Primary melioidotic prostatic abscess: presentation, diagnosis and management
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Published on: March 2, 2020
James K Tan1, Sidney K H Yip, Damian J C Png
1Division of Urology, National University Hospital, Singapore.
Introduction:
In South-East Asia and Northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community-acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare.
Methods:
The presenting features, investigations and management outcome of five patients who developed melioidotic prostatic abscesses from 1997 to 2000 were reviewed in the present study.
Results:
The mean age at presentation was 53 years (range: 29-69). Old age and diabetes mellitus were predisposing factors. All patients had a fever of at least 38.5 degrees C and presented with obstructive urinary symptoms culminating in urinary retention. Presence of prostatic abscess was demonstrated by transrectal ultrasound in all cases. The abscesses were drained with transurethral resection of the prostate. One patient required re-resection while another patient developed severe septic shock requiring intensive care and -inotropic support. There was no mortality in our series.
Conclusions:
Elderly diabetic men presenting with fever and urinary tract obstruction in endemic areas may harbour an unusual but potentially life threatening melioidotic prostatic abscess. Transrectal ultrasound and bacteriological confirmation are mandatory. Prompt surgical drainage coupled with appropriate antibiotics are keys to a favourable outcome.
Insights
Melioidosis, a severe sepsis cause in endemic areas, rarely presents as a prostatic abscess. Early diagnosis via transrectal ultrasound and prompt treatment are crucial for recovery.
Area of Science:
- Infectious Diseases
- Urology
- Tropical Medicine
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a significant cause of severe sepsis in Southeast Asia and Northern Australia.
- Prostatic abscesses are an uncommon presentation of melioidosis.
Purpose of the Study:
- To review the clinical features, diagnostic methods, and treatment outcomes of patients with melioidotic prostatic abscesses.
- To highlight the rarity and potential severity of this presentation.
Main Methods:
- Retrospective review of five patients diagnosed with melioidotic prostatic abscesses between 1997 and 2000.
- Analysis of presenting symptoms, diagnostic investigations (including transrectal ultrasound), and management strategies.
Main Results:
- The average patient age was 53 years, with older age and diabetes mellitus identified as predisposing factors.
- All patients presented with fever (≥38.5°C) and obstructive urinary symptoms, including urinary retention.
- Transrectal ultrasound confirmed prostatic abscesses, which were treated with transurethral resection. One patient experienced severe septic shock, but there was no mortality.
Conclusions:
- Elderly diabetic men in endemic regions presenting with fever and urinary obstruction should be evaluated for melioidotic prostatic abscess.
- Transrectal ultrasound and bacteriological confirmation are essential for diagnosis.
- Effective management involves prompt surgical drainage and appropriate antibiotic therapy.
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