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Which of the following is more frequently associated with Klebsiella pneumoniae than with Pseudomonas aeruginosa?
Options:
A. Artificial ventilation
B. Cystic fibrosis
C. Diabetes mellitus
D. Green-colored sputum
E. Upper lobe cavitation
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The correct answer is E. Klebsiella pneumoniae is a well-recognized cause of community-acquired lobar pneumonia associated with cavitation. It is found typically in alcoholic males over 40 years of age with underlying diabetes or obstructive lung disease. Klebsiella pneumoniae mimics Streptococcus pneumoniae as a pulmonary pathogen except that Klebsiella has a greater tendency to progress to lung abscess and empyema. Pseudomonas aeruginosa is usually associated with patients on ventilators, particularly in intensive care units. Immunocompetent patients usually have bilateral bronchopneumonia without cavitary lesions.
Artificial ventilation (choice A) is classically associated with P. aeruginosa infection. The
organism thrives in a wet environment such as respirators, cleaning solutions, disinfectants, sinks, vegetables, flowers, endoscopes, and physiotherapy pools.
P. aeruginosa is a very important pathogen. Mucoid strains of this organism infect the airways in
patients with cystic fibrosis (choice B), leading to acute exacerbations and chronic progression of lung damage.
Both organisms cause disease in association with diabetes (choice C). Klebsiella pneumoniae produces pulmonary disease and P. aeruginosacauses necrotic skin ulcers in diabetics.
Green-colored sputum (choice D) is associated with P. aeruginosa, since more than half of the
clinical isolates produce the blue-green pigment pyocyanin, which is helpful in identifying the organism
