A Retrospective Case–Control Study to Evaluate the Diagnostic Accuracy of Honeycomb Sign in Melioid Liver Abscess

Khiangte, Hannah L.; Vimala, Leena Robinson; Eapen, Anu; Veeraraghavan, Balaji; Karuppusami, Reka; Gibikote, Sridhar

doi:10.4269/ajtmh.18-0395

Cited by 12 publications

(12 citation statements)

References 25 publications

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“…A retrospective study in patients with culture-proven melioidosis in India demonstrated that 23/189 (12%) had liver abscesses, a similar proportion to the 11% in our study. 11 In Thailand, a prospective observational study in 230 patients with culture-confirmed melioidosis found one or more abscesses in the liver and/or spleen in 77 (33%) patients, 12 similar to the 28% observed in our study. Other studies have demonstrated that the combination of liver and splenic abscesses can be predictive for melioidosis.…”

supporting

confidence: 86%

“…Finally, we used a low-cost ultrasound machine, which may have limited the detection of very small abscesses as well as the morphological characteristics suggestive of melioidosis (such as the "necklace" or "honeycomb" appearance previously described in melioidosis). 11 Nevertheless, we intentionally opted for using simple equipment and simple image characteristics, as these more realistically reflect the conditions under which POCUS is applied. Furthermore, by adding a linear probe for screening of the spleen and soft tissue, we allowed for more sensitive detection of small abscess.…”

mentioning

confidence: 99%

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Point-of-Care Ultrasound in the Diagnosis of Melioidosis in Laos

Huson

Kling

Chankongsin

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Melioidosis is endemic in many rural areas in Southeast Asia where facilities for culture and identification of Burkholderia pseudomallei are often limited. We performed a prospective observational study in patients presenting with fever to Mahosot Hospital, the primary referral hospital in Laos, to establish whether the detection of abscesses on ultrasound could support a presumptive diagnosis of melioidosis. All patients underwent ultrasound examination to detect abscesses in the liver, spleen, prostate, or, if indicated, subcutaneous tissue. We enrolled 153 patients, including 18 patients with melioidosis. Of these, 11 (61%) had an abscess at one or more sites, including five (28%) with splenic and/ or liver abscesses. Absence of abscesses cannot rule out melioidosis, but the positive predictive value of abscesses for melioidosis was high at 93% (88-96%). Therefore, in endemic areas, the presence of abscesses in febrile patients should prompt empiric antibiotic therapy for melioidosis even in the absence of culture confirmation.

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confidence: 86%

mentioning

confidence: 99%

Point-of-Care Ultrasound in the Diagnosis of Melioidosis in Laos

Huson

Kling

Chankongsin

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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“…Melioid abscesses in the liver could be larger or smaller. Honeycomb sign is found to be specific for melioidosis [38]. Abscesses in the liver and spleen are not commonly encountered in tuberculosis, whereas they are common with other pyogenic infections.…”

Section: Discussionmentioning

confidence: 99%

Can the imaging manifestations of melioidosis prognosticate the clinical outcome? A 6-year retrospective study

et al. 2019

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Objective Melioidosis 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. Methods From 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. Results Out 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. Conclusions In 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.

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“…For prostatic abscesses, ultrasound has a sensitivity of approximately 85%, compared with 99% by CT (472). With regard to liver abscesses, the CT scan "honeycomb sign," described as an abscess with multiple similar-size loculations separated by thin septa, has a sensitivity of 85%, a tion of melioidosis visceral abscesses appears to favor CT scan (472,494). However, in resource-limited settings, ultrasound evaluation of all bacteremic melioidosis cases may be warranted.…”

Section: Imagingmentioning

confidence: 99%

Human Melioidosis

2020

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SUMMARY The causative agent of melioidosis, Burkholderia pseudomallei, a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.

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A Retrospective Case–Control Study to Evaluate the Diagnostic Accuracy of Honeycomb Sign in Melioid Liver Abscess

Cited by 12 publications

References 25 publications

Point-of-Care Ultrasound in the Diagnosis of Melioidosis in Laos

Point-of-Care Ultrasound in the Diagnosis of Melioidosis in Laos

Can the imaging manifestations of melioidosis prognosticate the clinical outcome? A 6-year retrospective study

Human Melioidosis

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