A traveller presenting with severe melioidosis complicated by a pericardial effusion: a case report

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.

Disseminated melioidosis with native valve endocarditis: a case report

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.

A review of melioidosis cases imported into Europe

Melioidosis is a tropical bacterial infection, rarely encountered, and poorly known by clinicians. In non-endemic areas, a misdiagnosis can lead to a fatal outcome. This study aims to identify the main characteristics of imported and diagnosed melioidosis cases in Europe to increase clinician's awareness of this diagnosis. A literature review of imported and diagnosed human melioidosis cases in Europe was performed. PubMed and Web of Science search engines were used for retrieving articles from 2000 to November 2018. Seventy-seven cases of imported melioidosis into Europe described in the literature were identified. More than half of the cases were acquired in Thailand (53%) by men (73%). Patients were usually exposed to Burkholderia pseudomallei during a holiday stay (58%) of less than 1 month (23%) and were hospitalized during the month following their return to Europe (58%). Among travelers, melioidosis is less often associated with risk factor (16%), diabetes being the most frequently comorbidity related (19%). The clinical presentation was multifaceted, pneumonia being the most common symptom (52%), followed by cardiovascular form (45%) and skin and soft tissues damages (35%). The diagnosis was obtained by culture (92%), often supplemented by morphological, biochemical, and molecular identification (23%). Misdiagnoses were common (21%). Over half of the patients received a complete and adapted treatment (56%). Mortality is lower for returning traveler (6%). Imported melioidosis cases into Europe have their own characteristics. This possibility should be considered in patients with pneumonia, fever, and/or abscess returning from endemic areas even years after.

Melioidosis: an unusual cause of infective endocarditis: a case report

INTRODUCTION

As a causal organism in infective endocarditis, Burkholderia pseudomallei is rare. Burkholderia pseudomallei is intrinsically resistant to aminoglycosides but a gentamicin-susceptible strain was discovered in Sarawak, Malaysian Borneo in 2010. We report the first occurrence of infective endocarditis due to the gentamicin-susceptible strain of B. pseudomallei.

CASE PRESENTATION

A 29-year-old man presented with pneumonia and melioidosis septicaemia. His condition was complicated with infective endocarditis and septic emboli to the brain. Despite difficulties in reaching a diagnosis, the patient was successfully treated using intravenous gentamicin and ceftazidime and was discharged well.

DISCUSSION

The role of gentamicin in the treatment of the gentamicin-susceptible strain of B. pseudomallei remains unclear.

Melioidosis in Travelers: Review of the Literature

BACKGROUND

Melioidosis is a bacterial infection endemic essentially in Southeast Asia and northern Australia. In temperate areas, the infection is extremely rare and is almost always imported by travelers or immigrants. The infection may affect almost any organ in the body, with various degrees of severity.

METHODS

We reviewed the literature on melioidosis in travelers. For this purpose we searched PubMed and Google for relevant articles up to July 2015.

RESULTS

We have identified 72 cases of melioidosis in travelers published in the literature. Melioidosis in travelers was acquired mostly in Thailand (46% of cases). The mean duration of stay in the endemic area was 36 days (range 7-330 days). Symptoms usually started at 23 days (range 1-360 days) after leaving the endemic area. The clinical presentation was varied, sepsis being the most common (34%) followed by pneumonia (29%) and abscess formation (25%). Melioidosis in travelers was less often associated with predisposing risk factors (37.5%), diabetes mellitus being the most common (21%), and had lower mortality (17%) than had the infection in autochthonous cases in Southeast Asia.

CONCLUSIONS

Melioidosis in travelers has its own characteristics, which distinguish it from other autochthonous diseases in indigenous populations. The possibility of melioidosis should be considered not only in patients originating from endemic areas, but also in patients returning from travel in those regions.

Melioidosis with a Pericardial Effusion, which Relapsed as a Chest Wall Abscess: A Rare Presentation

Melioidosis, which is caused by a soil saprophyte, Burkholderia pseudomallei, is most prevalent in the south-west coast of India. Although it is frequently seen in immunocompromised patients, melioidosis can occur in apparently normal individuals. Melioidosis can involve almost any organ. A relapse of melioidosis is usually associated with a poor adherence to the eradication therapy, a multifocal involvement and bacteraemia. A relapsing melioidosis is usually known to follow a similar pattern of organ involvement in the first and second episodes of the infection. We are discussing here, a rare case of melioidosis in a 38-year-old construction-worker, with no risk factors, who presented initially with a pericardial effusion. It relapsed 6 months after he completed the prescribed eradication therapy for 3 months, as an anterior chest wall abscess. The author recommends a high index of suspicion for the relapsed melioidosis cases, inspite of the primary episode being non-bacteraemic and compliant with the recommended therapy, in order to avoid further complications.