Klebsiella ozaenae Bacteremia in a Kidney Transplant Recipient

Infections remain a dreadful complication after solid organ transplantation. Almost all microorganisms could cause this complication, including unusual ones. We report a 73-year-old patient, with a history of kidney transplant for 38 years on minimum immunosuppression, who presented with high-grade fever and gastrointestinal symptoms. Klebsiella ozaenae was isolated from blood cultures. She had a prompt response to antibiotics and recovered completely in a short period. Subsequent evaluation of her nasal cavity and sinuses did not show any abnormalities. Klebsiella ozaenae is primarily a colonizer of the oral and nasopharyngeal mucosa, which does not usually cause severe infections. Only 12 cases of Klebsiella ozaenae bacteremia have been reported, none of them in the context of solid organ transplant recipient. 1. Introduction Infections are among the commonest causes of morbidity and mortality in solid organ transplant (SOT) recipients and are the second most cause of death in patients dying with functioning allografts [1]. Potential pathogens in this group of patients are diverse, ranging from common pathogens, like community-acquired bacteria and viruses to uncommon opportunistic pathogens that cause infections of clinical significance only in immunocompromised hosts [2]. Infections after SOT may follow a predictable pattern with regard to time elapsed after transplantation [3]. Late infections are often secondary to conventional or opportunistic pathogens; depending on the degree of immunosuppression and environmental exposures. Dealing with infection in a SOT recipient could be challenging for various reasons. It is more difficult to recognize infection in such patients than it is in persons with normal immune system, as inflammatory responses associated with microbial invasion are impaired by immunosuppressive therapy, which results in diminished symptoms and muted clinical and radiologic findings, and thereby delaying diagnosis. Serologic testing is not generally useful for the diagnosis of acute infection in the SOT recipient since seroconversion is often delayed. Choosing antimicrobial agents is more complex due to the drug toxicities and interactions, which mandate frequent monitoring of immunosuppressive drug levels. Finally, antimicrobial resistance is common in immunocompromised hosts and should be considered in the choice of antimicrobial regimens [2, 3]. Klebsiella (K.) ozaenae is a subtype of K. pneumonia [4], and has been a known cause of chronic inflammatory disease of the upper respiratory tract [5]. We present the first case of K.