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Hepatic Melioidosis: A State-of-the-Art Review

Nitin Gupta1, Chiranjay Mukhopadhyay2, Sundeep Malla3

  • 1Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India.

Journal of Clinical and Experimental Hepatology
|June 29, 2026
PubMed

Insights

Hepatic melioidosis, a liver abscess caused by Burkholderia pseudomallei, often mimics other conditions in immunocompromised individuals. Early recognition of its unique clinical and imaging signs is crucial for effective treatment and improved patient outcomes.

Area of Science:

  • Infectious Diseases
  • Hepatology
  • Microbiology

Background:

  • Hepatic melioidosis is a serious Burkholderia pseudomallei infection affecting the liver, common in South and Southeast Asia.
  • It disproportionately impacts diabetic and immunocompromised individuals, presenting as a subacute or chronic liver abscess.
  • The condition often mimics other liver abscesses due to complex bacterial and host immune interactions.

Purpose of the Study:

  • To highlight the clinical, radiological, and microbiological characteristics of hepatic melioidosis.
  • To emphasize the importance of distinguishing it from other liver abscesses for timely diagnosis.
  • To outline current management strategies and areas for improvement.

Main Methods:

  • Review of clinical presentations and diagnostic challenges of hepatic melioidosis.
  • Analysis of characteristic imaging findings like the honeycomb and necklace signs.
  • Discussion of microbiological confirmation difficulties and treatment protocols.

Main Results:

  • Hepatic melioidosis presents insidiously, often mistaken for pyogenic or amoebic liver abscesses.
  • Specific imaging signs (honeycomb, necklace) can aid in differentiation.
  • Microbiological misidentification can delay diagnosis, impacting treatment initiation.

Conclusions:

  • Hepatic melioidosis is an underdiagnosed but significant cause of liver abscess in endemic areas.
  • Enhanced clinician awareness and improved laboratory diagnostics are vital for accurate and prompt management.
  • Optimal treatment involves intensive intravenous antibiotics followed by an eradication phase, with drainage reserved for specific cases.
Keywords:
Burkholderia pseudomalleiMelioidosishepatic abscesshoneycomb signnecklace sign

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