Hypervirulent Klebsiella pneumoniae - clinical and molecular perspectives.,Journal of Internal Medicine

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Hypervirulent Klebsiella pneumoniae - clinical and molecular perspectives.
Journal of Internal Medicine ( IF 9.0 ) Pub Date : 2019-11-21 , DOI: 10.1111/joim.13007
J E Choby _{1,

2,

3} , J Howard-Anderson ₄ , D S Weiss _{1,

2,

3,

4,

5}

Affiliation

Hypervirulent Klebsiella pneumoniae (hvKp) has emerged as a concerning global pathogen. hvKp is more virulent than classical K. pneumoniae (cKp) and capable of causing community-acquired infections, often in healthy individuals. hvKp is carried in the gastrointestinal tract, which contributes to its spread in the community and healthcare settings. First recognized in Asia, hvKp arose as a leading cause of pyogenic liver abscesses. In the decades since, hvKp has spread globally and causes a variety of infections. In addition to liver abscesses, hvKp is distinct from cKp in its ability to metastasize to distant sites, including most commonly the eye, lung and central nervous system (CNS). hvKp has also been implicated in primary extrahepatic infections including bacteremia, pneumonia and soft tissue infections. The genetic determinants of hypervirulence are often found on large virulence plasmids as well as chromosomal mobile genetic elements which can be used as biomarkers to distinguish hvKp from cKp clinical isolates. These distinct virulence determinants of hvKp include up to four siderophore systems for iron acquisition, increased capsule production, K1 and K2 capsule types, and the colibactin toxin. Additionally, hvKp strains demonstrate hypermucoviscosity, a phenotypic description of hvKp in laboratory conditions that has become a distinguishing feature of many hypervirulent isolates. Alarmingly, multidrug-resistant hypervirulent strains have emerged, creating a new challenge in combating this already dangerous pathogen.

中文翻译：

高毒肺炎克雷伯菌-临床和分子观点。

高毒肺炎克雷伯菌已经成为一种令人关注的全球病原体。hvKp比典型的肺炎克雷伯菌（cKp）更具毒性，通常在健康个体中能够引起社区获得性感染。hvKp携带在胃肠道中，这有助于其在社区和医疗机构中的传播。hvKp在亚洲首次被发现，是化脓性肝脓肿的主要原因。从那以后的几十年中，hvKp已经在全球传播并引起多种感染。除肝脓肿外，hvKp与cKp的不同之处在于其转移至遥远部位（包括眼，肺和中枢神经系统（CNS））的能力。hvKp还与原发性肝外感染有关，包括菌血症，肺炎和软组织感染。高毒力的遗传决定因素通常在大毒力质粒以及染色体移动遗传元件上发现，可用作遗传标记，以区分hvKp和cKp临床分离株。hvKp的这些独特的毒力决定因素包括多达四个铁载体系统，用于铁的获取，增加的胶囊产量，K1和K2胶囊类型以及大肠菌素毒素。另外，hvKp菌株表现出高粘膜粘度，这是实验室条件下hvKp的表型描述，已成为许多高毒分离株的显着特征。令人震惊的是，出现了具有多重耐药性的高毒力菌株，在对抗这种已经很危险的病原体方面提出了新的挑战。

更新日期：2019-11-21

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