Melioidosis and the Heart: A Systematic Review

Abstract

Melioidosis is caused by Gram-negative bacterium Burkholderia pseudomallei. Clinical presentation can vary from pneumonia, sepsis and multi-focal abscess formation. The aim of this study was to systemically review the cardiac manifestations of melioidosis in the literature and describe their epidemiology, microbiological diagnosis and outcomes. A systematic review of the peer-reviewed literature was carried out in PubMed and Google Scholar for human melioidosis cases with cardiac involvement. Quantitative data for cases of melioidosis were obtained, including age, sex, microbiological diagnosis, treatment, and outcome. 980 articles were screened, of which 31 articles were eligible. The most common cardiac site of infection was pericarditis, followed by endocarditis and myocarditis. Over 95% of cardiac involvement occurred in males, and mortality was the lowest in pericarditis and highest in myocarditis. Valvular vegetations were all small, left-sided, and did not require surgery. Antibiotic treatment included a bactericidal induction therapy with ceftazidime or a carbapenem ± TMP-SMX, followed by eradication therapy with TMP–SMX in most patients as previously established. In conclusion, melioidosis varies in clinical presentation and is also known as a great imitator. Although cardiac involvement is rare, this is the first systematic review to summarise all cases reported in the literature to date.

Microbiome and metabolome features of the cardiometabolic disease spectrum

“…Among eight species enriched in IHD, two were Betaproteobacteria of the Burkholderiales order. Interestingly, Burkolderia pseudomallei is reported as a possible cause of endocarditis 26 . A single species, an uncharacterized Ruminococcus depleted in IHD, was an IHD escalation marker (Fig.…”

Melioidosis complicated with pericardial effusion - An emerging disease with a rare presentation

“…The other risk factors for melioidosis were found to be male gender, chronic smoking, alcoholism, chronic lung disease, malignancy, congestive cardiac disease, rheumatic heart disease and immunosuppression. 3,8 While most of the patients with cardiac melioidosis recovered following medical management, few recovered only after surgical intervention like pericardiectomy, whereas few patients with risk factors reported to develop recurrent pericarditis. 5,7 Here in our case also, no surgical interventions were needed and the patient was treated with intravenous ceftazidime after which clinical improvement was observed.…”

“…Treatment of melioidosis involves two phases, induction therapy with ceftazidime or meropenem followed by eradication therapy with cotrimoxazole. 3 There is definitely a surge in the number of melioidosis cases in India and lack of awareness among the clinician is one of the important reasons for it being misdiagnosed which leads to false treatment or delay in the treatment. Melioidosis is of public health importance and hence should be diagnosed at the earliest and appropriate management should be done to avoid mortality.…”

“…The incidence of cardiac involvement in melioidosis is less than 1%; however there has been a notable increase in the reports of melioidosis with cardiac involvement in the past decade. 3 Here we present a case of disseminated melioidosis, complicated with pericardial effusion.…”

Enfermedad de Whitmore en paciente diabético

“…El diagnóstico debe ser mediante laboratorios, dado a las características clínicas y las variables e inespecíficas presentaciones, se debe estudiar mediante más de un método de identificación microbiológica, preferiblemente los moleculares; especialmente, los sistemas Phoenix y MALDI TOF, este último es un procedimiento rápido y preciso para la identificación de la bacteria; sin embargo se puede identificar la bacteria mediante hemocultivos donde generalmente demuestra resistencia a penicilina y aminoglucósidos (1,(7)(8)(9).…”