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

Abstract

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.

Melioidosis in Bihar, India: unearthing the first of many?

“…CT scans of the neck, thorax and abdomen in the present case revealed multiple abscesses in the lungs, spleen, soft tissues of the shoulder joint and prostate. Khiangte et al report increased mortality in patients with imaging findings in the lungs [21]. They also report an increased association of splenic and musculoskeletal involvement in diabetic hosts, as was the case with our patient.…”

Osteomyelitis and Septic Arthritis Due to Burkholderia pseudomallei: A 10-Year Retrospective Melioidosis Study From South China

“…In Thailand, in 7126 culture-confirmed melioidosis cases from 2012 to 2015, the most common comorbidities reported were also diabetes mellitus (43%), followed by hypertension (15%) and CKD (11%) (Hantrakun et al, 2019). By comparison, in India, in 189 cultureproven melioidosis patients, those with diabetes were at a higher risk of musculoskeletal involvement (OR 2.14) (Khiangte et al, 2019). Diabetes was estimated to increase the risk of melioidosis by 100fold (Raja and Scarsbrook, 2016).…”

“…Having the isolation of B. pseudomallei strains from bone, marrow, joint fluid, or synovial biopsy, or 2. Having all of the following 4 conditions: ⑴ evidence of osteomyelitis or septic arthritis on direct examination of the bone or joint during a surgical operation, or histopathologic examination or radiographic evidence of infection (e.g., abnormal findings on x-ray, CT scan, MRI, radiolabel scan, ⑵ at least 2 of the following signs or symptoms with no other recognized cause: fever (≧38.8°C), localized swelling, tenderness, heat, or drainage at suspected site of bone infection, or joint pain, swelling, tenderness, heat, evidence of effusion or limitation of motion, ⑶ B. pseudomallei cultured from blood, and ⑷ other potential pathogens excluded (Horan et al, 2008;Saavedra-Lozano et al, 2017;Glaudemans et al, 2019;Khiangte et al, 2019). Mortality is determined based on a record of death within the hospitalization days in the routine hospital database (Hantrakun et al, 2019).…”

Melioidosis, an emerging infectious disease in the Midwest Brazil

“…Respiratory complication is associated with a severe form of infection, presenting a higher risk of mortality compared to the involvement of other organs or systems. Empyema, consolidation and nodules are common features of lung and pleural melioidosis, [11] as described in this case.…”