: Of the 57 patients diagnosed with primary abscess, 51 (89.47%) were older than 40 years and 42 (73.68%) were male. Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. Fourteen patients (24.56%) had comorbidities, of which diabetes mellitus was the most common. Positive pus cultures were obtained in 46.15% of the patients, and gram-negative enteric bacteria were found in 33.33% of them, with Klebsiella pneumoniae being the most frequently observed. Surgical treatment, most commonly in the form of stereotactic drainage, was received by 54.39% of the patients. Good outcomes were achieved in 75.44% of the patients. Multivariate logistic regression analysis showed that patients with headache were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.114–32.407, p = 0.037).Conclusions: Male patients and those older than 40 years were more susceptible to brain abscess than female patients and those younger than 40 years, respectively. Only a few patients showed the classical triad of clinical symptoms. Diabetes mellitus was the most common comorbidity. Positive pus culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. Most patients had a good outcome, and the presence of headache may influence the outcome.

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Klebsiella pneumoniae Brain Abscess and Endophthalmitis after Acute Epiglottitis

Journal of the Korean Neurological Association ◽

10.17340/jkna.2020.2.7 ◽

2020 ◽

Vol 38 (2) ◽

pp. 124-128

Author(s):

Soo Hwan Yim ◽

Yuseok Kim ◽

Jun Yeong Hong ◽

Sang-Jun Na

Keyword(s):

Klebsiella Pneumoniae ◽

Brain Abscess ◽

Rare Case ◽

Endogenous Endophthalmitis ◽

Acute Epiglottitis ◽

Metastatic Infection ◽

Focus Of Infection ◽

Primary Focus

Klebsiella pneumoniae is an unusual cause of brain abscess. Among the few cases of Klebsiella pneumoniae brain abscess that have been reported, most were associated with another underlying primary focus of infection. Endogenous endophthalmitis caused by Klebsiella pneumoniae is an infrequent but often devastating septic metastatic infection. We report a rare case of Klebsiella pneumoniae brain abscess and endophthalmitis after acute epiglottitis.

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Clinical characteristics and outcome of primary brain abscess: a retrospective analysis

BMC Infectious Diseases ◽

10.1186/s12879-021-06947-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Junying Huang ◽

Haining Wu ◽

Honghong Huang ◽

Weiqi Wu ◽

Bowen Wu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Klebsiella Pneumoniae ◽

Brain Abscess ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Multivariate Logistic Regression Analysis ◽

Enteric Bacteria ◽

Focal Neurological Deficit ◽

Gram Negative ◽

Classical Triad

Abstract Background Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. We investigated the demographic, laboratory, and neuroimaging features of patients with brain abscess at our hospital and identified factors associated with their outcomes. Methods We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. Their clinical characteristics, predisposing factors, laboratory and neuroimaging findings, treatment, and outcome were analyzed. Results Of the 57 patients diagnosed with primary abscess, 51 (89.47%) were older than 40 years, and 42 (73.68%) were male. Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. Fifteen patients (26.31%) had comorbidities, of which diabetes mellitus was the most common. Positive intracranial purulent material cultures were obtained in 46.15% of the patients, and gram-negative enteric bacteria were found in 33.33% of them, with Klebsiella pneumoniae being the most frequently observed. Surgical treatment, most commonly in the form of stereotactic drainage, was received by 54.39% of the patients. Good outcomes were achieved in 75.44% of the patients. Multivariate logistic regression analysis showed that patients with headaches were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.114–32.407, p = 0.037). Conclusions Male patients and those older than 40 years were more susceptible to brain abscess than female patients and those younger than 40 years, respectively. Only a few patients showed the classical triad of clinical symptoms. Diabetes mellitus was the most common comorbidity. Positive intracranial specimens’ culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. Most patients had a good outcome, and the presence of headache may influence the outcome.

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Klebsiella pneumoniae Brain Abscess in a Taiwanese Adult

Journal of Infection ◽

10.1053/jinf.2002.0957 ◽

2002 ◽

Vol 44 (3) ◽

pp. 205-206 ◽

Cited By ~ 2

Author(s):

Julio Marcolini ◽

Maria Nguyen ◽

Charles Ericsson

Keyword(s):

Klebsiella Pneumoniae ◽

Brain Abscess

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A k2A-positive Klebsiella pneumoniae causes liver and brain abscess in a Saint Kitt's man

International Journal of Medical Sciences ◽

10.7150/ijms.6.301 ◽

2009 ◽

pp. 301-304 ◽

Cited By ~ 13

Author(s):

Melissa S. Doud ◽

Reni Grimes-Zeppegno ◽

Enrique Molina ◽

Nancimae Miller ◽

Danajeyan Balachandar ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Brain Abscess

