Журнал клинических случаев

Sepsis with Klebsiella pneumoniae Complicated with Renal Abscess in Immunocompetent Host: A Case Report

Abstract

Caruntu FA and Radu MN

Introduction: The inflammatory response to an infectious trigger may evolve to sepsis and septic shock most frequently at the extremes of age and in immunosuppressed patients. Klebsiella pneumoniae is a gram-negative bacillus that is part of the saprophytic flora of the digestive tract. Bacteremia with commensal germs may be secondary to a localized infectious event from where bacteria crosses vascular endothelium.

Case presentation: We are presenting the case of a 17-years-old patient, admitted to the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” in June 2017, on the 4th day of illness. Symptoms started 8 hours after meal with nausea, vomiting, fever, and temporo-spatial disorientation. Clinical manifestations and paraclinical investigations have established the diagnosis of sepsis with Klebsiella pneumoniae.

Results: Although antibiotic treatment was promptly initiated according to the antibiogram, complications of bacteremia still occurred, and patient developed renal abscess. Evolution was favorable under antibiotic treatment and correction of modified biological parameters, the patient being discharged cured after 21 days.

Discussion: The particularity of the case is given by the immunocompetent profile of the patient who developed sepsis with commensal germ. Intestinal inflammation secondary to a food poisoning has facilitated bacterial translocation. Bacterial lipopolysaccharide (LPS) is transported by binding proteins to CD14 receptor from the effector cells (neutrophils, monocytes, macrophages). This receptor facilitates the interaction between LPS and TLR 4. As a result, synthesis of proinflammatory factors: cytokines, chemokines, prostaglandins are stimulated.

Conclusion: Klebsiella pneumoniae causes an increased level of endotoxemia. Consequently, the risk of sepsis is higher even in immunocompetent patients.