Clinical manifestations, computed tomography features, management and prognosis of <i>Klebsiella pneumoniae</i> liver abscess complicated with septic pulmonary embolism _Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WU Changming ,  QIU Yueling , YIN Jiantuan , HUANG Shu , LIN Bingqi

Department of Tuberculosis and Respiratory Disease, Dongnan Hospital of Xiamen University, Zhangzhou, Fujian 363000, P. R. China;

Corresponding author：

QIU Yueling, Email: 2925641244@qq.com

Keywords：

Septic pulmonary embolism; Liver abscess; Klebsiella pneumoniae

DOI：

10.7507/1671-6205.201705012

Video：

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Objective To explore the clinical manifestations, computed tomography features, management and prognosis of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Methods The clinical data of patients with Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism admitted to Dongnan Hospital of Xiamen University from January 2012 to January 2017 were retrospectively analyzed. Results There were 8 patients who had Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Fever occurred in all patients, respiratory symptoms were noted in 5 patients, abdominal pain occurred in 2 patients, endophthalmitis coexisted in 1 patient, and diabetes mellitus coexisted in 7 patients, with no chest pain or hemoptysis. In biochemical indexes, procalcitonin increased most obviously. Microbiological studies revealed Klebsiella pneumoniae in 8 patients. Chest CT showed peripheral nodules with or without cavities, peripheral wedge-shaped opacities, a feeding vessel sign, pleural effusion, and infiltrative shadow. One patient finally deteriorated to acute respiratory failure, and died due to acute respiratory distress syndrome and/or septic shock. There was one case of spontaneous discharge. A total of 6 patients were improved and cured. Conclusions The clinical manifestation of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism is unspecific and misdiagnosis rate is relatively high. The major characteristics of chest CT scan include peripheral nodules with or without cavities, peripheral wedge-shaped opacities and a feeding vessel sign. Diagnosis and differential diagnosis can be made based on these features combined with clinical data and primary disease (liver abscess).

Citation： WU Changming, QIU Yueling, YIN Jiantuan, HUANG Shu, LIN Bingqi. Clinical manifestations, computed tomography features, management and prognosis of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism . Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(6): 599-605. doi: 10.7507/1671-6205.201705012 Copy

1.	Siu LK, Yeh KM, Lin JC, et al. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis, 2012, 12(11):881-887.
2.	Chang Z, Gong Z, Zheng J, et al. Computed tomography features of septic pulmonary embolism caused by Klebsiella pneumoniae liver abscess associated with extrapulmonary metastatic infection. J Comput Assist Tomogr, 2016, 40(3):364-369.
3.	Chou DW, Wu SL, Chung KM, et al. Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses. Clinics, 2015, 70(6):400-407.
4.	Cook RJ, Ashton RW, Aughenbaugh GL, et al. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest, 2005, 128(1):162-166.
5.	Song XY, Li S, Cao J, et al. Cardiac septic pulmonary embolism: a retrospective analysis of 20 cases in a Chinese population. Medicine, 2016, 95(25): e3846.
6.	Liu S, Xie J, Chen Y, et al. Presenting features and clinical course of 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis. Chin Med J,2014, 127(15):2735-2739.
7.	王婉瑜, 曾奕明. 脓毒性肺栓塞 3 例报告并文献复习. 国际呼吸杂志, 2010, 30(10):592-596.
8.	Zenda T, Araki I, Hiraiwa Y, et al. Septic pulmonary emboli secondary to pyogenic liver abscess in a diabetic patient. Intern Med,1995, 34(1):42-45.
9.	Hagiya H, Kuroe Y, Nojima H, et al. Emphysematous liver abscesses complicated by septic pulmonary emboli in patients with diabetes: two cases. Intern Med, 2013, 52(1):141.
10.	Yang PW, Lin HD, Wang LM. Pyogenic liver abscess associated with septic pulmonary embolism. J Chin Med Assoc, 2008, 71(9):442-447.
11.	Cheng DL, Liu YC, Yen MY, et al. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med, 1991, 151(8):1557-1559.
12.	康焰. 脓毒症的现代诊断与治疗. 中国呼吸与危重监护杂志, 2009, 8(2): 104-105.
13.	中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014). 中华内科杂志, 2015, 54(6): 557-581.
14.	吴华, 李东冬, 王京等. 肺炎克雷伯菌肝脓肿的临床及微生物特征分析. 中华医学杂志, 2015, 95(40): 3259-3263.
15.	Liu Y, Li XY, Wan LG, et al. Virulence and transferability of resistance determinants in a noval Klebsiella pneumoniae sequence type 1137 in China. Microb Drug Resist, 2014, 20(2): 150-155.
16.	Lee CJ, Han SY, Lee SW, et al. Clinical features of gas-forming liver abscesses: comparison between diabetic and nondiabetic patients. Korean J Hepatol, 2010, 16(2):131-138.
17.	李东冬, 沈定霞. 高毒力肺炎克雷伯菌的研究现状与展望. 中华传染病杂志, 2014, 32(10):638-640.
18.	李春娜, 胡越凯, 邵凌云, 等. 肺炎克雷伯菌致肝脓肿侵袭综合征 3 例临床分析及文献复习. 微生物与感染, 2016, 11(4):247-251.
19.	刘瑶, 蒋龙凤, 李军, 等. 糖尿病合并细菌性肝脓肿的诊治进展. 国际流行病学传染病学杂志, 2016, 43(4): 262-266.
20.	尹大龙, 刘连新. 细菌性肝脓肿诊治进展. 中国实用外科杂志, 2013, 33(9):793-795.
21.	战微微, 蒋天安, 潘农. 肺炎克雷伯杆菌肝脓肿超声诊断及介入治疗价值分析. 浙江医学, 2007, 29(3):283-284.
22.	陈帆, 张艳亭, 乔慧捷, 等. 肺炎克雷伯菌肝脓肿的临床特征分析. 临床肝胆病杂志, 2016, 32(4):764-768.

