Headache and fever for unknown reasons, it turned out that this bacteria was at work!

*For medical professionals only

Learn about emergency department every day
 

High virulence Klebsiella pneumoniae (HvKP) is a novel variant of Klebsiella pneumoniae
.
Similar to Klebsiella pneumoniae classic, it has the characteristics of strong virulence and easy to spread, mainly causing liver abscess and multi-site invasive infections, including the eye, lungs and central nervous system, etc.
, with a very high
fatality rate.

The following small medicine shares 1 case to deepen everyone's understanding of HvKP, and the emergency department will not panic when encountering such patients!

Brilliant cases

Primary medical history

The patient, male, 44 years old, was admitted to the hospital
with "fever and headache with impaired consciousness for 3d".

The patient has fever and headache without obvious cause 3 days before admission, and the maximum body temperature during the period is about 39 ° C; Drowsiness, unresponsiveness, irritability, no vomiting, no obvious limb convulsions, no urinary and defecation disorders began 2 days before admission, and head CT in the local hospital showed brain tissue swelling;
1D before the emergency department, dehydration, anti-infection and other related treatments, and then due to shallow breathing, blood oxygen saturation decreased, tracheal intubation and ventilator assisted breathing, and hospitalized
.

Physical examination and ancillary examination

The patient was subconsciously blurred in the sedated state, bilateral pupils and other large isocircles, about 1.
5 mm in diameter, the presence of light reflex, the main activity of the extremities visible under painful stimulation, and the residual examination could not be cooperated;
auxiliary examination (only abnormal indicators were listed): white blood cell count 12.
33× 10 9 / L (↑), neutrophil 10.
41× 10⁹ /L (↑) blood biochemistry: random blood glucose 10.
02 mmol/L (↑), hypersensitivity C-reactive protein >320 mg/L (↑), procalcitonin > 100.
00 ng/ml (↑), uric acid 598.
0 μmol / L (↑), interleukin-6 is 362 pg / ml (↑); N-terminal brain natriuretic peptide precursor 3204.
0 pg/ml (↑), hypersensitive cardiac troponin 11688.
3 pg/ml (↑); Coagulation function: fibrinogen 8.
64 g/L (↑).

Image inspection

CT of the skull and chest: low-density foci in the right frontomaroparietal lobe, bilateral cerebral hemisphere brain tissue swelling; Micronodules in the lower lobe of the right lung; Blurred subpleural shadow between the middle lobe of the right lung, considering a little infection; A small amount of fluid in both pleural passages with incomplete expansion of the lower lobes of both lungs
.

CSF bacterial culture + susceptibility: Klebsiella pneumoniae (+), in addition to resistance to ampicillin, is sensitive
to other commonly used antibiotics.

MRI of the skull is shown by pan sweeping + enhancement: bilateral fronto-parietal temporal lobe, right hemiovical center and bilateral radiation crown, basal ganglia, thalamus, and island lobes, increased bilateral brain and cerebellar lepa meninges, bilateral ventricular and ependymal visible enhancement; Swelling of the cerebral tissue of both cerebral hemispheres
.

Diagnosis and treatment

Patients are diagnosed with purulent meningitis (Klebsiella pneumoniae infection), brain abscess, with pulmonary infection, myocardial injury, hypertension, and hyperuricemia
.

During hospitalization, patients received respiratory support, dehydration and cranial pressure lowering, neurotrophic agents, antibiotics, sputum, nutrition, and symptomatic support
.
Anti-infective therapy
with imipenem/cilastin plus tigecycline in combination with susceptibility results.

Although HvKP is extremely virulent and dangerous, HvKP is sensitive to almost all commonly used antibiotics in clinical practice, including three generations of cephalosporins, four generations of cephalosporins, monoamides, carbapenems, quinolones, etc
.

If patients can be treated in a timely and aggressive manner, the prognosis is good and social functioning
is restored.


Where to learn more about emergency care?
What should I do if I receive a patient when I am on duty in the emergency department and cannot find the cause? How to deal with emergencies correctly?
Severe allergic resuscitation, is epinephrine preferred? How is it administered? Where to see the flow chart, processing points, and summary of the most complete emergency drugs?
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References:[1] Zhang Ping, Xu Feng, Liang Qiming, Lian Lifei, Wang Furong.
A case of severe intracranial infection caused by Klebsiella pneumoniae with high virulence[J].
Chinese Journal of Neurology,2022,55(03):229-233.