Discussion:
Carl Friedlander discovered Klebsiella pneumoniae from a lung autopsy of a patient who died from pneumonia in 1882, initially named Friedlander’s bacillus. Klebsiella pneumoniae is the most common cause of hospital-acquired pneumonia in the United States, and it also accounts for 3-8% of nosocomial infections (6).
Klebsiella pneumoniae pathogenicity depends not only on host factors like diabetes or chronic alcoholism but also on the bacterial virulence (7). Many virulent factors contribute to the pathogenicity of Klebsiella pneumoniae, virulent factors including hypermucoviscosity-specific capsular antigens – i.e., K1, K2, and virulence genes FimH, rmpA, uge, kfu, and alls. K1/K2 Hypermucovisocus – specific capsular serotypes are associated with invasive infections and usually have a poor prognosis. (7-10).
Metastatic infection can spread to the brain and its meninges resulting in present as focal encephalitis/brain abscess and meningoencephalitis. As in our case patient had multiple micro- abscess in brain secondary Klebsiella pneumoniae metastasis.
In our reported case for embolic klebsiella pneumoniae, the risk factor is uncontrolled DM, which is well described in the literature and quite common in the middle east, therefore, the middle east is a particularly high-risk area for Klebsiella pneumoniae infection, which needs urgent attention. Unfortunately, we could not check capsular antigens which are the other common risk factors.
The prognosis of Klebsiella pneumoniae liver abscess (KLA) is good overall, but the embolic complications can cause significant morbidity (7), as in our case where the patient ended up with severe brain damage. Klebsiella pneumoniae liver abscess with the embolic disease is mainly observed in Asia, particularly in Taiwan, but there are case reports from other geographic regions (11). Appropriate antimicrobial treatment combined with percutaneous drainage of liver abscesses increases chances of survival in such patients. However, the availability of a facility for early detection of the virulent strain will help in early diagnosis and treatment, which will reduce the morbidity and will improve the outcome (12).