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Letter to the Editor| Volume 41, ISSUE 6, P676-677, December 2011

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Changing Spectrum of Microbiology of Liver Abscess: Now Klebsiella, Next Burkholderia pseudomallei

      I read with interest the article by Pope et al. on Klebsiella spp.-related pyogenic liver abscess (PLA) and the threat this organism poses for emergency physicians in the West (
      • Pope J.V.
      • Teich D.L.
      • Clardy P.
      • McGillicuddy D.C.
      Klebsiella pneumoniae liver abscess: an emerging problem in North America.
      ). By and large, clinicians in the West are still relatively unfamiliar with infections caused by Klebsiella spp., including PLA. There are now increasing numbers of reports in the West (
      • Lederman E.R.
      • Crum N.F.
      Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics.
      ,
      • Braiteh F.
      • Golden M.P.
      Cryptogenic invasive Klebsiella pneumoniae liver abscess syndrome.
      ,
      • Keynan Y.
      • Karlowsky J.A.
      • Walus T.
      • Rubinstein E.
      Pyogenic liver abscess caused by hypermucoviscous Klebsiella pneumoniae.
      ). Literature on Klebsiella spp.-related PLA has originated mostly from the East, where clinicians are more familiar with this infection. Klebsiella spp.-related sepsis typically occurs in patients with underlying disorders such as diabetes mellitus or other immune-compromising disorders. In Klebsiella-related PLA, it is not uncommon for patients to have multiple abscesses. In addition, metastatic infective foci are often reported (
      • Yang P.W.
      • Lin H.D.
      • Wang L.M.
      Pyogenic liver abscess associated with septic pulmonary embolism.
      ,
      • Cheng D.L.
      • Liu Y.C.
      • Yen M.Y.
      • Liu C.Y.
      • Wang R.S.
      Septic metastatic lesions of pyogenic liver abscess Their association with Klebsiella pneumoniae bacteremia in diabetic patients.
      ). Delay in diagnosis and appropriate treatment can lead to poor outcomes.
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      References

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