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Snapshot
  • A 55-year-old man is brought to the emergency department by police after being found confused in the park. Obtaining a history is difficult. On physical exam, the patient smells of alcohol and has a productive cough of red currant jelly. There are decreased breath sounds in the right lung fields. A chest radiograph is obtained, which demonstrates a lobar consolidation concerning for pneumonia. A sputum culture demonstrates Gram-negative bacilli that are facultative anaerobes and lactose fermenting. They have a mucoid appearance on MacConkey agar.  (Klebsiella pneumonia)
Introduction
  • Classification
    • a gram-negative, lactose-fermenting, facultative anaerobic bacilli
  • Microbiology
    • contains an abundant polysaccharide capsule leading to mucoid colonies
  • Associated conditions
    • granuloma inguinale
    • community-acquired pneumonia
    • lung abscess
    • aspiration pneumonia
    • urinary tract infection
    • invasive liver abscess syndrome
Presentation
  • Symptoms/physical exam
    • pneumonia
      • red currant jelly sputum 
        • typically seen in patients with diabetes and alcohol use disorder
    • sexually transmitted infection
      • chronic genital ulcers
    • urinary tract infection
      • dysuria
      • urinary frequency
      • urinary urgency
      • suprapubic pain
    • invasive liver abscess
      • right upper quadrant pain
Studies
  • Culture
    • obtained from possible sites of infection
      • mucoid and pink colonies on MacConkey agar 
Treatment
  • Medical
    • third generation cephalosporins, carbapenems, aminoglycosides, and quinolones
      • indication
        • these agents have activity against Klebsiella; however, susceptibility testing will dictate which antibiotic is best
Complications
  • Sepsis
 

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