Hypervirulent Klebsiella pneumoniae

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Hypervirulent Klebsiella pneumoniae
Other names: hvKp[1]
Hypervirulent K. pneumoniae
SpecialtyInfectious disease
SymptomsFevers, chills, abdominal pain, nausea[1] (necrotizing fasciitis[2], liver abscess[2],meningitis,[3] eye infection,[3] bone infection[2])
Diagnostic methodBiomarker[3]
Differential diagnosisClassical Klebsiella pneumoniae[3]
TreatmentCeftazidime/avibactam and meropenem/vaborbactam [4]
FrequencyCommon in Asian Pacific rim (but occurs globally)[5]

Hypervirulent Klebsiella pneumoniae (hvKp) is a evolving global pathogen. Unlike classical Klebsiella pneumoniae (cKp), hvKp is much more virulent and has the ability to cause severe infections in healthy as well as immunocompromised individuals.[3][5]As for treatments ceftazidime/avibactam and meropenem/vaborbactam have been used. [4]

Signs and symptoms

In terms of the presentation of Hypervirulent Klebsiella pneumoniae we find the following:[1]

Complications

As to complications an individual with hvKp could have, we find the following:[3]

Transmission

We find that hvKp is basically transmitted via person to person contact, though it can also occur via contact with contaminated water, or equipment such as ventilators and/or intravenous catheters[6]

Mechanism

In terms of the mechanism of Hypervirulent Klebsiella pneumoniae we find that the reason it is a more virulent form of the classical K. pneumoniae is primarily because of genetic factors present on a large virulence plasmid. Factors include:[3][7][8][9]

  • Increased capsule production- which increases bacterium’s potential to elude the host’s immune system.
  • Siderophore production-which help the bacteria get iron, which is important for growth, as well as infection
  • Hypermucoviscosity- is associated with an ability to cause severe infection
  • Virulence determinants of hypervirulent K. pneumoniae[10]

    Virulence determinants of hypervirulent K. pneumoniae[10]

  • K. pneumoniae virulence factors(classical versus hypervirulent)[11]

    K. pneumoniae virulence factors(classical versus hypervirulent)[11]

In a 2024 paper from Russo, et al it was determined that pVir is the primary genetic determinant that transforms virulence ability of classical K. pneumoniae strains to that of hypervirulent Klebsiella pneumoniae; the plasmid pVir has multiple virulence factors that enhance the bacteriums ability to provoke severe infection[12]

Diagnosis

The diagnosis of hypervirulent Klebsiella pneumoniae involves several methods:[2][13]

  • Clinical presentation
  • Biomarker
Classic K. pneumoniae

Differential diagnosis

The DDx in an affected individually essential consists of classical K. pneumoniae[3]

Treatment

Although the medical literature is limited as to treatment for Hypervirulent Klebsiella pneumoniae ceftazidime/avibactam and meropenem/vaborbactam have been used. [4]

Epidemiology

As to the epidemiology of Hypervirulent Klebsiella pneumoniae we find that it has been reported in 6 WHO regions, with most prevalence in Asia( Taiwan, South Korea, Japan, and China). [5]

In terms of demographic variations we find that in Asia, hvKp tends to affect young, previously healthy individuals more often. Though it affects immunocompromised individuals as well[14]

In terms of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP), we find that while the global Spread of hvKp has been identified in multiple countries, the specific sequence type ST23, which has carbapenemase genes, has been reported in countries like: [15][16]

  • Distribution of hypervirulent and carbapenem-resistant Klebsiella pneumoniae (CR-hvKP) [16]

    Distribution of hypervirulent and carbapenem-resistant Klebsiella pneumoniae (CR-hvKP) [16]

  • Global distribution of hvKp[17]

    Global distribution of hvKp[17]

History

As to the hypervirulent strain of Klebsiella pneumoniae was first reported in 1986 by Liu. The strain was known for having caused severe infections like pneumonia, liver abscess, and meningitis[18]

