Klebsiella Pneumoniae necrotizing fasciitis and septic arthritis: An appearance in the western hemisphere

Jonathan E. Kohler, Michael P. Hutchens, Peter M. Sadow, Biren P. Modi, Ali Tavakkolizadeh, Jonathan D. Gates

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Background: Necrotizing fasciitis caused by Klebsiella pneumoniae is rare, with 11 documented cases in the literature, all occurring in Asia and the Middle East. These reports have become more frequent in recent years in association with the emergence of the highly virulent K1 capsular serotype of Klebsiella. We report a case of Klebsiella necrotizing fasciitis and concurrent septic arthritis in the Western hemisphere. Methods: Case report and review of the literature. Results: Our patient, a 50-year-old Cambodian man with advanced hepatitis B-associated cirrhosis, who had last visited an endemic area six months prior to presentation, was hospitalized after several days of left knee and thigh pain. He was hypotensive, tachycardic, and bacteremic with K. pneumoniae. A computed tomography scan showed gas in the tissues of the thigh and left knee joint. Despite aggressive surgical debridement and antibiotic therapy, the patient died on day three. Serotyping of blood, wound, and synovial cultures revealed K1-type K. pneumoniae. Conclusions: Although K. pneumoniae is common, monomicrobial necrotizing fasciitis and septic arthritis caused by this pathogen has not been reported previously outside Asia, where it is rare. The appearance of this infection in the Western hemisphere may reflect geographic spread of the aggressive K1 phenotype. Physicians treating patients with symptoms and signs of necrotizing fasciitis or septic arthritis, particularly in the setting of underlying chronic illness or recent travel to Asia, should consider K. pneumoniae as a potential cause and treat accordingly.

Original languageEnglish (US)
Pages (from-to)227-232
Number of pages6
JournalSurgical Infections
Volume8
Issue number2
DOIs
StatePublished - Apr 1 2007

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

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