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Published on: February 24, 2023
Isolated liver abscesses in melioidosis
A Mukhopadhya1, V Balaji, M V Jesudason
1Department of Gastrointestinal Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu, India. ashis@cmcvellore.ac.in
Abstract:
Melioidosis is a suppurative chronic infection caused by a gramnegative bacterium, Burkholderia pseudomallei. We report two patients who presented with isolated liver abscesses caused by this pathogen. Both patients presented with high-grade fever and abdominal pain. On examination they were toxic and had tender hepatomegaly. Investigations showed leucocytosis and a shift to the left. Early diagnosis of melioidosis was made by culture and growth of Burkholderia pseudomallei from aspirated pus from the abscesses and the patients were treated with ceftazidime and co-trimoxazole. Despite institution of antibiotics both the patients succumbed to their illness. Melioidosis is an emerging infection in the Indian subcontinent and can cause isolated liver abscesses.
Insights
Melioidosis, a chronic infection from Burkholderia pseudomallei, can cause isolated liver abscesses. Early diagnosis and treatment were unsuccessful in two patients, highlighting the severity of this emerging infection.
Area of Science:
- Infectious Diseases
- Microbiology
- Hepatology
Background:
- Melioidosis is a severe suppurative infection caused by Burkholderia pseudomallei, a gram-negative bacterium.
- The infection is increasingly recognized in the Indian subcontinent.
- Liver abscesses are a potential, though less common, manifestation of melioidosis.
Observation:
- Two patients presented with clinical signs of severe illness, including high-grade fever, abdominal pain, toxicity, and tender hepatomegaly.
- Leukocytosis with a left shift was noted in laboratory investigations.
- Burkholderia pseudomallei was identified as the causative agent through pus culture from isolated liver abscesses.
Findings:
- Despite prompt diagnosis and treatment with ceftazidime and co-trimoxazole, both patients with isolated liver abscesses due to Burkholderia pseudomallei succumbed to the infection.
- The study highlights the potential for melioidosis to present as isolated liver abscesses.
- The cases underscore the aggressive nature of this infection even with appropriate antimicrobial therapy.
Implications:
- Melioidosis should be considered in the differential diagnosis of liver abscesses, particularly in endemic regions.
- The findings suggest a need for improved diagnostic and therapeutic strategies for melioidosis, especially for severe presentations.
- Further research is warranted to understand the pathogenesis and optimize treatment outcomes for melioidosis-induced liver abscesses.
