Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed

Abstract

A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae has emerged. First described in the Asian Pacific Rim, it now increasingly recognized in Western countries. Defining clinical features are the ability to cause serious, life-threatening community-acquired infection in younger healthy hosts, including liver abscess, pneumonia, meningitis and endophthalmitis and the ability to metastatically spread, an unusual feature for enteric Gram-negative bacilli in the non-immunocompromised. Despite infecting a healthier population, significant morbidity and mortality occurs. Although epidemiologic features are still being defined, colonization, particularly intestinal colonization, appears to be a critical step leading to infection. However the route of entry remains unclear. The majority of cases described to date are in Asians, raising the issue of a genetic predisposition vs. geospecific strain acquisition. The traits that enhance its virulence when compared with "classical" K. pneumoniae are the ability to more efficiently acquire iron and perhaps an increase in capsule production, which confers the hypermucoviscous phenotype. An objective diagnostic test suitable for routine use in the clinical microbiology laboratory is needed. If/when these strains become increasingly resistant to antimicrobials, we will be faced with a frightening clinical scenario.

Keywords: Klebsiella pneumoniae; diagnosis; epidemiology; hypermucoviscous; hypervirulent; infection; pathogenesis; treatment; virulence factors.

Figure 1. Positive “string test” on a hypervirulent strain of K. pneumoniae

Figure 2. Endophthalmitis as the presenting symptom for hypervirulent K. pneumoniae infection in a previously healthy 33-year-old male.