Abstract
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. The charts of patients aged < 16 years admitted to Songklanagarind Hospital during 2002-2014 with a clinical presentation suspicious of melioidosis were reviewed. 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. 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.
Highlights
Melioidosis can have multiple organ involvement which can mimic other infections
We retrospectively reviewed the medical records of all children with clinically suspected melioidosis who visited the outpatient clinic of or who were admitted to Songklanagarind Hospital, the major tertiary care and referral center in southern Thailand, during January 2002-December 2014
Clinical characteristics of confirmed and nonconfirmed melioidosis patients During the 13-year study period, there were 145 patients suspected of having melioidosis, of whom 27 were confirmed to have melioidosis (5 cases confirmed by both culture and serology, 11 cases confirmed by culture only and 11 cases confirmed by serology only)
Summary
Melioidosis can have multiple organ involvement which can mimic other infections. 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. There are other tests used to diagnose melioidosis, such as the indirect hemagglutination antibody (IHA) test or immunofluorescent assays for immunoglobulin M or G (IFA IgM, IgG), which have sensitivities of 76% and 73% and specificities of 91% and 99%, respectively [9,10] Another method used to diagnose melioidosis is the polymerase chain reaction (PCR) to detect Burkholderia pseudomallei, but PCR testing is not available in many hospitals in Thailand
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
