Klebsiella: Ankylosing Spondylitis, Reactive Arthritis & Infections


Some may find the link between gut microbes and disease states like ankylosing spondylitis hard to grasp. How can an imbalanced gut ecosystem result in an inflammatory arthritic condition? This article will explore these concepts with a focus on Klebsiella infections and dysbiosis.

For a primer on Klebsiella, how to screen for it, symptoms  see here – Klebsiella – Bacterial Dysbiosis, Detection and Treatment

Ankylosing Spondylitis

Ankylosing spondylitis, or AS, is an inflammatory rheumatic disease that primarily affects the lower spinal joints. It predominantly affects younger people with the initial symptom of chronic lower back pain and increasing stiffness (2).

“Typically, the vertebrae of the spine become inflamed, causing chronic pain and discomfort. In more severe cases, this inflammation can lead to new bone formation on the spine, causing the spine to fuse in a fixed, immobile position resulting in a forward-stooped posture. If left untreated, the inflammation of the spinal joints will gradually destroy the cartilage and fibrous tissue of the surrounding structures as well as the ligaments and literally replace them with bone.” – Michael Weisman (3).

As with many chronic diseases there appears to be an interplay between genetics and environment. From a genetic perspective there is a strong correlation between HLA genes and AS, particularly the HLA-B27 or Human leukocyte antigen B27. Some early studies found 95% of AS patients to have the HLA-B27 marker compared to only 8% of the general population (4).

Are Microbes At Play in Ankylosing Spondylitis?

Microbial infections have been outlined as possible environmental factors that contribute to reactive arthritis, arthritis that occurs after infection. One study implicated a number of different bacteria including:

  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter
  • Clostridium difficile

Many of these bacterial antigens were found in the synovial fluid and tissue of the joints of patients with reactive arthritis.

Returning to AS and Klebsiella a range of different studies have explored the cross-reactivity between Klebsiella and the particular gene HLA-B27. One study summarised many of the different findings including

  1. Animal studies that demonstrate reactions between HLA-B27 and antigenic extracts from Klebsiella, Yersinia, Salmonella and Shigella.
  2. Specific anti-B27 antibodies bound to Klebsiella, Yersinia and Shigella.
  3. AS patients have “significantly elevated levels of antibodies” to Klebsiella.
  4. There have been similarities discovered between Klebsiella and collagen tissues, possibly explaining the location of the issues in AS (tendons, spine, large joints)
  5. One 2003 study found “IgG antibodies from AS patients were found to be significantly cytotoxic to HLA-B27 peptide bearing cells”

Spondyloarthritis has also been associated with inflammation in the gut. Two theories on the association between gut inflammation and spondyloarthritis have been suggested. The first being an increased activation of the immune cells and the second being gut dysbiosis, or an altered gut microbiome. The same study outlined correlations between chronic gut inflammation and the progression of AS (7).

Testing for Klebsiella Infections

As covered in a previous article different Klebsiella species have been shown to be opportunistic pathogens. Any insult to the microbiome, particularly antibiotics, strong antimicrobial herbs, a poor diet full of refined carbohydrates, particularly starches can create an ideal niche for these microbes to take up residence.

From personal experience I would recommend a comprehensive stool analysis, or a CDSA, to screen anyone that presents with gastrointestinal complaints. Unfortunately the more advanced PCR DNA based techniques here in Australia don’t generally include Klebsiella in the list of microbes that they screen for. Other countries may be more ahead of the game in terms of testing available.

Have you had any experience with gut imbalances? Share your thoughts below.

