Q J Med 2014; 107:1053 doi:10.1093/qjmed/hcu124
Advance Access Publication 2 June 2014
Clinical picture String test of hypervirulent Klebsiella pneumonia
Figure 1. Results of String tests (A string 5 mm or longer is defined as positive). Stretching of the Klebsiella pneumoniae colonies isolated from our patient’s sample resulted in the formation of a string 6 mm in length.
in the laboratory, defines the infection and is also useful for early diagnosis.1 Photographs and text from: A. Kumabe and T. Kenzaka, Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan. email: [email protected] Conflict of interest: None declared.
Reference 1. Shon AS, Bajwa RP, Russo TA. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed. Virulence 2013; 4:107–18.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 13, 2015
A 63-year-old woman with a history of type 1 diabetes mellitus and IgA nephropathy, on maintenance dialysis for 10 years, presented with exertional dyspnea of 1 week’s duration and bloody sputum since the previous day. On the day of admission, the patient had awoken with clouding of consciousness; she was brought to the emergency outpatient department by ambulance. On arrival, vital signs were: blood pressure, 84/35 mmHg; regular pulse rate, 92/min; respiratory rate, 24/min; body temperature, 35.68C; SpO2, 97% (oxygen 10 l/min); level of consciousness, GCS E4V4M5. Coarse crackles were audible over both lungs. She was hospitalized with pneumonia confirmed by chest computed tomography; on the same day, she was placed on a ventilator in the intensive care unit due to progressive deterioration of her condition. Septic shock occurred and was treated with intensive care; she died the day after admission. Autopsy revealed the main lesions in the lungs but no infectious foci in the heart, liver or dialysis shunt. Klebsiella pneumoniae was detected from sputum and blood cultures. String tests of colonies from the culture media, which have a pathognomonic gross appearance, were positive with strings 6 mm in length (Figure 1). The magA and rmpA genes were identified; establishing the diagnosis of infection due to hypervirulent K. pneumoniae was established.1 This bacterial infection is extremely invasive with a high mortality rate.1 A positive string test, which can easily be performed
Advance Access Publication 2 June 2014
Clinical picture String test of hypervirulent Klebsiella pneumonia
Figure 1. Results of String tests (A string 5 mm or longer is defined as positive). Stretching of the Klebsiella pneumoniae colonies isolated from our patient’s sample resulted in the formation of a string 6 mm in length.
in the laboratory, defines the infection and is also useful for early diagnosis.1 Photographs and text from: A. Kumabe and T. Kenzaka, Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan. email: [email protected] Conflict of interest: None declared.
Reference 1. Shon AS, Bajwa RP, Russo TA. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed. Virulence 2013; 4:107–18.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 13, 2015
A 63-year-old woman with a history of type 1 diabetes mellitus and IgA nephropathy, on maintenance dialysis for 10 years, presented with exertional dyspnea of 1 week’s duration and bloody sputum since the previous day. On the day of admission, the patient had awoken with clouding of consciousness; she was brought to the emergency outpatient department by ambulance. On arrival, vital signs were: blood pressure, 84/35 mmHg; regular pulse rate, 92/min; respiratory rate, 24/min; body temperature, 35.68C; SpO2, 97% (oxygen 10 l/min); level of consciousness, GCS E4V4M5. Coarse crackles were audible over both lungs. She was hospitalized with pneumonia confirmed by chest computed tomography; on the same day, she was placed on a ventilator in the intensive care unit due to progressive deterioration of her condition. Septic shock occurred and was treated with intensive care; she died the day after admission. Autopsy revealed the main lesions in the lungs but no infectious foci in the heart, liver or dialysis shunt. Klebsiella pneumoniae was detected from sputum and blood cultures. String tests of colonies from the culture media, which have a pathognomonic gross appearance, were positive with strings 6 mm in length (Figure 1). The magA and rmpA genes were identified; establishing the diagnosis of infection due to hypervirulent K. pneumoniae was established.1 This bacterial infection is extremely invasive with a high mortality rate.1 A positive string test, which can easily be performed
