Klebsiella a formidable cousin

Proven content

He can be our good roommate, quiet, calm and not disturbing anyone. Sometimes, however, he attacks unexpectedly. It can be deadly then. Meet the cousin of salmonella – klebsiella.

For several years, my granddaughter has been suffering from recurrent, more and more often, cystitis. The antibiotic was dealt with it at first, but now it doesn’t even work anymore. The doctor eventually sent her for a specialist examination, and it was discovered that she was attacked by Klebsiella pneumoniae. It turns out that this bacterium is very difficult to deal with because it mutates and becomes resistant to antibiotics. What to do? Where and how to cure my granddaughter? — Irena

Klebsiella sticks were discovered by the pathologist Theodor Albrecht Edwin Klebs and described by the German scientist Carl Friedländer. Edwin Klebs in 1875 noticed unknown bacteria in the respiratory tract of a patient who died of pneumonia. But it wasn’t until 1882 that Carl Friedländer linked the presence of these microbes to disease. Friedländer died prematurely, at the age of 40, of respiratory failure most likely caused by the bacteria he described.

Scientists describe klebsiella sticks as gram-negative, slow-moving and relatively anaerobic (i.e., those that grow in both oxygen-containing and oxygen-free environments). They belong to the family of the intestinal bacilli (Enterobacteriaceae). In the same family we can find microorganisms that are dangerous to humans, such as: typhoid fever, paratyphoid fever, salmonella, dysentery and yersiniosis.

This is history

Among the klebsiella sticks there are those that previously caused serious diseases. Today these conditions are extremely rare, but they used to be killing. Few people in Poland have heard of someone suffering from a tough guy. The word is associated rather with the male protagonist of action movies. Meanwhile, tough guy is a chronic infectious disease of the respiratory tract, caused by Klebsiella rhinoscleromatis. The disease develops insidiously and slowly over many years. It results in narrowing of the upper (and sometimes lower) airways due to the formation of granulation tissue. The patient has difficulty breathing, his respiratory system becomes less and less efficient, which can lead to death. If the disease affects the nose, the skin on it is thickened, it is the so-called heart-shaped nose (rhinoscleroma). People in many European countries, such as Belarus, Ukraine, Lithuania, Poland, Austria, Switzerland, Italy, as well as South Asia and Central and South America suffered from toughness. The cases were endemic, i.e. local. When the borders of Poland shifted to the west in 1945, most of the areas affected by the disease found themselves abroad. There are a few places left in the country in the voivodeship Lublin and Podlasie, where cases were recorded. People who, as a result of post-war migration, found themselves in Greater Poland, Western Pomerania and Lower Silesia, also fell into toughness after the war. Tough guy was incurable for years. The breakthrough was the introduction of streptomycin to therapy, thanks to which all patients were cured. New cases are recorded extremely rarely – only 1-2 every few years. There are still outbreaks of this disease beyond our eastern border, but much smaller than in the first half of the XNUMXth century.

The second disease that is fortunately made history is foul-smelling atrophic rhinitis (ozena). Its cause is infection with Klebsiella ozaenae.

Crouching tiger

This bacterium is part of the microflora of the human mouth, skin and intestines. It is also found in soil. It is closely related to the Klebsiella oxytoca. Both types of bacteria can cause many serious diseases:

* sepsis,

* endotoxic shock,

* pneumonia,

* lung abscesses,

* urinary, digestive and biliary tract infections,

* inflammation of the sinuses, middle ear,

* meningitis,

* inflammation of soft tissues

* osteomyelitis.

You can only become infected from another person, and the infection (when a bacterium breaks our immune system and causes disease) can be the result of long-term contact with the sick person. We most often get infected with Klebsiella pneumoniae in the hospital. The bacterium causes more or less serious infections, such as: bronchitis, inflammation of postoperative wounds, urinary tract infections and bacteraemia, i.e. bloodstream infections.

Bacteria attack when the immune system is severely weakened. Their victims are people who suffer from other infections or chronic diseases, such as diabetes, lung diseases or… alcoholism. Klebsiella pneumoniae are so dangerous to humans for two reasons. First, they are common in the environment and the body. Second, they become resistant to most antibiotics very quickly and easily.