References and Resources

  1.  Klebsiella – Bacterial Dysbiosis, Detection and Treatment
  2. Ankylosing Spondylitis – Muhammad Asim Khan
  3. Ankylosing Spondylitis – Michael H. Weisman
  4. Ankylosing spondylitis is linked to Klebsiella—the evidence
  5. Reactive arthritis – M. Leirisalo-Repo
  6. Ankylosing Spondylitis, HLA-B27 and Klebsiella – An Overview: Proposal for early diagnosis and Treatment
  7. Gut inflammation and microbiome in spondyloarthritis
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  1. Hello. I was diagnosed with bilateral scleritis mid January. I had surgery on left knee for meniscus tear 1-7-20. That same night I started feeling pressure in my right eye. Initially diagnosed 1-22 with episcleritis then by 2-13 w/ actual scleritis. Have been treating first w/ prednisone drops & now FML drops. 2-14 started 2 wks of 2400 mg Advil & then 3-2 started 2 wks Aleve.Trying to avoid high dose Prednisone or Methrotrexate. Functional Med doctor just informed me have significant overgrowth of Klebsiella after doing stool test. Doing AI diet, taking lots of supplements & trying to heal gut. Before all this, ate very healthy, exercised 6 days wk & took supplements. Could this Klebsiella overgrowth be causing my scleritis? Rheumatologist & Fun Med doctors have run very extensive blood work. Negative on everything (other than a few HHV’s 3, 4, 5, 6) CRP .1 sed rate 5. Thank you.

    1. Hi Vicki,

      Thanks for sharing your experience here.

      I have come across a number of papers linking klebsiella and disorders of the eye (endophthalmitis, scleritis). I believe this would be something your doctor could test for directly (as opposed to testing the gut).

  2. Hi Todd, It is recommended to avoid consuming starchy foods when Klebsiella is present. But I worry that this means underfeeding beneficial gut bacteria. Do you know of any prebiotics/vegetable foods that would feed the beneficial bacteria, but not Klebsiella pneumoniae?

  3. Hi I have ankylosing spondylitis. I recently had a comprehensive stool test done and it showed up that I have two different strains of klebsiella. I was wondering if you’ve worked with people with AS before and if so, if you were able to cure them of the disease?

  4. Hello…
    I’ve suffered from ankylosing spondylitis for about 50 years, after first symptoms about age 20. About five years ago I was “elevated” to psoriatic arthritis. I’d be grateful for any suggestions you might have to address the cause. I’m looking for a cure. My several rheumatologists have only treated symptoms, not real problem.
    Thanks, Phil

    1. Hi Phil,

      Depending on your case a good quality stool test would help. I am leaning more and more towards OAT tests from Great Plains to get a whole health picture. Often AS and even psoriatic arthritis has an infectious trigger (bacteria, viral…occasionally mould or fungal). If this isn’t found and addressed patients often go around in circles treatment wise.



  5. Hi Todd, I have chronic AS and have found that quality Probiotics could help to fight with Kiebsiella, there are heaps of Probiotics in the market but the top most brand have below strains;
    Lactobacillus rhamnosus CUL 63 15.6 billion CFU*
    Lactobacillus casei CUL 06 9.5 billion CFU
    Lactobacillus acidophilus CUL 21 + CUL 60 7.4 billion CFU
    Bifidobacterium animalis ssp. lactis CUL 34 4.3 billion CFU
    Lactobacillus plantarum CUL 66 3.2 billion CFU
    Streptococcus thermophilus CUL 68 2.3 billion CFU
    Lactobacillus fermentum CUL 67 1.4 billion CFU
    Bifidobacterium breve CUL 74 1.4 billion CFU
    Bifidobacterium bifidum CUL 20 225 million CFU

    Do you think take 2 tablets of above strains can help to eradicate this bug issue, I am on low starch and Keto diet, would appreciate if you can advise any particular product in market. Thanks

    1. Hi Jawad,
      L. reuteri DSM17938 can be helpful for Klebsiella. Shifting the gut towards a more acidic environment with tolerated prebiotics or even butyrate combined with herbal medicine is my approach!

  6. Hello!
    I have a high overgrowth of klebsiella on the GI Map. Excruciating stomach pain and diarrhea began a month after being in a coma and life support for 10 days. I was given tons of drugs and antibiotics via IV during this time and after as well. Later diagnosed with “Crohn’s”. Never had Crohn’s before any of this. Feels like I have food poisoning everyday. GI Map results showed no toxic pathogens, h pylori, parasites etc. Just major dysbiosis and high inflammation. Also overgrowth of streptococcus and enterococcus. Elastase is low. Zonulin high. Do you think this could be healed with the herbal protocol? I don’t feel that immunosuppressive drugs or steroids are the answer or address the root cause. I personally think Crohn’s is simply leaky gut and SIBO. The bacteria go through the tight junctions causing an immune response and inflammation. And it keeps going until it’s fixed. What do you think?

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