Periorbital cellulitis and eyelid abscess as ocular manifestations of melioidosis: A report of three cases in Kapit, Sarawak, Malaysian Borneo

Abstract

Background: Melioidosis is an infection caused by the Gram-negative bacterium Burkholderia pseudomallei. It can virtually affect any organ and result in a broad spectrum of diseases. Ocular involvement in melioidosis is rare with a prevalence rate of 0.49–1.02%, but can potentially lead to devastating outcomes. Case Description: We describe ocular manifestations in three patients diagnosed with culture-confirmed melioidosis in Kapit, Sarawak, Malaysian Borneo. Two of them were farmers with underlying diabetes mellitus, which predisposed them to melioidosis. The principal clinical features invariably include fever and unilateral eye swelling. All of them were diagnosed with eyelid abscesses; periorbital cellulitis was associated in two patients. Surgical drainage of the eyelid abscess was performed and was useful for diagnostic purposes. Two patients had concomitant pneumonia and splenic abscesses as part of disseminated septicaemia. In all three patients, B. pseudomallei was identified in the blood and pus culture. All of them received intravenous ceftazidime as intensive phase therapy and subsequently completed eradication phase therapy. Post-treatment, our patients achieved total resolution of eyelid and splenic abscesses without any long-term ophthalmic complications. Discussion: Yaisawang et al. in her case series of ocular involvement in melioidosis reported orbital cellulitis as the most common manifestation of ocular melioidosis, followed by endophthalmitis, preseptal cellulitis, panophthalmitis, and panuveitis. This is in contrary to our observation whereby eyelid abscess, either occurs in isolation or association with periorbital cellulitis was the most common presentation in our setting. Conclusion: Melioidosis affecting the eye can present as periorbital cellulitis and eyelid abscess. High clinical suspicion and early empirical treatment were key to a successful outcome. Surgical drainage of the abscess was an important part of management beyond standard antibiotic therapy.