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.
Highlights
Melioidosis was first characterised by Whitmore and Krishnaswami in 1912 as a glanders-like disease, yet distinguishable from glanders [1]
A century later, we understand the causative agent for melioidosis to be Burkholderia pseudomallei, previously known as Pseudomonas pseudomallei
The epidemiology and risk factors of melioidosis have been well described in the literature
Summary
Melioidosis was first characterised by Whitmore and Krishnaswami in 1912 as a glanders-like disease, yet distinguishable from glanders [1]. A century later, we understand the causative agent for melioidosis to be Burkholderia pseudomallei, previously known as Pseudomonas pseudomallei. This Gram-negative organism is found abundantly in soil and water in endemic regions such as northern regions of Australia and South East Asia, increasing reports have emerged in South America and South Asia. Humans acquire melioidosis through percutaneous inoculation or inhalation during exposure to contaminated soil or water [2]. The clinical presentation of melioidosis remains diverse, with acute, subacute, latent and disseminated infections reported. As higher mortality rates are associated with delayed commencement of appropriate treatment [4]
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