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Acute respiratory failure in melioidosis
S D Puthucheary1, J Vadivelu, K T Wong
1Department of Medical Microbiology, University Hospital, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. puthu@medicine.med.um.edu.my
Background:
In melioidosis caused by Burkholderia pseudomallei, although every organ in the body may be involved, the highest mortality of 73% occurs when the respiratory system is affected. These patients invariably die of acute respiratory failure. Most of them also have underlying predisposing factors like diabetes mellitus.
Aim Of Study:
A retrospective study of six such cases was carried out in order to elicit the possible causes and mechanisms of acute respiratory failure in patients with melioidosis.
Method:
Patients' records were reviewed for demographic, clinical, laboratory, radiological and histopathological data.
Results:
The rapidity of onset of respiratory failure was remarkable and was accompanied by relentless hypoxaemia that was refractory to treatment despite the application of high positive end expiratory pressure and other supportive measures. All had bilateral opacities on frontal chest radiographs, focal and diffuse necrotizing pneumonia and presence of hyaline membranes in lung tissues seen histologically, supporting the accepted criteria for ALI/ARDS.
Conclusion:
Patients with sepsis due to B. pseudomallei develop ALI/ARDS very rapidly resulting in high mortality rates. Possible mechanisms involved are discussed. Awareness of the disease in endemic areas, the development of rapid diagnostic methods and appropriate management procedures are urgently needed for the prevention of ARDS and subsequent reduction in mortality in such cases.
Insights
Melioidosis patients rapidly develop acute respiratory distress syndrome (ARDS) from Burkholderia pseudomallei sepsis, leading to high mortality. Early diagnosis and management are crucial for preventing ARDS and reducing deaths.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Melioidosis, caused by Burkholderia pseudomallei, frequently involves the respiratory system, leading to severe outcomes.
- High mortality rates, up to 73%, are associated with respiratory involvement in melioidosis.
- Predisposing factors such as diabetes mellitus are common in patients with melioidosis.
Observation:
- This retrospective study reviewed six cases of melioidosis with respiratory failure.
- Data analyzed included demographic, clinical, laboratory, radiological, and histopathological information.
- The focus was to understand the causes and mechanisms of acute respiratory failure in these patients.
Findings:
- Patients experienced rapid onset of hypoxemia refractory to treatment, indicating acute lung injury/acute respiratory distress syndrome (ALI/ARDS).
- Histological examination revealed necrotizing pneumonia and hyaline membranes, consistent with ALI/ARDS criteria.
- Radiographs showed bilateral opacities, further supporting the diagnosis of severe lung involvement.
Implications:
- Sepsis from B. pseudomallei can rapidly lead to ALI/ARDS and high mortality.
- Understanding the mechanisms of ARDS in melioidosis is critical for improving patient outcomes.
- Urgent needs include increased awareness in endemic areas, rapid diagnostics, and effective management strategies to prevent ARDS and reduce mortality.