Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children

Mohan, Anand; Manan, Kamilah; Tan, Lee-See; Tan, Yee-Chin; Chin, Shi-Tying; Raza, Ahmad; Hamli, Qairul Irwan; Chuah, Teik-Beng; Chien, Su-Lin; Lau, Peter Sie-Teck; Podin, Yuwana; Ooi, Mong-How

doi:10.1016/j.ijid.2020.06.025

Cited by 10 publications

(12 citation statements)

References 42 publications

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“…This percentage is considerably higher than the 7%-22% in other study cohorts [16][17][18]20]. Hence, bedside ultrasound scan in the acute setting may be helpful in the early detection of melioidosis [22]. We also observed that patients with septic shock tend to develop acute kidney injury, as there were significant differences in serum bicarbonate, urea and creatinine levels.…”

Section: Discussionmentioning

confidence: 58%

“…The initial choice of empirical antibiotics for serious febrile illnesses were Cpenicillin and ceftazidime. Bedside ultrasound scans were routinely performed in casualty for early identification of liver or splenic abscesses to confirm the clinical suspicion of melioidosis [22]. We believe that the synergistic effect of early detection of melioidosis with bedside abdominal ultrasonography and initiation of melioidosis antibiotics may be the main reason for the low mortality rate at our centre.…”

Section: Discussionmentioning

confidence: 92%

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Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience

Toh

Tee

Lee³

2021

Tropical Med Int Health

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objectives Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. The aim of this study is to delineate the epidemiology and predictors of mortality from melioidosis in Kapit district, Sarawak.methods For this retrospective study of patients with culture-confirmed melioidosis admitted to Kapit Hospital, Sarawak, Malaysia, between July 2016 and July 2019, epidemiological, clinical and microbiological data were obtained. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality.results Seventy three patients met inclusion criteria. Diabetes mellitus (28.8%) and hypertension (27.4%) were primary co-morbidities. Clinical spectrum of melioidosis ranged from bacteraemia (64.4%), pneumonia (61.6%) and internal organ abscesses (49.3%) to localised soft tissue (21.9%) and joint abscesses (6.9%). Mortality rate was 12.3%. Bacteraemia and pneumonia were significantly associated with septic shock, whereas patients with soft tissue abscesses tended to present with a milder form of melioidosis without septic shock. Septic shock, mechanical ventilation, intensive care unit admission, serum urea, creatinine, bicarbonate, albumin and aspartate transaminase were all significantly associated with increased mortality on univariate analysis (all P < 0.05). Multivariate analysis revealed that low serum bicarbonate (P = 0.004, OR 0.64, 95% CI 0.48-0.87) and albumin (P = 0.031, OR 0.73, 95% CI 0.54-0.97) could be associated with a higher mortality.conclusion Melioidosis remains a fatal infection and commonly presents with septic shock, in the form of bacteraemia and pneumonia. Two routine clinical parameters, serum bicarbonate and serum albumin, may have important prognostic implications in septicaemic melioidosis.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 92%

Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience

Toh

Tee

Lee³

2021

Tropical Med Int Health

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“…Thus, the spleen is the second most affected organ (after the lungs). Interestingly, the spleen was also found to be one of the commonest affected organs in children with melioidosis in this region [ 34 ]. In comparison, splenic abscesses are detected in only 25% and 5% of melioidosis patients in Thailand and Australia, respectively [ 29 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-SusceptibleBurkholderia pseudomalleiin Sarawak, Malaysia

Sia

Mohan

Ooi

et al. 2021

Open Forum Infectious Diseases

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Background Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections. Methods We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016. Results One-hundred and forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B. pseudomallei. The average annual incidence of melioidosis was 12·3 per 100,000 population, with marked variation between districts ranging from 5·8-29·3 per 100,000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B. pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections. Conclusions Gentamicin-susceptible B. pseudomallei infections are common in Sarawak and dominate in the high incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B. pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B. pseudomallei in Sarawak are clonal and to ascertain their environmental drivers and niches.

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“…The spleen was the most common organ affected in disseminated infections; occult splenic abscesses were present in 85% (11/13) of children with disseminated disease and in 58% (11/19) overall. As previously reported, detection of splenic abscesses by abdominal ultrasonography offers a useful and rapid clue to melioidosis diagnosis [ 46 ]. In addition, the detection of occult splenic abscesses in children with seemingly localized head and neck melioidosis in this study is also important in view of recent suggestions that localized infections might adequately be treated with oral antibiotics alone [ 21 ].…”

Section: Discussionmentioning

confidence: 89%

Fine-needle aspiration to improve diagnosis of melioidosis of the head and neck in children: a study from Sarawak, Malaysia

et al. 2021

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Background Melioidosis, the infection caused by Burkholderia pseudomallei, is associated with a high case fatality rate, due in part to difficulties in clinical recognition and diagnostic confirmation of the disease. Although head and neck involvement is common in children, specific disease manifestations differ between geographic regions. The aim of this study was to provide a detailed description of melioidosis of the head and neck among children in Sarawak, Malaysia, and determine if fine-needle aspiration of suspected head or neck lesions could improve melioidosis diagnosis. Methods We conducted a retrospective descriptive study of all children aged < 12 years with culture-confirmed melioidosis presenting with head and neck manifestations and admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2020. Fine-needle aspiration of head and neck lesions suspected to be due to melioidosis with inoculation in blood culture bottles (FNA + BCB) was used from the beginning of 2016. Results Of 34 children with culture-confirmed melioidosis, 20 (59%) had an infection involving one or more sites in the head and neck. Of these, 17 (85%) were diagnosed in or after 2016. Cervical lymph nodes were the most common organ or site affected, involved in 19 (95%) children. Clinical presentations of B. pseudomallei lymph node infections were highly variable. Five (25%) children had salivary gland involvement. Lacrimal gland involvement (dacryocystitis) and skin or soft tissue infection (scalp abscess) were less frequent. B. pseudomallei was isolated from the head or neck using FNA + BCB in 15 (75%) children and by standard culture methods of direct plating of pus on agar following incision and drainage in only 2 (10%) children. B. pseudomallei was isolated from non-head or neck specimens or blood in 3 (15%) children. Conclusions Manifestations of pediatric head and neck melioidosis in Sarawak, Malaysia, differ from those of other regions. Fine-needle aspiration, mainly of affected cervical lymph nodes, facilitates B. pseudomallei detection and enables confirmation of melioidosis infections.

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Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children

Cited by 10 publications

References 42 publications

Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience

Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience

Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-SusceptibleBurkholderia pseudomalleiin Sarawak, Malaysia

Fine-needle aspiration to improve diagnosis of melioidosis of the head and neck in children: a study from Sarawak, Malaysia

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