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Klebsiella brain abscess in an immunocompetent patient: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02633-0 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Clay Wu ◽

Semi Han ◽

Ahmet Baydur ◽

Brett Lindgren

Keyword(s):

Computed Tomography ◽

Klebsiella Pneumoniae ◽

Brain Abscess ◽

Mental Status ◽

Klebsiella Oxytoca ◽

Brain Magnetic Resonance Imaging ◽

Altered Mental Status ◽

Immunocompetent Patient ◽

Normal Limits ◽

Brain Abscesses

Abstract Background Klebsiella pneumoniae brain abscesses are a rare entity and typically present in immunocompromised patients. We present a case of an overall healthy patient who developed a Klebsiella pneumoniae brain abscess in the absence of liver pathology. Case presentation A 46-year-old Vietnamese man with past medical history significant for hypertension presented to the hospital with acute on chronic worsening of altered mental status, personality changes, and gait dysfunction. Initial vitals revealed temperature of 37.1 °C, heart rate 87 beats/minute, blood pressure 150/87 mmHg, respiratory rate 18/minute, and oxygen saturation 99% on room air. Physical exam was notable for altered mental status, Glasgow Coma Scale (GCS) score of 14, and right lower facial droop. Cardiopulmonary exam was within normal limits. Head computed tomography (CT) showed a left frontotemporal mass, with subsequent brain magnetic resonance imaging (MRI) revealing a ring-enhancing lesion concerning for a brain abscess. The abscess was urgently drained; however, there was intraoperative spillage into the ventricles. Intraoperative cultures grew Klebsiella pneumoniae, and the patient was maintained on appropriate antibiotics. He developed worsening mental status, septic shock, and cerebral edema requiring decompressive left hemicraniectomy. Computed tomography of the abdomen and pelvis revealed no hepatic lesions. The patient did not improve, and the family elected for comfort measures. Conclusion High mortality is associated with Klebsiella pneumoniae (as opposed to Klebsiella oxytoca) brain abscesses, especially in the setting of intraventricular spread. This case illustrates the need for early detection, and an aggressive medical and surgical treatment approach is required for a potential favorable outcome.

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Neonatal Brain Abscess due to Extended-Spectrum Beta-Lactamase Producing Klebsiella pneumoniae

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2014/10160.5198 ◽

2014 ◽

Author(s):

Biswajit Biswas

Keyword(s):

Klebsiella Pneumoniae ◽

Brain Abscess ◽

Beta Lactamase ◽

Neonatal Brain ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

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Klebsiella Pneumoniae-related Brain Abscess and Meningitis in Adults: Case Report and Literature Review

10.21203/rs.3.rs-591081/v1 ◽

2021 ◽

Author(s):

Jingru Zhao ◽

Tiantian Huo ◽

Xintong Luo ◽

Litao Li ◽

Baoming Yang

Keyword(s):

Klebsiella Pneumoniae ◽

Brain Abscess ◽

Imaging Techniques ◽

Sudden Onset ◽

Antimicrobial Treatment ◽

Cns Infection ◽

Klebsiella Species ◽

Common Cause ◽

New Antibiotics ◽

The Right

Abstract Background: Despite the progress of modern neurosurgical techniques, new antibiotics and modern imaging techniques, brain abscess is still a potentially fatal infection. Streptococci have always been the common organisms resulting in brain abscess. Nevertheless, Klebsiella species, once thought to be a less common cause of brain abscess in adults, have become an increasingly important cause of brain abscess, especially in Asia. Case presentation: A 64-year-old woman felt sudden onset severe continuous headache, accompanied by intermittent nausea, vomiting and fever. Meanwhile, she felt tinnitus and had a feeling of swelling in the right ear. Electroencephalogram (EEG) examination showed mild abnormality. A neurological examination revealed obvious nuchal rigidity with four transverse fingers under the chin. Cranial magnetic resonance imaging (MRI) revealed abnormal hyperintensities signals in the left head of caudate nucleus. The cerebral spinal fluid (CSF) common results indicated bacterial infection The next generation sequencing (NGS) of CSF showed the infection of K pneumoniae. The patient was diagnosed with Klebsiella pneumoniae-related brain abscess and meningitis. After positive antimicrobial treatment for nearly two months. The patient got a good recovery.Conclusion: K pneumoniae is once thought to be a less common cause of brain abscess in adults and mainly hospital-acquired. Community-acquired CNS infection (brain abscess and meningitis) caused by K pneumoniae without other metastatic septic abscesses is exceedingly rare. Therefore, we present a rare adult patient with invasive cerebral abscess and meningitis without other invasive abscesses related to K pneumoniae.

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