58

Journal of The Association of Physicians of India Vol. 63 November 2015

Pictorial CME

Klebsiella Bacteremia Detected on Peripheral Blood Smear

Samir S Shah1, Rupali S Parikh2, Lakshmi P Vaswani3

Fig. 1: Photomicrograph of Leishman-stained smear showing rod-shaped bacilli

within the vacuolated neutrophils

Fig. 2: Photomicrograph of Gram-stained smear

showing Gram-negative rod-shaped bacilli
within the vacuolated neutrophil

45 year old man, a known case of

chronic kidney disease since 10
years and on maintenance hemodialysis
twice a week since then, hypertensive
since 4 years and positive for Australia
A n t i g e n , wa s h o s p i t a l i z e d i n I C U
with fever and chills, 7-8 episodes of
diarrhea and breathlessness. There was
no history of diabetes and asthma.

with toxic vacuoles and intracellular

structures that exhibited a uniform
and definite rod shape, suggestive of
phagocytosed bacilli which were Gram
negative on Gram stain.

The blood samples were sent to

the lab for further investigations.
A complete blood count showed
hemoconcentration, leucopenia and
thrombocytopenia. Hb 15.1 gm/dl, total
WBC count 1.93 x 10 9 /L, (myelocyte
1%, metamyelocyte 4%, band forms
14%, segmented neutrophils 30%
lymphocytes 47% and monocytes 4%.)
and platelet count 102 x 109/L. Peripheral
blood smear demonstrated leucopenia
with shift to left in granulocytes

Th e p a t i e n t s con d i t i on f u r t h e r
deteriorated with blood pressure falling
down to 70/30 mm of Hg and HGT of
17 gm/dl. Peripheral extremities were
mottled and cyanosed.

Blood culture confirmed the blood

smear finding of bacteremia and
revealed the presence of Klebsiella
pneumoniae.

peripheral blood smear is unusual and

should be regarded as a useful indicator
of overwhelming infection, supporting
an early and definitive diagnosis of
septicemia. Although several species
of bacteria have been described on
the examination of peripheral blood
smears, detection of bacteremia due to
Gram negative rods on a film has been
rarely reported. 1

References
1.

Takihi I, Sandes A: Killers on the road: Klebsiella and

Pseudomonas bacteremia detected on peripheral blood
smear. Blood 2013; 122:1851.

Despite all efforts he died.

The finding of microorganisms in
1
Consultant Haematologist, 2Associate Pathologist, 3Assistant Pathologist, Bhatia Hospital, Mumbai, Maharashtra.
Received: 04.08.2014; Revised: 25.09.2014; Accepted: 19.11.2014