Melioidosis of the Parotid Gland: Lessons Learned from a Fatal Case

Meliodosis is an infectious disease also called whitemore's disease that can be fatal and is caused by the bacteria Burkholderia pseudomallei. This facultative intracellular aerobic gram-negative bacterium is typically transmitted through direct contact with contaminated water or soil (Currie et al. in Seminars in Respiratory and Critical Care Medicine 36:111-125, 2015). Endemic and widespread, it often affects individuals with underlying health conditions like diabetes, chronic lung disease, chronic renal disease, chronic liver disease, malignancy, connective tissue diseases, or on immunosuppressive treatment. The most common clinical presentation includes septicaemia, pneumonia, hepatic abscess, splenic abscess, skin and soft tissue infection, urinary tract infection and osteoarticular infection. Isolated parotid gland involvement in meliodosis is rare, particularly in adults, even in endemic regions. While parotid abscesses due to meliodosis are more commonly seen in children, where they account for 30-40% of cases, adult cases are much less frequent (Dance et al. in Journal of Infectious Diseases 159:654-60, 1989). According to a study by Tipre et al., which reviewed literature from 1953 to June 2016, only 4 out of 99 cases reported meliodosis involving parotid gland (Chandrasekaran et al. in International Journal of Medical and Biomedical Studies 22-24, 2020). Similarly, in another study by Mohanty et al., which focused on meliodosis of the head and neck in Eastern India, only three patients with the parotid gland involvement (Mohanty et al. in Infectious Disease Reports 12:36-45, 2020). This emphasize the rarity of this clinical presentation in adults and the limited documentation available in medical literature, even in regions where meliodosis is prevalent. Parotid gland meliodosis can mimic other conditions such as bacterial sialadenitis, or abscesses, making diagnosis challenging. It is critical to recognize this unusual manifestation because a delayed diagnosis can have serious consequences.