SEVERE KLEBSIELLA PNEUMONIA MIMICKING MIDDLE EAST RESPIRATORY SYNDROME IN A DIABETIC MALE RETURNING FROM SAUDI ARABIA

Talha Mahmud, Abdul Hafeez, Muhammad Saqib, Adnan Najab, Muhammad Ramzan

Abstract


A 35 year old diabetic male returned from Riyadh, KSA (April 2014) with history
of a recent upper respiratory febrile illness followed by intractable dyspnea and
bilateral crackles on chest examination. His chest radiology revealed diffuse
bilateral alveolar shadowing and blood gas analysis was consistent with acute
respiratory failure in association with deranged liver function tests. Meeting all
the clinical criteria, he was managed in strict isolation with precautions as he
was a high suspect ‘patient under investigation’ (WHO/CDC)1 for Middle East
Respiratory Syndrome (MERS) versus an acute respiratory viral infection like
swine or human influenza or a disseminated bacterial pneumonia. His bronchoalveolar
lavage (BAL) specimen along with nasopharyngeal swabs for Middle
East Respiratory Syndrome corona virus (MERS Co-V) RT PCR, H1N1 and
H5N1 influenza viruses were negative but growth of Klebsiella Pneumoniae on
culture was positive. Treatment with appropriate antibiotic lead to complete
clinical, biochemical, physiological and radiological recovery.


Keywords


Acute respiratory failure; acute respiratory distress syndrome; bronchoalveolar lavage; klebsiella pneumonia; pulmonary edema; Middle East Respiratory Syndrome

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