Melioidosis and the Heart: A Systematic Review

Melioidosis is caused by Gram-negative bacterium Burkholderia pseudomallei. Clinical presentation can vary from pneumonia, sepsis and multi-focal abscess formation. The aim of this study was to systemically review the cardiac manifestations of melioidosis in the literature and describe their epidemiology, microbiological diagnosis and outcomes. A systematic review of the peer-reviewed literature was carried out in PubMed and Google Scholar for human melioidosis cases with cardiac involvement. Quantitative data for cases of melioidosis were obtained, including age, sex, microbiological diagnosis, treatment, and outcome. 980 articles were screened, of which 31 articles were eligible. The most common cardiac site of infection was pericarditis, followed by endocarditis and myocarditis. Over 95% of cardiac involvement occurred in males, and mortality was the lowest in pericarditis and highest in myocarditis. Valvular vegetations were all small, left-sided, and did not require surgery. Antibiotic treatment included a bactericidal induction therapy with ceftazidime or a carbapenem ± TMP-SMX, followed by eradication therapy with TMP–SMX in most patients as previously established. In conclusion, melioidosis varies in clinical presentation and is also known as a great imitator. Although cardiac involvement is rare, this is the first systematic review to summarise all cases reported in the literature to date.

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Disseminated melioidosis with native valve endocarditis: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz097 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Hariharan Subramony ◽

Sengottuvelu Gunasekaran ◽

Vinodh Kumar Paul Pandi

Keyword(s):

Infective Endocarditis ◽

Burkholderia Pseudomallei ◽

Cardiac Involvement ◽

Clinical Presentation ◽

South East Asia ◽

Northern Australia ◽

Native Valve ◽

Gram Negative ◽

Native Valve Endocarditis ◽

Case Summary

Abstract Background Burkholderia pseudomallei is a Gram negative, soil-water saprophytic bacterium endemic in South-East Asia and Northern Australia. Melioidosis is being increasingly diagnosed in other regions like India, China, and Sri Lanka during recent years. The clinical presentation of melioidosis is extremely variable. Case summary We present a case of melioidosis presenting as native valve infective endocarditis with concomitant hepatic and splenic abscesses. This is the second case of melioidosis with infective endocarditis reported from India. Discussion Melioidosis can present with pneumonia, pleural effusion, subcutaneous abscesses, visceral abscesses, osteomyelitis, and septicaemia, but cardiac involvement is rare. Endocarditis due to melioidosis is rare (∼1%) and is rarely reported in literature. This case highlights the unusual presentation of this emerging disease.

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Epidemiology of Neuromelioidosis in Asia-Pacific: A Systematic Review

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6688 ◽

2021 ◽

Vol 9 (F) ◽

pp. 318-326

Author(s):

Mohd ’Ammar Ihsan Ahmad Zamzuri ◽

Mohd Nazrin Jamhari ◽

Haniff Mohd Nawi ◽

Mohd Rohaizat Hassan ◽

Nicholas Tze Ping Pang ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Burkholderia Pseudomallei ◽

Web Of Science ◽

Rare Complication ◽

Eradication Therapy ◽

Neurological Complications ◽

Asia Pacific ◽

Asia Pacific Region ◽

Mortality And Morbidity

Introduction: Neuromelioidosis is a rare complication of melioidosis caused by Burkholderia pseudomallei, a Gram-negative bacterium commonly found in soil and surface water. Although cerebral involvement of melioidosis comprises only 4% of total complications, it significantly impacts mortality and morbidity. This study aims to perform a systematic review on various neurological complications of melioidosis in the Asia-Pacific region within the previous 5 years. Method: Systematic search was performed in PubMed, Web of Science databases and Google Scholar on neuromelioidosis complications published from 2015-2019. Results: Central nervous system (CNS) complications comprise 5% of all cases of melioidosis. 16 selected articles were analysed based on its risk factors like diabetes mellitus, chronic renal and lung disease, alcohol abuse, and immunosuppression. Neuromelioidosis is detected 6-14 days after the first presentation and confirmed by detailed investigations. Radioimaging helps to differentiate neuromelioidosis from other diagnoses such as meningitis or brain abscess. The majority of literature recommended 2-week intensive Ceftazidime or Meropenem therapy, followed by 3–6 months Trimethoprim and Sulfamethoxazole oral eradication therapy. Conclusion: Neuromelioidosis is rare, with relatively nonspecific CNS clinical features. Patients or travelers from endemic areas with risk factors should be treated cautiously. Radioimaging modalities aid early microbiological sampling and appropriate antibiotic therapy.

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MELIOIDOSIS PRESENTING AS PAROTID ABSCESS IN AN ADULT - A CASE REPORT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i3.987 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Jagadeesh Chandrasekaran ◽

Mathi Manoj Kumar Ravichandran ◽

Shobana Paulraj ◽

Venkatakarthikeyan Chokkalingam

Keyword(s):

Case Report ◽

Medical Treatment ◽

Burkholderia Pseudomallei ◽

Pediatric Population ◽

Splenic Abscess ◽

Tropical Disease ◽

Rare Entity ◽

Negative Bacterium ◽

Gram Negative ◽

Neurological Infections

Burkholderia pseudomallei, a facultative intracellular Gram-negative bacterium casuses melioidosis, a tropical disease which is more commonly reported these days. Melioidosis can present as visceral abscess, pneumonia, localized ulcers, musculoskeletal and neurological infections, even as full blown sepsis. Melioidosis presenting as parotid abscess is commonly reported among pediatric population, however in adults it is a rare entity with only very few cases being reported. There are very limited studies that have described melioidosis with abscess in unusual sites apart from liver and splenic abscess. Here we present a case of a diabetic male with left sided parotid abscess and on microbiological evaluation found to have melioidosis which was successfully treated with combined surgical and medical treatment.

