BURKHOLDERIA PSEUDOMALLEI AS THE PREDOMINANT CAUSE OF SPLENIC ABSCESS IN KAPIT, SARAWAK, MALAYSIAN BORNEO

Authors

  • Chee Yik Chang Department of Medicine, Hospital Sultanah Aminah, Johor, Malaysia

DOI:

https://doi.org/10.55519/JAMC-02-11390

Keywords:

Splenic abscess, Melioidosis, Burkholderia pseudomallei, Ultrasonography

Abstract

Background: Splenic abscess is an uncommon condition, with autopsy studies estimating an incidence rate of 0.14–0.70%. Causative organisms can be extremely diverse. Burkholderia pseudomallei is the most common cause of splenic abscess in melioidosis-endemic areas. Methods: We reviewed 39 cases of splenic abscesses in a district hospital in Kapit, Sarawak, from January 2017 to December 2018. The demographics, clinical characteristics, underlying diseases, causative organisms, therapeutic methods, and mortality rates were investigated. Results: There were 21 males and 18 females (mean age, 33.7±2.7 years). Almost all patients (97.4%) had a history of pyrexia. Diabetes mellitus was present in 8 patients (20.5%). Splenic abscesses were diagnosed using ultrasonography and were multiple in all 39 cases. Positive blood cultures were obtained in 20 patients (51.3%), and all yielded B. pseudomallei. Melioidosis serology was positive in 9 of 19 patients (47.4%) with negative blood cultures. All patients were treated for melioidosis with antibiotics without the need for surgical intervention. All splenic abscesses resolved after anti-melioidosis treatment was completed. One patient died (2.6%) as a result of B. pseudomallei septicaemia with multiorgan failure. Conclusion: Ultrasonography is a valuable tool for diagnosing splenic abscesses in resource-limited settings. B. pseudomallei was the most common etiological agent of splenic abscesses in our study. Background: Splenic abscess is an uncommon condition, with autopsy studies estimating an incidence rate of 0.14–0.70%. Causative organisms can be extremely diverse. Burkholderia pseudomallei is the most common cause of splenic abscess in melioidosis-endemic areas. Methods: We reviewed 39 cases of splenic abscesses in a district hospital in Kapit, Sarawak, from January 2017 to December 2018. The demographics, clinical characteristics, underlying diseases, causative organisms, therapeutic methods, and mortality rates were investigated. Results: There were 21 males and 18 females (mean age, 33.7±2.7 years). Almost all patients (97.4%) had a history of pyrexia. Diabetes mellitus was present in 8 patients (20.5%). Splenic abscesses were diagnosed using ultrasonography and were multiple in all 39 cases. Positive blood cultures were obtained in 20 patients (51.3%), and all yielded B. pseudomallei. Melioidosis serology was positive in 9 of 19 patients (47.4%) with negative blood cultures. All patients were treated for melioidosis with antibiotics without the need for surgical intervention. All splenic abscesses resolved after anti-melioidosis treatment was completed. One patient died (2.6%) as a result of B. pseudomallei septicaemia with multiorgan failure. Conclusion: Ultrasonography is a valuable tool for diagnosing splenic abscesses in resource-limited settings. B. pseudomallei was the most common etiological agent of splenic abscesses in our study.

References

Lee WS, Choi ST, Kim KK. Splenic abscess: a single institution study and review of the literature. Yonsei Med J. 2011;52(2):288-92.

Ng KK, Lee TY, Wan YL, Tan CF, Lui KW, Cheung YC, et al. Splenic abscess: diagnosis and management. Hepatogastroenterology. 2002;49(44):567-71.

Radcliffe C, Tang Z, Gisriel SD, Grant M. Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series. Open Forum Infect Dis. 2022;9(4):ofac085.

Chang CY, Lau NLJ, Currie BJ, Podin Y. Disseminated melioidosis in early pregnancy - an unproven cause of foetal loss. BMC Infect Dis. 2020;20(1):201.

Sangchan A, Mootsikapun P, Mairiang P. Splenic abscess: clinical features, microbiologic finding, treatment and outcome. J Med Assoc Thai. 2003;86(5):436-41.

Vancauwenberghe T, Snoeckx A, Vanbeckevoort D, Dymarkowski S, Vanhoenacker FM. Imaging of the spleen: what the clinician needs to know. Singapore Med J. 2015;56(3):133-44.

Chang CY. Periorbital cellulitis and eyelid abscess as ocular manifestations of melioidosis: A report of three cases in Sarawak, Malaysian Borneo. IDCases. 2019;19:e00683.

Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DAB, Limmathurotsakul D. Melioidosis. Nat Rev Dis Primers. 2018;4:17107.

Mohan A, Manan K, Tan LS, Tan YC, Chin ST, Ahmad R, et al. Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children. Int J Infect Dis. 2020;98:59-66.

Yik CC. Ruptured splenic abscess and splenic vein thrombosis secondary to melioidosis: A case report. J Acute Dis. 2020;9:89–92.

Additional Files

Published

2023-05-16

Issue

Vol. 35 No. 2 (2023): JOURNL OF AYUB MEDICAL COLLEGE ABBOTTABAD

Section

SHORT COMMUNICATION

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Copyright (c) 2023 Chee Yik Chang

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