Burkholderia Aortic Aneurysm: A Case Report and Review of the Literature

Abstract

Melioidosis is a frequently fatal infection caused by the Gram-negative bacillus Burkholderia pseudomallei endemic to Southeast Asia and Northern Australia. It is a rare imported pathogen in the United States and is a potential bioterror agent. We report the case of an 82-year-old previously healthy man who presented with 2 weeks of fever and epigastric pain after he returned from the Philippines. A diagnosis of nondissecting mycotic aneurysm in the descending thoracic aorta was made with the help of CT angiogram and positive blood cultures. The patient completely recovered with a 6-month antibiotic therapy followed by surgical repair of the aneurysm. Given the slight increase in the number of melioidosis cases reported by CDC since 2008, melioidosis might be considered an emerging infectious disease in the United States. The purpose of this report is to raise awareness of the disease among clinicians as well as travelers.

Mycotic aneurysm secondary to melioidosis in China: A series of eight cases and a review of literature

“…Mycotic aneurysm is a very infrequent presentation of melioidosis that might be missed [1,26]. Compared with melioidosis alone, mycotic aneurysm secondary to melioidosis might result in the rupture of the aneurysm, and is associated with high mortality rates [42].…”

“…Burkholderia pseudomallei is an aerobic Gram-negative, invasive bacillus, found in soil and stagnant water in tropical regions, and predominantly endemic to Southeast Asia and Australia [1][2][3][4]. Melioidosis, transmitted via percutaneous inoculation and inhalation of soil or water containing B. pseudomallei in the environment, is a potentially fatal infection, manifesting as acute, subacute, or chronic disease [5].…”

“…It was documented initially in 1995 that B. pseudomallei (named Pseudomonas pseudomallei at that time) caused pseudoaneurysm of the renal artery [8]. Afterwards, similar cases were reported worldwide [1,[9][10][11]. Most infected mycotic aneurysms by B. pseudomallei are located in the abdominal aorta [6,12].…”

Infected aneurysm after returning from Southeast Asia: thinkBurkholderia pseudomallei!

“…In the few reported cases, aneurysms secondary to melioidosis are often treated with long-term intravenous antibiotics (high dose ceftazidime or meropenem/imipenem 4–6 weeks) and then a course of oral antibiotics (sulfamethoxazole/trimethoprim 3–6 months) 1 8. Some drug combinations, like sulfamethoxazole/trimethoprim and doxycycline, remain questionable, due to an in vitro antagonism between both drugs.…”

“…However, given the rarity of cases, the level of evidence for managing melioidosis aneurysm remains very low. However, surgical removal of the aneurysm is always required 8. The timing is determined by estimating the risk of rupture and the surgical risk based on the patient’s general condition.…”