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Melioidosis

KYAMC Journal ◽

10.3329/kyamcj.v4i1.32262 ◽

2017 ◽

Vol 4 (1) ◽

pp. 353-356

Author(s):

Nazia Haque ◽

Md Shafikul Bari ◽

Md Moinul Hoque ◽

Md Amirul Islam ◽

Syada Monira Hoque ◽

...

Keyword(s):

Clinical Features ◽

Burkholderia Pseudomallei ◽

Favourable Outcome ◽

Negative Bacterium ◽

Gram Negative ◽

Specific Diagnosis ◽

True Incidence ◽

Laboratory Facilities ◽

The World ◽

Important Disease

Melioidosis is an important disease caused by a Gram-negative bacterium, Burkholderia pseudomallei. The true incidence of melioidosis is unknown for most countries of the world including Bangladesh. Due to its increasing incidence in many countries of the world it is an important issue now days. Due to variability of clinical features and limited availability of laboratory facilities the disease remains largely under-reported.Early and specific diagnosis is important to ensure a favourable outcome regarding this disease. In this paper history, transmission, sign symptoms, diagnosis and prevention of melioidosis are critically reviewed to know about something regarding this diseaseKYAMC Journal Vol. 4, No.-1, July 2013, Page 353-356

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Clinical presentation and microbiological diagnosis in paediatric respiratory tract infection: a systematic review

British Journal of General Practice ◽

10.3399/bjgp15x683497 ◽

2015 ◽

Vol 65 (631) ◽

pp. e69-e81 ◽

Cited By ~ 13

Author(s):

Hannah V Thornton ◽

Peter S Blair ◽

Andrew M Lovering ◽

Peter Muir ◽

Alastair D Hay

Keyword(s):

Systematic Review ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Clinical Presentation ◽

Microbiological Diagnosis

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Avidity of IgG class antibodies to Francisella tularensis in the course of tularemia in humans

Medycyna Doświadczalna i Mikrobiologia ◽

10.32394/mdm.71.05 ◽

2019 ◽

pp. 43-50

Author(s):

Waldemar Rastawicki ◽

Karolina Śmietańska ◽

Natalia Rokosz-Chudziak ◽

Urszula Roguska

Keyword(s):

Francisella Tularensis ◽

Clinical Symptoms ◽

Active Phase ◽

Microbiological Diagnosis ◽

Igg Antibodies ◽

Negative Bacterium ◽

Avidity Index ◽

Serum Samples ◽

Recent Infection ◽

Gram Negative

Introduction: Tularemia is a highly infectious zoonotic disease caused by Gram-negative bacterium Francisella tularensis. The microbiological diagnosis of tularemia is based mainly on serological investigations. The present study was undertaken to determine the avidity of IgG class antibodies to Francisella tularensis in the course of tularemia in humans and to evaluate its value for estimation of the phase of diseases. Methods: Fifty two serum samples obtained from 40 patients with tularemia were tested by in-house ELISA in duplicate in the same plate, without and after the 0.5 h incubation with 8M urea. The age of the subjects was between 6 and 77 years. From one patient, a 9-years-old girl with oculoglandular form of tularemia, five serum samples were taken, respectively after 0.5, 1.5, 3, 6 and 12 months from the beginning of the first clinical symptoms. Results: The results of the study showed higher values of the avidity index (AI) of IgG antibodies for F. tularensis, often exceeding the value of 0.9, in children and adolescents than in adults. The examination of serum samples obtained 2-3 times in the course of tularemia from few patients did not show significant differences in the level of avidity index depending on the period of the disease. However, in five serum samples obtained from a 9-years-old girl in the different phases of tularemia the avidity index showed increasing values (0.51, 0.80, 0.92, 0.90 and 0.94, respectively). Conclusions: The avidity index of IgG may be helpful in excluding recent infection, but its usefulness in detecting an active phase of invasion requires further research.

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Melioidosis complicated with pericardial effusion - An emerging disease with a rare presentation

IP International Journal of Medical Microbiology and Tropical Diseases ◽

10.18231/j.ijmmtd.2021.025 ◽

2021 ◽

Vol 7 (2) ◽

pp. 116-119

Author(s):

Apurba Sankar Sastry ◽

Monika Sivaradjy ◽

Lokesh Koumar ◽

Lakshmi Shanmugam ◽

Ketan Priyadarshi ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Differential Diagnosis ◽

Pericardial Effusion ◽

Blood Culture ◽

Rare Case ◽

Cardiac Involvement ◽

Clinical Presentation ◽

Pericardial Fluid ◽

Rare Presentation ◽

Gram Negative

Melioidosis, caused by a non-fermenting gram negative bacilli, can mimic a variety of diseases due to its diverse clinical presentation. The incidence of cardiac involvement in melioidosis is less than 1%. We report a rare case of melioidosis in a 65 year old male with chronic kidney disease who presented with fever and pericardial effusion which was misdiagnosed and treated as tuberculous pericardial effusion. Later, on isolation of from paired blood culture samples, pericardial fluid and also from pleural fluid confirmed the diagnosis of disseminated melioidosis. The patient was treated with intravenous ceftazidime after which clinical improvement was observed. Cardiac melioidosis should always be considered in the differential diagnosis of tuberculous pericardial effusion and it should be ruled out before the start of anti-tubercular treatment. This will prevent unnecessary exposure to anti-tubercular drugs and also aids to start early treatment for melioidosis thereby reducing the mortality.

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