Isolated liver abscesses in melioidosis

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.