Hepatic/splenic abscess and/or skin and soft tissue infection as predictors of melioidosis in children

Abstract

Introduction: Melioidosis can have multiple organ involvement which can then mimic other infections. The aim of this study was to determine if there are any factors significantly associated with melioidosis which can inform diagnostic evaluations before receiving the results of confirming laboratory testing. Methodology: The charts of patients aged < 16 years admitted to Songklanagarind Hospital during 2002-2014 with a clinical presentation suspicious of melioidosis were reviewed. Results: Of the 145 suspected cases, 27 patients had a confirmed diagnosis of melioidosis by either serology and/or culture. The melioidosis group had a higher proportion of patients with liver or splenic abscess (44.4% vs. 11.9%, p < 0.01) and were less likely to have splenomegaly by physical examination (3.7% vs. 22.9%, p = 0.02) than patients without melioidosis. Logistic regression analysis found that patients suspected of melioidosis who had (a) hepatic abscess or (b) splenic abscess or (c) skin or soft tissue infection were more likely to have melioidosis with likelihood ratios of 5.6, 4.0, and 2.2 respectively, and specificities of 0.94, 0.89, and 0.68 respectively. Suspected patients who did not have hepatic abscess, splenic abscess, or soft tissue infection were unlikely to have melioidosis with negative predictive value of 0.90. Conclusion: patients who have clinically suspected melioidosis without skin or soft tissue infection should have hepatic-splenic ultrasonography performed, and suspected patients who have one of these 3 findings should be treated initially as melioidosis while waiting for culture or serologic test results.

Osteomyelitis and Septic Arthritis Due to Burkholderia pseudomallei: A 10-Year Retrospective Melioidosis Study From South China

“…In China, most melioidosis cases were reported in Hainan Province (Zheng et al, 2019;Wu et al, 2020;Zhu et al, 2020). B. pseudomallei can involve tissues and organs throughout the body and lead to variable clinical manifestations, ranging from mild localized abscess to invasive infections (Chanvitan et al, 2019;Gassiep et al, 2020;Wu et al, 2020). Bone and Joint Infection (BJI) caused by B. pseudomallei, including septic arthritis and osteomyelitis, is a rare but potentially severe infection which might end with bleak outcomes (Raja and Scarsbrook, 2016).…”

Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children

“…Splenic abscesses were documented in only 3% and 7% of Cambodian and Thai children, respectively, although it is unclear how many children in total had imaging performed (Lumbiganon and Viengnondha, 1995;Pagnarith et al, 2010). A more recent study from Thailand, however, reported liver and/or spleen abscesses in 44% of cases (Chanvitan et al, 2019). In Sabah (another Malaysian Bornean state), spleen abscesses were detected in 67% of those who had abdominal imaging (Fong et al, 2015).…”

Newly detected pediatric melioidosis cases in a single referral children’s hospital in Ho Chi Minh City indicate the probable under-recognition of melioidosis in South Vietnam

“…Previous studies in Malaysia showed that a majority of pediatric melioidosis cases had occult liver and spleen abscesses, although clinical features of the abdomen were silent [12,13,33]. Hepatic and splenic abscesses have recently been suggested as predictors for children suspected of having melioidosis in South Thailand [34].…”