Melioidosis: Spectrum of radiological manifestations

Abstract

Melioidosis, a bacterial infection caused by Burkholderia pseudomallei is expanding in its endemicity around the world. Melioidosis most commonly infects adults with an underlying predisposing condition, mainly diabetes mellitus. Primary skin and soft tissue involvement is more common in younger patients. Almost every organ can be affected, but the most commonly affected organ is the lung followed by the spleen. Melioidosis has a wide range of radiological manifestations making it a mimicker. Diagnosis requires a high index of clinical suspicion in patients with septicemia or a fever of unknown origin living in or with a travel history to endemic areas. We present a pictorial review of the radiological manifestations of melioidosis, which is a useful knowledge for radiologists to help arrive at an early diagnosis. In this pictorial review, we present the radiological manifestations chosen from 139 patients with culture proven melioidosis. Illustrated examples are chosen from our clinical experience of the past 15 years at the National University Hospital in Singapore.

Disseminated Melioidosis Presenting with Community-Acquired Pneumonia: A Presentation Not to be Missed – A Case Report

“…Melioidosis may display a wide array of clinical features, ranging from asymptomatic to clinical conditions such as pneumonia, encephalomyelitis, musculoskeletalrelated infections, and genitourinary infections [2]. Indeed, the lungs are the most commonly affected organ in patients with melioidosis [4], [5]. Upper lobe involvement is the most common, classical radiological finding in melioidosis presenting with pneumonia and has been frequently reported [4], [5].…”

“…Indeed, the lungs are the most commonly affected organ in patients with melioidosis [4], [5]. Upper lobe involvement is the most common, classical radiological finding in melioidosis presenting with pneumonia and has been frequently reported [4], [5]. So much so, that when a case of upper lobe pneumonia is identified within a melioidosis endemic area, physicians should consider melioidosis as one of their differential diagnoses [6].…”

Melioidosis: Can tropical infections present in nonendemic areas? A case report and review of the literature

“…[5] Thus, having knowledge about this disease and its manifestations may help physicians take appropriate steps to make an early diagnosis. [6]…”

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

“…Because the clinical presentation of melioidosis is often unspecific and the laboratory capacity for microbiological confirmation is frequently limited in endemic areas, establishing the diagnosis remains challenging, and many cases are likely missed. However, because abscess formation (especially in the liver, spleen, and soft tissue, although prostatic abscesses were additionally reported in Northern Australia) is frequently observed in melioidosis and easily assessable by ultrasound, [7][8][9] we hypothesized that POCUS might provide a valuable adjunct diagnostic tool to corroborate the diagnosis and allow early initiation of effective antimicrobial treatment. The latter is critical because melioidosis has an overall case fatality rate of up to 40%, 9 and B. pseudomallei requires treatment with ceftazidime or a carbapenem, two drugs not often used as first-line empiric treatment of sepsis.…”