Safer at home

Klebsiella pneumoniae bacteria are especially dangerous to babies. The main carrier of these rods is humans, therefore, during childbirth and several to several hours after birth, Klebsiella pneumoniae inhabits the newborn’s body, mainly the gastrointestinal tract. This happens in 12-55 percent. healthy full-term babies born in hospital. Klebsiella sticks then become one of the components of the normal intestinal flora of the newborn. Therefore, they are not a direct threat to the health of the child.

Occasionally, more than one strain of Klebsiella pneumoniae is established in the infant’s gastrointestinal tract, nose and throat. They differ in biochemical (different biogroups), antigenic (different serotypes) and DNA structure properties. When a child leaves the hospital, he or she is a carrier of these sticks for a few more weeks, and sometimes for several months. Usually they do him no harm.

It is completely different when a newborn is premature or weighs less than 1500 g and must be placed in an incubator. In such children it is necessary to use parenteral nutrition, administer intravenous drugs (usually protective antibiotics). Premature babies require oxygen therapy, heart rate monitoring, blood pressure, breathing and blood oxygenation, and nursing procedures more frequent than healthy, full-term newborns. The temperature in the incubator is also higher than room temperature – about 35 ° C. All this makes the premature baby’s body – not only the digestive tract, but also the skin, nose and throat – often inhabited by bacterial strains resistant to antibiotics. And they stay there much longer than in term newborns.

According to many pediatricians, the colonization of the newborn’s body by bacteria is inevitable, it is a normal physiological process. Therefore, it is better to limit the administration of protective antibiotics. Thanks to this, it will be possible to minimize the resistance of klebsiella to antibiotics.

The second group of people at risk of klebsiella attack are hospital patients and people associated with these institutions. Research shows that even the organisms of healthy adults who come into contact with the hospital are colonized by these bacteria (1-6%). Patients who receive antibiotics are three times more likely to carry klebsiella than those outside the hospital environment.

Klebsiella pneumoniae comes out of hiding and causes disease when we have very weakened immunity. Sometimes these bacteria cause infections of the urinary, digestive and respiratory systems. It happens that the disease ends with sepsis and even death. The symptoms of infection depend on which organ is affected. For example, if your lungs are affected, you have pneumonia with symptoms such as high fever, chills, broken bones, weakness, coughing and coughing up large amounts of mucus (often stained with blood).

Klebsiella infections are difficult to treat and the disease is often very violent. This is because of the special properties of these bacteria. They have a thick, multi-sugar coating that makes it difficult for phagocytosis, that is, they are absorbed by the cells of the immune system that fight infection. This coating also reduces the bactericidal effect of the serum. In addition, klebsiella quickly becomes resistant to antibiotics, so you must always follow the rule: drugs (especially antibiotics) are always taken until the end, even if after a few days we feel well. If we stop the treatment, we will not destroy all bacteria, and those that remain will become resistant to this drug and attack with double strength. Symptoms of the disease will return and a new antibiotic will have to be found that will successfully destroy the aggressor. What happens if it turns out that we are attacked by an antibiotic-resistant strain of klebsiella bacteria? The doctor will continue to look for a drug that will destroy the bacteria. Fortunately, in Poland no case of infection with the mutation of the Klebsiella pneumoniae bacterium, which is resistant to all antibiotics (mutated microorganism NDM-1, which comes from New Delhi, India) has been reported. People who have detected any drug-resistant strain of bacteria should be isolated until they are completely cured.

Effective defense

Klebsiella bacteria attack when the immune system is weakened. So you need to take care of it through physical activity, which promotes the production of immune antibodies, and diet. Our meals should contain plenty of fruits and vegetables, whole grains, healthy fats (canola oil, olive oil) and probiotics. Probiotic bacteria work, among others in the intestines. They compete with the pathogenic ones and drive them out of the body. In addition, probiotic microorganisms produce lactic acid, which acidifies the intestine. Such an environment is unfavorable for pathogenic bacteria. In addition, there are strains of probiotics that increase the production of antibodies and thus improve immunity. Probiotics can be found in foods, such as yoghurts fortified with live bacteria, or in over-the-counter preparations in pharmacies.

To avoid klebsiella, hygiene is also necessary, as bacteria can spread from person to person. It is also not worth overusing antibiotics, so do not persuade your doctor to prescribe them for every infection. The body will fight an ordinary cold by itself, it is enough to rest for a few days.

Konsultation: lek. med. Alexandra Mossakowska family medicine specialist www.ol Rodzinna.