Relapsing, bacteremic Klebsiella pneumoniae meningitis in an AIDS patient

Community-acquired Klebsiella pneumoniae meningitis in an alcoholic patient with an infected pancreatic pseudocyst; a case report and review of literature

We report a case of a 49-year-old male with a history of chronic alcoholism and evidence of a pancreatic pseudocyst on CT scanning. He presented with a 3-days history of fever, loss of appetite and upper abdominal pain. Blood cultures grew Klebsiella pneumoniae and he improved clinically with a seven-day course of intravenous co-amoxiclav and metronidazole. Two weeks later he was readmitted to hospital with impaired consciousness and septic shock, and died three days later in intensive care. Post mortem examination revealed bacterial meningitis and an infected pancreatic pseudocyst. Klebsiella pneumoniae was isolated from the pancreas and meninges.

Bacterial infections

Non-opportunistic bacterial infections are an important cause of morbidity and mortality for HIV-infected adults and children. Factors associated with increased risk of these include altered B- and T-cell function; altered phagocytic cell function; skin and mucous membrane defects; and use of indwelling vascular catheters, antibiotics, or cytotoxic agents. The pathogens encountered most frequently are S. aureus, S. pneumoniae, H. influenzae, Salmonella sp., and Pseudomonas aeruginosa. Less commonly encountered organisms include Rhodococcus equi, Listeria monocytogenes, Shigella sp., and Nocardia asteroides, Strategies for prevention as well as diagnosis and treatment of these are discussed.

Septicaemia in patients with AIDS

During a 5 year period at St Stephen's hospital, London, septicaemia was detected in 66 patients with the acquired immune deficiency syndrome (AIDS) and in 13 other patients with non-AIDS-associated HIV infections. The most frequent pathogens in patients with AIDS were Mycobacterium avium-intracellulare, Streptococcus pneumoniae, Pseudomonas aeruginosa, Cryptococcus neoformans and staphylococci. A series of HIV-associated septicaemias reported from other centres in different countries has shown great variation in the pattern of aetiological agents observed, which may partly reflect differences in the local socio-economic condition, ethnic backgrounds, other predisposing factors, and blood culture techniques. Salmonella species were a prominent cause of septicaemia in several reports. Most centres have also reported an increasing problem with septicaemias associated with intravenous lines in patients receiving antiviral or other parenteral drug therapy.