A Report of a Case of Klebsiella Pneumoniae Arthritis and a Review of Extrapulmonary Klebsiella Infections

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Abstract
A 65-year-old diabetic female on admission was found to have a purulent arthritis of her left wrist associated with ketoacidosis. This patient had been followed for 4 months previously with recurrent otitis media treated with both local and systemic antibiotics, and myringotomy. Joint pus, blood and ear drainage all revealed type I Klebsiella pneumoniae. Therapy consisted of surgical drainage, tetracycline, and penicillin-G, initially, replaced later by chloramphenicol, streptomycin, and sulfisoxazole. The patient developed an acute mastoiditis one month later, the etiological agent being a type I Klebsiella pneumoniae, more antibiotic resistant in vitro than the previously obtained organism. Again prompt antibiotic therapy and surgical drainage produced a rapid improvement. A review of the literature found pneumonia to be the most frequent Klebsiella infection, of which 73-100% were type I. Extrapulmonary Klebsiella infections, namely, urinary tract infections, meningitis, arthritis and bacteremia were reviewed. An extraordinarily high number of Klebsiella extrapulmonary infections were associated with diabetes mellitus. Only one other case of Klebsiella arthritis has been reported. Despite the antibiotic sensitivity of this organism, the mortality of Klebsiella infections other than the urinary tract infections approaches 50%.