Abstract
ObjectiveMelioidosis being an important cause of community-acquired sepsis, caused by Burkholderia pseudomallei in the tropical and subtropical countries, is often underreported or misinterpreted on imaging investigations. We aim to describe the spectrum of imaging manifestations of melioidosis and to evaluate its role in prognosticating clinical outcome, and look for association of specific organ involvement with risk factors.MethodsFrom January 2011 to October 2017, retrospective analysis of imaging investigations of 189 consecutive patients with culture-proven melioidosis was performed. Clinical and demographic records were collected from the hospital medical records.ResultsOut of 67% with a localised disease musculoskeletal involvement was most common, whereas the common organs involved in disseminated infections were the lungs, spleen, liver and genitourinary tract in descending order. Twenty percent suffered unfavourable outcome with a mortality rate of 8.5%. The lung involvement was associated with unfavourable outcome (OR 3.2 [95%CI 1.54–6.63] p = 0.002). The lymph node involvement (OR 0.22 [95% CI 0.05–0.95] p = 0.04) predicted a favourable outcome. Those with diabetes were at a higher risk of splenic (OR 3.05 [95% CI 1.62–5.77]; p = 0.001) and musculoskeletal involvement (OR 2.14 [95% CI 1.09–4.17] p = 0.03) of melioidosis.ConclusionsIn this study, we have described the spectrum of imaging manifestation of melioidosis and evaluated its association with clinical outcome. Respiratory system involvement in melioidosis showed significant association with unfavourable outcome. Diabetes mellitus, a common risk factor for melioidosis, is more prone for infection of the spleen and musculoskeletal system. Thus awareness of imaging manifestations of melioidosis can complement microbiological diagnostic tests for accurate early diagnosis and management.
Highlights
Melioidosis is an important cause of community-acquired sepsis in the tropical and subtropical countries being well documented in Southeast Asia and northern Australia [1, 2]
We aim to describe the imaging manifestations of melioidosis and to analyse the organ involvement which could predict unfavourable outcome, and evaluate the association between the organ imaging manifestation and known risk factors/predisposing conditions
Lab diagnosis of Burkholderia pseudomallei was made on pus culture in 95 patients and on blood culture in 79 patients
Summary
Melioidosis is an important cause of community-acquired sepsis in the tropical and subtropical countries being well documented in Southeast Asia and northern Australia [1, 2]. Sporadic case reports from India were noted by Cheng et al [1] in 2005, most of the Indian subcontinent is recognised endemic for melioidosis since 2008 [3]. Along with the expansion in human travel and movement, and climate change, there is a risk of imported infection worldwide and extension in the boundaries of endemic melioidosis [3, 8]. The reported mortality rate from the published literature in endemic countries varied from up to 58% in 2003 [13] and 9 to 25% in recent years [14, 15]
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