Visceral abscess in melioidosis

A retrospective analysis was done in 81 patients with visceral abscess due to melioidosis treated at Khon Kaen Hospital, northeastern Thailand from 1985 to 1993. The clinical presentations were fever 100 per cent, abdominal pain 39 per cent, cough 34.8 per cent, abdominal tenderness 27.5 per cent and palpable mass 24.6 per cent. The laboratory findings were not diagnostic of the etiology. The abscesses were detected by ultrasonography in 97.25 per cent and computed tomography 2.25 per cent. The lesions were found in the spleen 72.8 per cent, liver 45.7 per cent, kidney 12.3 per cent and prostate gland 2.5 per cent. Seventy-six per cent of the patients had diseases in multiple organs (viscera, lungs and others). The preliminary diagnoses were fever of unknown origin, septicemia and urinary tract diseases in one-half of the cases. Patients presenting with fever of unknown origin from an endemic area, like northeastern Thailand, should arouse suspicion of melioidosis and search for the organism is advised. Diagnostic imaging methods, ultrasonography and computed tomography are valuable tools for detection of a solid internal organ abscess.