References

  1. ↑ 1.0 1.1 1.2 Choby, J. E.; Howard-Anderson, J.; Weiss, D. S. (March 2020). "Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives". Journal of internal medicine. 287 (3): 283–300. doi:10.1111/joim.13007. ISSN 0954-6820. Archived from the original on 2023-06-28. Retrieved 2024-09-04.
  2. ↑ 2.0 2.1 2.2 2.3 Harada, Sohei; Doi, Yohei (September 2018). "Hypervirulent Klebsiella pneumoniae: a Call for Consensus Definition and International Collaboration". Journal of Clinical Microbiology. 56 (9). doi:10.1128/JCM.00959-18. ISSN 0095-1137. Archived from the original on 2024-04-05. Retrieved 2024-09-04.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Russo, Thomas A.; Marr, Candace M. (19 June 2019). "Hypervirulent Klebsiella pneumoniae". Clinical Microbiology Reviews. 32 (3). doi:10.1128/CMR.00001-19. ISSN 0893-8512. Archived from the original on 29 November 2023. Retrieved 4 September 2024.
  4. ↑ 4.0 4.1 4.2 Kumar, Sunil; Anwer, Razique; Yadav, Mukesh; Vats, Gourav; Thakur, Shivali; Sehrawat, Nirmala; Kumar, Vikas; Singh, Manoj (1 December 2022). "An Update on Advancements in Treatment Options for Managing Klebsiella pneumoniae Infections". Current Pharmacology Reports. 8 (6): 439–449. doi:10.1007/s40495-022-00302-y. ISSN 2198-641X. Archived from the original on 5 September 2024. Retrieved 4 September 2024.
  5. ↑ 5.0 5.1 5.2 "Antimicrobial Resistance, Hypervirulent Klebsiella pneumoniae - Global situation". www.who.int. Archived from the original on 8 September 2024. Retrieved 4 September 2024.
  6. ↑ "About Klebsiella". Klebsiella. 16 May 2024. Archived from the original on 15 September 2024. Retrieved 18 September 2024.
  7. ↑ Zhu, Jie; Wang, Tao; Chen, Liang; Du, Hong (8 April 2021). "Virulence Factors in Hypervirulent Klebsiella pneumoniae". Frontiers in Microbiology. 12. doi:10.3389/fmicb.2021.642484. ISSN 1664-302X. Archived from the original on 4 June 2024. Retrieved 15 September 2024.
  8. ↑ Marr, Candace M; Russo, Thomas A (February 2019). "Hypervirulent Klebsiella pneumoniae : a new public health threat". Expert Review of Anti-infective Therapy. 17 (2): 71–73. doi:10.1080/14787210.2019.1555470. ISSN 1478-7210. Archived from the original on 2024-09-05. Retrieved 2024-09-04.
  9. ↑ Patel, Payal K.; Russo, Thomas A.; Karchmer, Adolf W. (1 March 2014). "Hypervirulent Klebsiella pneumoniae". Open Forum Infectious Diseases. 1 (1). doi:10.1093/ofid/ofu028. Archived from the original on 18 November 2021. Retrieved 15 September 2024.
  10. ↑ Kocsis, Béla (4 December 2023). "Hypervirulent Klebsiella pneumoniae: An update on epidemiology, detection and antibiotic resistance". Acta Microbiologica et Immunologica Hungarica. 70 (4): 278–287. doi:10.1556/030.2023.02186. ISSN 1217-8950. Archived from the original on 5 September 2024. Retrieved 4 September 2024.
  11. ↑ Arato, Vanessa; Raso, Maria Michelina; Gasperini, Gianmarco; Berlanda Scorza, Francesco; Micoli, Francesca (14 April 2021). "Prophylaxis and Treatment against Klebsiella pneumoniae: Current Insights on This Emerging Anti-Microbial Resistant Global Threat". International Journal of Molecular Sciences. 22 (8): 4042. doi:10.3390/ijms22084042. ISSN 1422-0067. Archived from the original on 13 March 2024. Retrieved 4 September 2024.
