Pitfalls and optimal approaches to diagnose melioidosis

Abstract

Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

Melioidosis in Malaysia: A Review of Case Reports

“…Because of the protean manifestations, the disease is often misdiagnosed and mistreated. Our previous paper discusses pitfalls and optimal approached to diagnosing melioidosis [59]. Early recognition is the cornerstone of management.…”

Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis

“…The disease is characterized by abscess formation in multiple organs and is referred to as ‘the great mimicker’ because of its similarity to other infections that obscure its correct diagnosis [ 38 ]. The pitfalls and optimal approaches to diagnosis have been previously reviewed by Kingsley et al [ 43 ] and are highlighted in a latter section.…”

“…Less than 10% of cases were chronic in onset (symptoms more than two months), presenting as chronic pneumonia, chronic skin ulcers/abscesses, and disseminated infection progressing to sepsis, while subclinical infections have also been documented. The major reasons for emergency hospital admissions were acute pulmonary infection progressing to acute respiratory failure, acute bacteraemia progressing to septic shock, severe soft tissue infection, or pyrexia of unknown origin [ 31 , 37 , 43 ].…”

Comparison of mast Burkholderia cepacia, ashdown + gentamicin, and Burkholderia pseudomallei selective agar for the selective growth of Burkholderia spp.

“…Melioidosis presents with unspecific symptoms and remains often unrecognized by the first responder, i.e., the clinician at a private practice or a local hospital especially in nonendemic areas where the physicians are unaware of the disease [6]. Blood culture in case of sepsis and subsequent culture on standard routine media result in unspecific growth, comparable to that of many other Gramnegative nonglucose fermenting rod-shaped bacteria like Pseudomonas spp.…”