Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: A case report and genomic characterization of the isolate

Seung Eun Lee; Ammara Mushtaq; Melissa Gitman; Alberto Paniz-Mondolfi; Marilyn Chung; Ajay Obla; Emilia M. Sordillo; Michael D. Nowak; Harm van Bakel; Juan David Ramírez; Marina Muñoz; Mikyung Lee

doi:10.1016/j.idcr.2021.e01173

Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: A case report and genomic characterization of the isolate

Seung Eun Lee, Ammara Mushtaq, Melissa Gitman, Alberto Paniz-Mondolfi, Marilyn Chung, Ajay Obla, Emilia M. Sordillo, Michael D. Nowak, Harm van Bakel, Juan David Ramírez, Marina Muñoz, Mikyung Lee

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Resumen

We describe a case of Lemierre's syndrome (LS) caused by a hypervirulent strain of Klebsiella pneumoniae in a 63-year-old female with hypertension, hyperlipidemia, and diabetes mellitus, who presented with right neck pain and fevers. Computerized tomography of the neck and chest revealed an occluded right internal jugular vein secondary to thrombosis and septic emboli in lungs. Blood cultures grew K. pneumoniae. The patient was treated with ampicillin-sulbactam and then transitioned to amoxicillin-clavulanate to complete a 6-week course of antibiotics, and a 3-month course of rivaroxaban. String test of the K. pneumoniae isolate was positive at 2 cm. Whole genome sequencing identified several genes associated with the hypervirulent strain, notably the genes encoding for aerobactin (iucA and iucB) and salmochelin (iroB) iron acquisition systems. LS can rarely be caused by K. pneumoniae. Clinicians should monitor for known complications, such as septic emboli in patients with LS.

Idioma original	Inglés estadounidense
Número de artículo	e01173
Publicación	IDCases
Volumen	25
DOI	https://doi.org/10.1016/j.idcr.2021.e01173
Estado	Publicada - ene. 2021

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Lee, S. E., Mushtaq, A., Gitman, M., Paniz-Mondolfi, A., Chung, M., Obla, A., Sordillo, E. M., Nowak, M. D., van Bakel, H., Ramírez, J. D., Muñoz, M., & Lee, M. (2021). Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: A case report and genomic characterization of the isolate. IDCases, 25, Artículo e01173. https://doi.org/10.1016/j.idcr.2021.e01173

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title = "Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: A case report and genomic characterization of the isolate",

abstract = "We describe a case of Lemierre's syndrome (LS) caused by a hypervirulent strain of Klebsiella pneumoniae in a 63-year-old female with hypertension, hyperlipidemia, and diabetes mellitus, who presented with right neck pain and fevers. Computerized tomography of the neck and chest revealed an occluded right internal jugular vein secondary to thrombosis and septic emboli in lungs. Blood cultures grew K. pneumoniae. The patient was treated with ampicillin-sulbactam and then transitioned to amoxicillin-clavulanate to complete a 6-week course of antibiotics, and a 3-month course of rivaroxaban. String test of the K. pneumoniae isolate was positive at 2 cm. Whole genome sequencing identified several genes associated with the hypervirulent strain, notably the genes encoding for aerobactin (iucA and iucB) and salmochelin (iroB) iron acquisition systems. LS can rarely be caused by K. pneumoniae. Clinicians should monitor for known complications, such as septic emboli in patients with LS.",

author = "Lee, {Seung Eun} and Ammara Mushtaq and Melissa Gitman and Alberto Paniz-Mondolfi and Marilyn Chung and Ajay Obla and Sordillo, {Emilia M.} and Nowak, {Michael D.} and {van Bakel}, Harm and Ram{\'i}rez, {Juan David} and Marina Mu{\~n}oz and Mikyung Lee",

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doi = "10.1016/j.idcr.2021.e01173",

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AU - Obla, Ajay

AU - Sordillo, Emilia M.

AU - Nowak, Michael D.

AU - van Bakel, Harm

AU - Ramírez, Juan David

AU - Muñoz, Marina

AU - Lee, Mikyung

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N2 - We describe a case of Lemierre's syndrome (LS) caused by a hypervirulent strain of Klebsiella pneumoniae in a 63-year-old female with hypertension, hyperlipidemia, and diabetes mellitus, who presented with right neck pain and fevers. Computerized tomography of the neck and chest revealed an occluded right internal jugular vein secondary to thrombosis and septic emboli in lungs. Blood cultures grew K. pneumoniae. The patient was treated with ampicillin-sulbactam and then transitioned to amoxicillin-clavulanate to complete a 6-week course of antibiotics, and a 3-month course of rivaroxaban. String test of the K. pneumoniae isolate was positive at 2 cm. Whole genome sequencing identified several genes associated with the hypervirulent strain, notably the genes encoding for aerobactin (iucA and iucB) and salmochelin (iroB) iron acquisition systems. LS can rarely be caused by K. pneumoniae. Clinicians should monitor for known complications, such as septic emboli in patients with LS.

AB - We describe a case of Lemierre's syndrome (LS) caused by a hypervirulent strain of Klebsiella pneumoniae in a 63-year-old female with hypertension, hyperlipidemia, and diabetes mellitus, who presented with right neck pain and fevers. Computerized tomography of the neck and chest revealed an occluded right internal jugular vein secondary to thrombosis and septic emboli in lungs. Blood cultures grew K. pneumoniae. The patient was treated with ampicillin-sulbactam and then transitioned to amoxicillin-clavulanate to complete a 6-week course of antibiotics, and a 3-month course of rivaroxaban. String test of the K. pneumoniae isolate was positive at 2 cm. Whole genome sequencing identified several genes associated with the hypervirulent strain, notably the genes encoding for aerobactin (iucA and iucB) and salmochelin (iroB) iron acquisition systems. LS can rarely be caused by K. pneumoniae. Clinicians should monitor for known complications, such as septic emboli in patients with LS.

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Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: A case report and genomic characterization of the isolate

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