Splenic abscess and association with melioidosis in an endemic region: A retrospective review of 39 cases in Kapit, Sarawak, Malaysian Borneo

Abstract

Background: Splenic abscess is an uncommon condition with an estimated incidence rate of 0.05–0.7% in autopsy studies. Causative microorganisms can be very diverse. However, in areas where melioidosis is endemic, Burkholderia pseudomallei is the most frequent cause of splenic abscess. Methods and materials: We analyzed retrospectively a total of 39 cases of splenic abscesses in a district hospital in Kapit, Sarawak during the period of January 2017 to December 2018. The demographics, clinical characteristics, underlying diseases, causative organism, therapeutic methods, and mortality rates were analyzed. Results: There were 21 males and 18 females (mean age, 33.7 ± 2.7 years). Almost all patients (38 patients, 97.4%) had a history of pyrexia. Diabetes mellitus was present in 8 patients (20.5%). Splenic abscesses were diagnosed using ultrasonography due to the unavailability of computed tomography and were multiple in all 39 cases. Four out of 39 patients had extra-splenic abscess, namely liver abscess (1 patient) and eyelid abscess (3 patients). Positive blood cultures were obtained in 20 patients (51.3%) and all yielded B. pseudomallei. ELISA for melioidosis was positive in 9 out of 19 patients (47.4%) with negative blood cultures. All patients were treated for melioidosis with antibiotic therapy without the need for surgical intervention. Treatment was highly effective, as all splenic abscesses resolved upon completion of anti-melioidosis treatment. Death occurred in 1 patient (2.6%) due to B. pseudomallei septicaemia with multiorgan failure. Conclusion: Ultrasonography serves as an important tool for diagnosis of splenic abscess in resource-limited settings. B. pseudomallei was the most common aetiological agent of splenic abscesses in our study. In the treatment of melioidosis with splenic abscesses, antibiotic therapy alone would suffice.