Mycotic aneurysm secondary to melioidosis in China: A series of eight cases and a review of literature

Abstract

Burkholderia pseudomallei is the causative agent of melioidosis, endemic in Southeast Asia and Northern Australia, and increasingly recognized in southern China, especially in Hainan Province. Mycotic aneurysm caused by B. pseudomallei is a rare but potentially severe illness with a high mortality rate. The clinical features of the mycotic aneurysm secondary to melioidosis have not been illustrated in China. Over a seven-year period (2013 to 2019), 159 patients with bacteremic melioidosis were retrospectively analyzed in Hainan province, China, of whom eight patients were confirmed to have mycotic aneurysm through the combination of imaging examination, pathologic examination and aneurysm tissue culture. We summarized these eight patients' clinical characteristics, demographical features, treatments and outcomes. The susceptibilities to five commonly-used antibiotics for these eight B. pseudomallei isolates were also determined by E-test strips. Furthermore, the mycotic aneurysm cases secondary to melioidosis retrieved from the literature were also reviewed. Of the eight cases, six had abdominal mycotic aneurysms, one had a left iliac aneurysm, and the other one had an infectious mesenteric aneurysm. They were aged from 48 to 69 years old, and had the underlying risk factors of diabetes mellitus (2 patients), long-term smoking (4 patients), hypertension (6 patients), and soil and water contact history (6 patients), respectively. The positive arterial aneurysm imaging was observed in all patients via computed tomography (CT) or angiography. Eight B. pseudomallei isolates collected from both blood and mycotic aneurysm tissues remained 100% susceptible to imipenem and ceftazidime. After surgery combined with antibiotic administration, six patients survived, with a mortality rate of 25%. In melioidosis endemic areas, the mycotic aneurysm secondary to melioidosis might be underdiagnosed, and increased awareness of predisposing risk factors and clinical features of the mycotic aneurysm is required. Following a positive B. pseudomallei blood culture, the diagnosis of mycotic aneurysm should be under consideration in PLOS NEGLECTED TROPICAL DISEASES

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

“…Global mortality rates of human melioidosis vary between 9% and 70% (Gassiep et al, 2020). Similarly, as we reported previously, in 159 bacteremic melioidosis patients, 42 died with a mortality rate of 26.4% (Wu et al, 2020), whereas in melioidosis osteomyelitis and septic arthritis patients in the present study, the mortality rate was 20.5% (9/44). Relapse is one of the most important complications of human melioidosis with an incidence ranging from 6% to 23% (McRobb et al, 2014;Li et al, 2017;Perumal Samy et al, 2017).…”

“…A marked male predominance is observed in melioidosis studies (Gassiep et al, 2020;Klimko et al, 2020;Wu et al, 2020). It was infrequently documented that female was overrepresented in the bone and joint cohort (Weerachai Kosuwon, 2003).…”

“…Burkholderia pseudomallei might cause melioidosis through inhalation or percutaneous inoculation, endemic in Southeast Asia and Northern Australia (Limmathurotsakul et al, 2016;Dance and Limmathurotsakul, 2018;Chakravorty A, 2019;Gassiep et al, 2020). In China, most melioidosis cases were reported in Hainan Province (Zheng et al, 2019;Wu et al, 2020;Zhu et al, 2020). B. pseudomallei can involve tissues and organs throughout the body and lead to variable clinical manifestations, ranging from mild localized abscess to invasive infections (Chanvitan et al, 2019;Gassiep et al, 2020;Wu et al, 2020).…”

“…In China, most melioidosis cases were reported in Hainan Province (Zheng et al, 2019;Wu et al, 2020;Zhu et al, 2020). B. pseudomallei can involve tissues and organs throughout the body and lead to variable clinical manifestations, ranging from mild localized abscess to invasive infections (Chanvitan et al, 2019;Gassiep et al, 2020;Wu et al, 2020). Bone and Joint Infection (BJI) caused by B. pseudomallei, including septic arthritis and osteomyelitis, is a rare but potentially severe infection which might end with bleak outcomes (Raja and Scarsbrook, 2016).…”

“…Melioidosis has been studied in mainland China over the past twenty years, but there is a limited description in the literature of the infection involving bone, joints, and soft tissues (Dong et al, 2018;Wu et al, 2019;Zheng et al, 2019;Wu et al, 2020;Zhu et al, 2020). Herein, 44 cases of melioidotic osteomyelitis and septic arthritis were reported with the aim of determining the prevalence of rheumatological involvement in melioidosis patients in China, and describing their clinical characteristics in terms of demographic and clinical profiles, treatment, and outcomes (Teparrakkul et al, 2008).…”