1. Siu LK, Yeh KM, Lin JC, et al. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis, 2012, 12(11):881-887.
2. Chang Z, Gong Z, Zheng J, et al. Computed tomography features of septic pulmonary embolism caused by Klebsiella pneumoniae liver abscess associated with extrapulmonary metastatic infection. J Comput Assist Tomogr, 2016, 40(3):364-369.
3. Chou DW, Wu SL, Chung KM, et al. Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses. Clinics, 2015, 70(6):400-407.
4. Cook RJ, Ashton RW, Aughenbaugh GL, et al. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest, 2005, 128(1):162-166.
5. Song XY, Li S, Cao J, et al. Cardiac septic pulmonary embolism: a retrospective analysis of 20 cases in a Chinese population. Medicine, 2016, 95(25): e3846.
6. Liu S, Xie J, Chen Y, et al. Presenting features and clinical course of 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis. Chin Med J,2014, 127(15):2735-2739.
7. 王婉瑜, 曾奕明. 脓毒性肺栓塞 3 例报告并文献复习. 国际呼吸杂志, 2010, 30(10):592-596.
8. Zenda T, Araki I, Hiraiwa Y, et al. Septic pulmonary emboli secondary to pyogenic liver abscess in a diabetic patient. Intern Med,1995, 34(1):42-45.
9. Hagiya H, Kuroe Y, Nojima H, et al. Emphysematous liver abscesses complicated by septic pulmonary emboli in patients with diabetes: two cases. Intern Med, 2013, 52(1):141.
10. Yang PW, Lin HD, Wang LM. Pyogenic liver abscess associated with septic pulmonary embolism. J Chin Med Assoc, 2008, 71(9):442-447.
11. Cheng DL, Liu YC, Yen MY, et al. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med, 1991, 151(8):1557-1559.
12. 康焰. 脓毒症的现代诊断与治疗. 中国呼吸与危重监护杂志, 2009, 8(2): 104-105.
13. 中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014). 中华内科杂志, 2015, 54(6): 557-581.
14. 吴华, 李东冬, 王京等. 肺炎克雷伯菌肝脓肿的临床及微生物特征分析. 中华医学杂志, 2015, 95(40): 3259-3263.
15. Liu Y, Li XY, Wan LG, et al. Virulence and transferability of resistance determinants in a noval Klebsiella pneumoniae sequence type 1137 in China. Microb Drug Resist, 2014, 20(2): 150-155.
16. Lee CJ, Han SY, Lee SW, et al. Clinical features of gas-forming liver abscesses: comparison between diabetic and nondiabetic patients. Korean J Hepatol, 2010, 16(2):131-138.
17. 李东冬, 沈定霞. 高毒力肺炎克雷伯菌的研究现状与展望. 中华传染病杂志, 2014, 32(10):638-640.
18. 李春娜, 胡越凯, 邵凌云, 等. 肺炎克雷伯菌致肝脓肿侵袭综合征 3 例临床分析及文献复习. 微生物与感染, 2016, 11(4):247-251.
19. 刘瑶, 蒋龙凤, 李军, 等. 糖尿病合并细菌性肝脓肿的诊治进展. 国际流行病学传染病学杂志, 2016, 43(4): 262-266.
20. 尹大龙, 刘连新. 细菌性肝脓肿诊治进展. 中国实用外科杂志, 2013, 33(9):793-795.
21. 战微微, 蒋天安, 潘农. 肺炎克雷伯杆菌肝脓肿超声诊断及介入治疗价值分析. 浙江医学, 2007, 29(3):283-284.
22. 陈帆, 张艳亭, 乔慧捷, 等. 肺炎克雷伯菌肝脓肿的临床特征分析. 临床肝胆病杂志, 2016, 32(4):764-768.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical manifestations, computed tomography features, management and prognosis of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism

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