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Pulmonary melioidosis: clinical-radiologic correlation in 183 cases in northeastern Thailand
T Dhiensiri1, S Puapairoj, W Susaengrat
1Department of Radiology, Khon Kaen Regional Hospital, Thailand.
Abstract:
The chest radiographs of 183 patients with pulmonary melioidosis seen over a 4-year period were evaluated retrospectively. Disseminated nodular lesions occurred in 46 of 55 patients (84%) with the acute septicemic form of the disease and in 17 of 31 (55%) with the subacute or chronic form and positive blood cultures. Alveolar lesions occurred in 26 of 50 patients (52%) with the acute pneumonic form. There was no typical pattern of pulmonary infiltrates in 16 patients with the subacute pneumonic form, but in the chronic form, 17 of 31 patients (55%) had mixed infiltrates with cavities. The lesions were confluent in the upper lobes but tended to spare the apices in nonsepticemic cases. Rapid progression and early cavitation are distinctive features in acute cases, but in chronic cases the lesions may remain unchanged up to 20 months. Pleural effusion or empyema was seen in 22 of 105 patients (21%) with acute disease and four of 31 (13%) with chronic disease. Six of 105 patients (6%) with acute disease and three of 31 (10%) with subacute or chronic disease and positive blood cultures had pericardial involvement.
Insights
Pulmonary melioidosis chest X-rays reveal distinct patterns. Acute septicemic forms show disseminated nodules, while chronic cases present mixed infiltrates with cavities, aiding diagnosis.
Area of Science:
- Radiology
- Infectious Diseases
- Pulmonary Medicine
Background:
- Melioidosis is a serious bacterial infection caused by Burkholderia pseudomallei.
- Pulmonary involvement is common and can present with diverse radiographic findings.
- Accurate interpretation of chest radiographs is crucial for timely diagnosis and management.
Purpose of the Study:
- To retrospectively analyze chest radiographic findings in patients with pulmonary melioidosis.
- To identify characteristic patterns associated with different clinical forms of the disease.
- To correlate radiographic features with disease severity and outcomes.
Main Methods:
- Retrospective review of chest radiographs from 183 patients diagnosed with pulmonary melioidosis over a 4-year period.
- Classification of patients based on clinical presentation (septicemic, pneumonic, chronic).
- Detailed analysis of lesion types (nodular, alveolar, infiltrates, cavities) and their distribution.
Main Results:
- Disseminated nodular lesions were frequent in acute septicemic (84%) and subacute/chronic forms with positive blood cultures (55%).
- Alveolar lesions were observed in 52% of acute pneumonic cases.
- Chronic forms showed mixed infiltrates with cavities in 55%, often in upper lobes, sparing apices in non-septicemic cases.
- Rapid progression and early cavitation were noted in acute cases; chronic lesions could persist for up to 20 months.
- Pleural effusion/empyema occurred in 21% of acute and 13% of chronic cases.
- Pericardial involvement was seen in 6% of acute and 10% of chronic cases with positive blood cultures.
Conclusions:
- Chest radiography plays a vital role in diagnosing pulmonary melioidosis.
- Distinct radiographic patterns, including nodular, alveolar, and mixed infiltrates with cavitation, can help differentiate clinical forms.
- Radiographic features like rapid progression and cavitation are characteristic of acute disease, aiding in early recognition and treatment.