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Oral Melioidosis in Odontogenic Keratocyst of Mandible
Subham S Agarwal1, A Abdul Hafeez1, Santhosh Rao1
1Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Raipur, India.
Abstract:
Melioidosis is a potentially fatal, life-threatening infection caused by the gram-negative saprophytic organism Burkholderia. It is a disease endemic to Southeast Asia and Northern Australia. This infection transmits through direct contact, cutaneous inoculation, inhalation, or ingestion, and patients clinically exhibit abscesses in single or multiple organs. It is clinically under-reported due to a low index of suspicion, lack of diagnostic facilities, and misdiagnosis as tuberculosis. Infections of the musculoskeletal system are exceedingly rare, and clinical presentation may vary from the involvement of femoral bone, palmar tenosynovitis, and parietal bone osteomyelitis secondary to central nervous system involvement. The rarity of the melioidosis to secondarily infect a developmental odontogenic cyst leading to focal osteomyelitis of mandible prompts the clinician toward thorough evaluation for early diagnosis and treatment.
Insights
Melioidosis, a severe infection from Burkholderia, is endemic in Southeast Asia and Australia. This rare case highlights melioidosis secondary to an odontogenic cyst, causing mandibular osteomyelitis, emphasizing the need for early diagnosis.
Area of Science:
- Infectious Diseases
- Microbiology
- Oral and Maxillofacial Surgery
Background:
- Melioidosis is a severe infection caused by Burkholderia, endemic in Southeast Asia and Northern Australia.
- Transmission occurs via direct contact, inhalation, or ingestion, often presenting as abscesses.
- Under-reporting is common due to low suspicion, diagnostic challenges, and misdiagnosis as tuberculosis.
Observation:
- Musculoskeletal infections from melioidosis are rare.
- Clinical presentations include femoral bone involvement, tenosynovitis, and osteomyelitis.
- This case details a rare instance of melioidosis secondarily infecting a developmental odontogenic cyst.
Findings:
- The infection led to focal osteomyelitis of the mandible.
- This secondary infection highlights an unusual presentation of melioidosis.
- Early diagnosis and treatment are crucial for managing such rare complications.
Implications:
- This case underscores the importance of considering melioidosis in diverse clinical presentations, even in non-endemic areas.
- Highlights the need for advanced diagnostic capabilities to identify rare infectious disease presentations.
- Emphasizes the potential for infectious organisms to cause secondary infections in pre-existing pathologies like odontogenic cysts.
