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Melioidosis of the head and neck
W K Lim1, G S Gurdeep, K Norain
1ENT Department, Hospital Ipoh, Perak.
Abstract:
Melioidosis is a potentially deadly infection that can affect any organ system. Reports of melioidosis of the ENT/head and neck region are relatively uncommon. Four cases are presented: (i) parotid abscess evolving into necrotising fasciitis, (ii) acute sinusitis and parapharyngeal cellulitis resulting in upper airway obstruction, (iii) acute suppurative lymphadenitis (iv) and chronic suppurative otitis media causing meningoencephalitis. Three of the four cases are believed to be unique, as a literature review of melioidosis in ENT/head and neck is also presented. Some practical issues of management are also discussed. Not suspecting melioidosis does not change contemporary empirical broadspectrum antibiotic therapy. The value of suspicion or on confirmation of diagnosis lies in anticipating and planning for rapid change.
Insights
Melioidosis, a severe infection, can affect the head and neck, though rarely. Early suspicion and prompt management are crucial for better outcomes in these uncommon ENT/head and neck melioidosis cases.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Microbiology
Background:
- Melioidosis is a severe systemic infection caused by Burkholderia pseudomallei.
- While affecting any organ, head and neck manifestations are infrequent.
- This study focuses on rare presentations of melioidosis within the Ear, Nose, and Throat (ENT) region.
Observation:
- Four distinct cases of head and neck melioidosis are detailed.
- Case 1: Parotid abscess progressing to necrotizing fasciitis.
- Case 2: Sinusitis and parapharyngeal cellulitis leading to airway compromise.
- Case 3: Acute suppurative lymphadenitis.
- Case 4: Chronic otitis media complicated by meningoencephalitis.
Findings:
- Three of the presented cases represent unique occurrences in the literature.
- A comprehensive literature review on ENT/head and neck melioidosis is included.
- Management strategies and practical considerations are discussed.
Implications:
- While empirical broad-spectrum antibiotics remain standard, early suspicion is vital.
- Prompt diagnosis allows for tailored treatment and anticipation of rapid clinical changes.
- Increased awareness of rare head and neck melioidosis presentations is necessary for timely intervention.