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. 膿毒性肺栓塞 3 例報告并文獻復習. 國際呼吸雜志, 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. 膿毒癥的現代診斷與治療. 中國呼吸與危重監護雜志, 2009, 8(2): 104-105.
13.	中華醫學會重癥醫學分會. 中國嚴重膿毒癥/膿毒性休克治療指南(2014). 中華內科雜志, 2015, 54(6): 557-581.
14.	吳華, 李東冬, 王京等. 肺炎克雷伯菌肝膿腫的臨床及微生物特征分析. 中華醫學雜志, 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.	李東冬, 沈定霞. 高毒力肺炎克雷伯菌的研究現狀與展望. 中華傳染病雜志, 2014, 32(10):638-640.
18.	李春娜, 胡越凱, 邵凌云, 等. 肺炎克雷伯菌致肝膿腫侵襲綜合征 3 例臨床分析及文獻復習. 微生物與感染, 2016, 11(4):247-251.
19.	劉瑤, 蔣龍鳳, 李軍, 等. 糖尿病合并細菌性肝膿腫的診治進展. 國際流行病學傳染病學雜志, 2016, 43(4): 262-266.
20.	尹大龍, 劉連新. 細菌性肝膿腫診治進展. 中國實用外科雜志, 2013, 33(9):793-795.
21.	戰微微, 蔣天安, 潘農. 肺炎克雷伯桿菌肝膿腫超聲診斷及介入治療價值分析. 浙江醫學, 2007, 29(3):283-284.
22.	陳帆, 張艷亭, 喬慧捷, 等. 肺炎克雷伯菌肝膿腫的臨床特征分析. 臨床肝膽病雜志, 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. 膿毒性肺栓塞 3 例報告并文獻復習. 國際呼吸雜志, 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. 膿毒癥的現代診斷與治療. 中國呼吸與危重監護雜志, 2009, 8(2): 104-105.
13. 中華醫學會重癥醫學分會. 中國嚴重膿毒癥/膿毒性休克治療指南(2014). 中華內科雜志, 2015, 54(6): 557-581.
14. 吳華, 李東冬, 王京等. 肺炎克雷伯菌肝膿腫的臨床及微生物特征分析. 中華醫學雜志, 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. 李東冬, 沈定霞. 高毒力肺炎克雷伯菌的研究現狀與展望. 中華傳染病雜志, 2014, 32(10):638-640.
18. 李春娜, 胡越凱, 邵凌云, 等. 肺炎克雷伯菌致肝膿腫侵襲綜合征 3 例臨床分析及文獻復習. 微生物與感染, 2016, 11(4):247-251.
19. 劉瑤, 蔣龍鳳, 李軍, 等. 糖尿病合并細菌性肝膿腫的診治進展. 國際流行病學傳染病學雜志, 2016, 43(4): 262-266.
20. 尹大龍, 劉連新. 細菌性肝膿腫診治進展. 中國實用外科雜志, 2013, 33(9):793-795.
21. 戰微微, 蔣天安, 潘農. 肺炎克雷伯桿菌肝膿腫超聲診斷及介入治療價值分析. 浙江醫學, 2007, 29(3):283-284.
22. 陳帆, 張艷亭, 喬慧捷, 等. 肺炎克雷伯菌肝膿腫的臨床特征分析. 臨床肝膽病雜志, 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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