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  Table of Contents    
CASE REPORT  
Year : 2014  |  Volume : 57  |  Issue : 1  |  Page : 139-140
Fatal Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen's disease


Department of Microbiology, Sri Manakula Vinayagar Medical College & Hospital, Puducherry, India

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Date of Web Publication17-Apr-2014
 

   Abstract 

Klebsiella is a Gram-negative bacterium that causes different types of health care-associated infections including pneumonia, bloodstream infections, surgical site infections and meningitis. We report here a case of Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen's disease. A middle-aged man with a known case of diabetes mellitus and Hansen's disease presented with the complaints of blurred vision in the left eye and the patient was found to have cataract. Patient was operated for cataract and Intraocular lens implanted. Patient developed headache and vomiting on the 4 th post-operative day. Lumbar puncture was carried out and gram stain of cerebrospinal fluid showed Gram-negative bacilli in the direct smear and culture yielded a heavy growth of K. pneumoniae. The patient was treated with antimicrobials according to the susceptibility pattern. He initially showed improvement but later on developed altered sensorium and hypotension. Patient succumbed to infection in spite of all medical attention.

Keywords: Diabetes, Hansen′s, Klebsiella pneumoniae meningitis

How to cite this article:
Gopal V, Mangaiyarkarasi T, Gopal R. Fatal Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen's disease. Indian J Pathol Microbiol 2014;57:139-40

How to cite this URL:
Gopal V, Mangaiyarkarasi T, Gopal R. Fatal Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen's disease. Indian J Pathol Microbiol [serial online] 2014 [cited 2019 Jul 17];57:139-40. Available from: http://www.ijpmonline.org/text.asp?2014/57/1/139/130927



   Introduction Top


Bacterial meningitis is a life-threatening illness that requires early diagnosis and treatment. [1] Klebsiella is a Gram-negative bacterium that causes different types of healthcare-associated infections including pneumonia, bloodstream infection, surgical site infections and meningitis. [2] We report here a case of Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen's disease.


   Case Report Top


The present case report is about a 34-year-old male patient who was presented with blurred vision in the left eye. Patient was found to have intumescent cataract and was planned for cataract surgery. Pre-operative routine blood investigations were normal. Extracapsular cataract extraction with intraocular lens implantation was performed without any complications. During the post-operative stay, patient developed sweating, giddiness and headache on 4 th day. On physical examination, blood pressure was 150/98 mmHg, pulse rate-150/min, neck rigidity was present and Kernig's sign was positive. Computed tomography scan of the brain was normal. Cerebrospinal fluid (CSF) analysis revealed a cell count of more than 10,000 cells/cu.mm and gram staining showed plenty of pus cells and short stout capsulated Gram negative bacilli [Figure 1]. Ziehl Neelsen staining showed no acid fast bacilli. CSF culture showed heavy growth of K. pneumoniae [Figure 2] which was found to be sensitive to ceftriaxone, amikacin, gentamicin and imipenem. Blood culture also showed the same results. The patient was initially treated with intravenous ceftriaxone empirically and amikacin was added after susceptibility testing. Patient initially responded to treatment but later, on the 20 th post-operative day the patient's condition deteriorated. Patient was intubated and put on a ventilator. Patient succumbed to infection in spite of all active measures taken.
Figure 1: Gram staining of cerebrospinal fluid direct smear

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Figure 2: Gram staining of cerebrospinal fluid culture smear

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   Discussion Top


Bacterial meningitis is associated with a high rate of morbidity and mortality despite the availability of new antibiotics and improvement in clinical care techniques. [2] K. pneumoniae was the most common pathogen among adults with bacterial meningitis in a study at Taiwan. [3] Reports of meningitis have shown that more than half of patients with K. pneumoniae meningitis die in spite of adequate therapy. [4] In diabetic patients the intimal vascular abnormality probably predisposes to a hematogenous spread of K. pneumoniae. [5] In our case, this pathology might have probably predisposed to hematogenous spread of the bacterium as the patient was diabetic. Other risk factors for an unfavorable outcome may be an immunocompromised state due to underlying disease as this patient had Hansen's disease and was on steroids for treatment of lepra reaction.


   Acknowledgment Top


We acknowledge Dr. Girija, Professor of Medicine for her general support in accessing the patient's clinical data.

 
   References Top

1.Ryan KJ, Ray CG. Sherris Medical Microbiology. 4 th ed. New York, USA McGraw Hill Publisher; 2004.  Back to cited text no. 1
    
2.van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351:1849-59.  Back to cited text no. 2
    
3.Huang CR, Lu CH, Chang HW, Lee PY, Lin MW, Chang WN. Community-acquired spontaneous bacterial meningitis in adult diabetic patients: An analysis of clinical characteristics and prognostic factors. Infection 2002;30:346-50.  Back to cited text no. 3
    
4.Chang WN, Lu CH, Huang CR, Tsai NW, Chuang YC, Chang CC, et al. Changing epidemiology of adult bacterial meningitis in southern Taiwan: A hospital-based study. Infection 2008;36:15-22.  Back to cited text no. 4
    
5.Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med 1991; 151:1557-9.  Back to cited text no. 5
    

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Correspondence Address:
R Gopal
Department of Microbiology, Sri Manakula Vinayagar Medical College & Hospital, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.130927

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    Figures

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    Abstract
   Introduction
   Case Report
   Discussion
   Acknowledgment
    References
    Article Figures

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