Prostatic abscess due to Burkholderia pseudomallei: 81 cases from a 19-year prospective melioidosis study

We review the epidemiology, clinical presentation, management and outcome of prostatic abscess secondary to Burkholderia pseudomallei infection in the Northern Territory, Australia. We highlight the frequency of prostatic abscess occurrence in melioidosis, and formulate recommendations for its detection and management.

We reviewed a prospective database of all culture confirmed melioidosis cases in the Northern Territory between October 1989 and July 2008. This review was supplemented with data obtained from a review of case notes and postmortem records during the same period.

There were 514 patients with 561 episodes of melioidosis, and of these patients 394 (70%) were male. A prostatic abscess was identified, usually by computerized tomography, in 81 (21%) of these episodes, in 77 patients. In 75 (93%) of the 81 episodes there was clinical evidence of prostatic infection or positive urine culture for B. pseudomallei. Kava use and hazardous alcohol use were independent predictors of prostatic abscesses compared to male patients without prostatic abscesses. All were treated with antibiotics and in 57 of the 81 episodes the abscesses were drained. Ultrasound guided needle drainage was used in 51 instances and open drainage in 28 (transurethral 13, transrectal 11, transperineal 4). There were 20 patients who underwent multiple procedures while 24 underwent no procedures.

Prostatic abscess is common in melioidosis. Clinical signs are usually present but may be subtle. Detection is enhanced by routine computerized tomographic screening of the abdomen and pelvis for occult visceral abscesses in all cases of melioidosis. Ultrasound guided needle drainage is adequate initial therapy in conjunction with appropriate antibiotics.