高毒力肺炎克雷伯菌致原发性肺炎及脓胸一例并文献复习

Primary Pneumonia and Empyema Caused by Hypervirulent Klebsiella pneumoniae: A Case Report and Literature Review

摘要: 肺炎克雷伯菌(Klebsiella pneumoniae, KP)，是一种临床常见的革兰阴性杆菌，作为肠杆菌科细菌中重要的致病菌可引起社区及医院获得性感染，导致肺炎、肝脓肿、泌尿系统感染以及血流感染等多种感染性疾病。高毒力肺炎克雷伯菌(hypervirulent Klebsiella pneumoniae, hvKP)是肺炎克雷伯菌的新型高毒力变种，其显著特征是高黏液表型。与经典肺炎克雷伯菌(classical Klebsiella pneumoniae, cKP)相比，hvKP毒力更强，而非机会致病菌，多在健康人群中引起社区获得性感染。本文报道了一名老年免疫功能正常的女性患者，因咳嗽咳痰4天，气短伴发热2天入院，通过胸腔积液及血液(bronchoalveolar lavage fluid, BALF)送检宏基因组二代测序(metagenomics Next-Generation Sequencing, mNGS)鉴定出高毒力肺炎克雷伯菌感染，采用输注亚胺培南西司他丁、多粘菌素B控制感染的病例，进一步提高临床对该病的认识。

Abstract: Klebsiella pneumoniae (KP) is a common gram-negative bacillus. As an important pathogen of Enterobacteriaceae bacteria, it can cause community-acquired and hospital-acquired infections, leading to pneumonia, liver abscess, urinary tract infection, bloodstream infection and other infectious diseases. Hypervirulent Klebsiella pneumoniae (hvKP) is a new type of high virulence in Klebsiella pneumoniae variant, and its characteristic is a high slime phenotype. Compared to classical Klebsiella pneumoniae (cKP), hypervirulent Klebsiella pneumoniae (hvKP) exhibits stronger virulence and is not an opportunistic pathogen. Instead, it predominantly causes community-acquired infections in healthy populations. This article reports a case of an elderly female patient with normal immune function who was admitted to the hospital due to intermittent cough with expectoration for 4 days and shortness of breath accompanied by fever for 2 days. Metagenomics Next-Generation Sequencing (mNGS) of pleural effusion and bronchoalveolar lavage fluid (BALF) identified infection with hypervirulent Klebsiella pneumoniae. The infection was controlled with intravenous infusions of imipenem/cilastatin and polymyxin B. This case aims to further enhance clinical awareness of this disease.