  12. ↑ Russo, Thomas A.; Carlino-MacDonald, Ulrike; Drayer, Zachary J.; Davies, Connor J.; Alvarado, Cassandra L.; Hutson, Alan; Luo, Ting L.; Martin, Melissa J.; McGann, Patrick T.; Lebreton, Francois (September 2024). "Deciphering the relative importance of genetic elements in hypervirulent Klebsiella pneumoniae to guide countermeasure development". eBioMedicine. 107: 105302. doi:10.1016/j.ebiom.2024.105302. Archived from the original on 2024-09-20. Retrieved 2024-09-19.
  13. ↑ Liao, Wenjian; Long, Dan; Huang, Qisen; Wei, Dandan; Liu, Xiaobing; Wan, Lagen; Feng, Yuling; Zhang, Wei; Liu, Yang (4 June 2020). "Rapid Detection to Differentiate Hypervirulent Klebsiella pneumoniae (hvKp) From Classical K. pneumoniae by Identifying peg-344 With Loop-Mediated Isothermal Amplication (LAMP)". Frontiers in Microbiology. 11. doi:10.3389/fmicb.2020.01189. ISSN 1664-302X. Archived from the original on 26 September 2024. Retrieved 20 September 2024.
  14. ↑ Lee, Chang-Ro; Lee, Jung Hun; Park, Kwang Seung; Jeon, Jeong Ho; Kim, Young Bae; Cha, Chang-Jun; Jeong, Byeong Chul; Lee, Sang Hee (21 November 2017). "Antimicrobial Resistance of Hypervirulent Klebsiella pneumoniae: Epidemiology, Hypervirulence-Associated Determinants, and Resistance Mechanisms". Frontiers in Cellular and Infection Microbiology. 7. doi:10.3389/fcimb.2017.00483. ISSN 2235-2988. Archived from the original on 17 September 2024. Retrieved 16 September 2024.
  15. ↑ Anderer, Samantha (30 August 2024). "WHO Warns of Carbapenem-Resistant Hypervirulent Klebsiella pneumonia". JAMA. doi:10.1001/jama.2024.15884. ISSN 0098-7484. Archived from the original on 20 September 2024. Retrieved 17 September 2024.
  16. ↑ 16.0 16.1 Lan, Peng; Jiang, Yan; Zhou, Jiancang; Yu, Yunsong (1 June 2021). "A global perspective on the convergence of hypervirulence and carbapenem resistance in Klebsiella pneumoniae". Journal of Global Antimicrobial Resistance. 25: 26–34. doi:10.1016/j.jgar.2021.02.020. ISSN 2213-7165. Archived from the original on 31 October 2023. Retrieved 17 September 2024.
  17. ↑ Abbas, Rim; Chakkour, Mohamed; Zein El Dine, Hiba; Obaseki, Eseiwi Folorunsho; Obeid, Soumaya T.; Jezzini, Aya; Ghssein, Ghassan; Ezzeddine, Zeinab (27 January 2024). "General Overview of Klebsiella pneumonia: Epidemiology and the Role of Siderophores in Its Pathogenicity". Biology. 13 (2): 78. doi:10.3390/biology13020078. ISSN 2079-7737. Archived from the original on 12 September 2024. Retrieved 15 September 2024.
  18. ↑ Chang, De; Sharma, Lokesh; Dela Cruz, Charles S.; Zhang, Dong (22 December 2021). "Clinical Epidemiology, Risk Factors, and Control Strategies of Klebsiella pneumoniae Infection". Frontiers in Microbiology. 12. doi:10.3389/fmicb.2021.750662. ISSN 1664-302X. Archived from the original on 17 September 2024. Retrieved 16 September 2024.

Further reading

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