Family Outbreak of Shiga Toxin–producing Escherichia coli O123:H–, France, 2009

Genotyping was performed on isolates from 4 patients. One isolate contained the rmpA gene; 3 contained rmpA and magA genes. Three of these isolates also underwent capsule serotyping; 2 were type K1 and 1 was K2. We found 4 additional patients infected with K. pneumoniae in 2009 who did not have invasive infections. Briefl y, a 21-year-old pregnant recent emigrant from Yemen and a 35-yearold Hispanic pregnant woman each had a urinary tract infection; a 78-year-old Vietnamese man had nosocomial aspiration pneumonia in which K. pneumoniae was considered a pathogen; and a 34-year-old African American woman who was receiving mechanical ventilation had sputum transiently colonized with K. pneumoniae. This case series confi rms that the clinical syndrome of K. pneumoniae bacteremia and primary liver abscess has emerged in Alameda County. Other sites of infection included kidney, brain, lung, pleural space, neck, and mediastinum, as reported in Asia (1–4). Although K. pneumoniae infections are predominantly a communityassociated phenomenon, nosocomial infections as we observed have been reported (8). Death refl ected underlying disease rather than K. pneumoniae infection in this study. We present evidence that hypermucoviscous K. pneumoniae also can behave as a colonizer or low-virulence pathogen, as manifested in our patients with urinary tract infection, sputum colonization, and aspiration pneumonia. Our K. pneumoniae isolates appear similar to those from Asia (5) with respect to in vitro susceptibility, capsule serotypes, and magA and rmpA genes. Most of our patients were Asian but of widely dispersed origin and without recent travel to Asia. The number of thrombotic complications in this series is striking. Such complications appear not to have been noted in the literature, and this fi nding requires further investigation. Our data show the emergence of hypermucoviscous K. pneumoniae in northern California and suggest that it might be unrecognized elsewhere in North America.