Melioidosis in Malaysia: A Review of Case Reports

Abstract

BackgroundMelioidosis is a tropical infectious disease associated with significant mortality due to early onset of sepsis.ObjectiveWe sought to review case reports of melioidosis from Malaysia.MethodsWe conducted a computerized search of literature resources including PubMed, OVID, Scopus, MEDLINE and the COCHRANE database to identify published case reports from 1975 to 2015. We abstracted information on clinical characteristics, exposure history, comorbid conditions, management and outcome.ResultsOverall, 67 cases were reported with 29 (43%) deaths; the median age was 44 years, and a male preponderance (84%) was noted. Forty-one cases (61%) were bacteremic, and fatal septic shock occurred in 13 (19%) within 24–48 hours of admission; nine of the 13 cases were not specifically treated for melioidosis as confirmatory evidence was available only after death. Diabetes mellitus (n = 36, 54%) was the most common risk factor. Twenty-six cases (39%) had a history of exposure to contaminated soil/water or employment in high-risk occupations. Pneumonia (n = 24, 36%) was the most common primary clinical presentation followed by soft tissue abscess (n = 22, 33%). Other types of clinical presentations were less common—genitourinary (n = 5), neurological (n = 5), osteomyelitis/septic arthritis (n = 4) and skin (n = 2); five cases had no evidence of a focus of infection. With regard to internal foci of infection, abscesses of the subcutaneous tissue (n = 14, 21%) was the most common followed by liver (18%); abscesses of the spleen and lung were the third most common (12% each). Seven of 56 males were reported to have prostatic abscesses. Mycotic pseudoaneurysm occurred in five cases. Only one case of parotid abscess was reported in an adult. Of the 67 cases, 13 were children (≤ 18 years of age) with seven deaths; five of the 13 were neonates presenting primarily with bronchopneumonia, four of whom died. Older children had a similar presentation as adults; no case of parotid abscess was reported among children.ConclusionsThe clinical patterns of cases reported from Malaysia are consistent for the most part from previous case reports from South and Southeast Asia with regard to common primary presentations of pneumonia and soft tissue abscesses, and diabetes as a major risk factor. Bacteremic melioidosis carried a poor prognosis and septic shock was strong predictor of mortality. Differences included the occurrence of: primary neurological infection was higher in Malaysia compared to reports outside Malaysia; internal foci of infection such as abscesses of the liver, spleen, prostate, and mycotic pseudoaneurysms were higher than previously reported in the region. No parotid abscess was reported among children. Early recognition of the disease is the cornerstone of management. In clinical situations of community-acquired sepsis and/or pneumonia, where laboratory bacteriological confirmation is not possible, empirical treatment with antimicrobials for B. pseudomallei is recommended.

Characterization of Stress and Innate Immunity Resistance of Wild-Type and Δp66 Borrelia burgdorferi

“…Additionally, it has been documented that chronically hyperglycemic rodents have impairments of multiple components of the immune system. Bone marrow-derived dendritic cells isolated from chronically hyperglycemic mice have reduced phagocytic ability toward Burkholderia pseudomallei (67), a bacterial infection to which it is well known that human diabetics are more susceptible (68,69). In the same study, both isolated bone marrow-derived dendritic cells and peritoneally elicited macrophages from chronically hyperglycemic mice had a reduced ability to kill internalized B. pseudomallei (67).…”

Systemic Melioidosis with Acute Osteomyelitis and Septic Arthritis Misdiagnosed as Tuberculosis: A Case Report

“…Diabetes is the most important risk factor for melioidosis followed by heavy alcohol use, chronic pulmonary disease, chronic renal disease, etc. [3,[12][13][14]. To our surprise, none of the above risk factors were present in our patient.…”

Prostatic abscess: a rare complication of staghorn calculi

“…Like all abscesses, prostatic abscess is often associated with patients with diabetes and are immunocompromised, which was not a feature seen in our case. More interestingly, prostatic abscesses have been reported in patients who had melioidosis infection,12 coccidioidomycosis infection,13 postsalvage cryotherapy for prostate cancer14 and even in a child 15. A secondary cause to a staghorn calculus has not been reported before in the literature.…”