A 58-year-old man with uncontrolled diabetes mellitus presents with fever, right upper quadrant pain, and a multiloculated liver abscess on CT. Blood culture grows a gram-negative capsulated bacterium with hypervirulent characteristics. The most likely causative organism is:

• A Escherichia coli
• B Klebsiella pneumoniae ✓
• C Entamoeba histolytica
• D Streptococcus milleri group

Explanation

In Asian populations, including India, hypervirulent Klebsiella pneumoniae has overtaken E. coli as the leading cause of community-acquired pyogenic liver abscess, particularly in diabetic patients. These abscesses are often monomicrobial and multiloculated. Entamoeba histolytica produces the classic anchovy paste aspirate and is diagnosed serologically, while Streptococcus milleri is classically linked to cryptogenic abscesses arising from appendicitis or diverticulitis in Western series.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.