Bedside ultrasonography for rapid detection of splenic abscess in melioidosis

A 35-year-old farmer presented with a 3-week history of intermittent fever and malaise. Physical examination showed stable vital signs and no other abnormalities. Bedside ultrasonography performed for investigation of pyrexia of unknown origin revealed a small splenic microabscess measuring 0.8 cm × 0.8 cm (Figure 1). Chest radiography and transthoracic echocardiography findings were normal. The patient was empirically treated for melioidosis using intravenous ceftazidime, and blood culture results were positive for Burkholderia pseudomallei, which confirmed the diagnosis. The patient received 4-week treatment with intravenous ceftazidime, followed by a 3-month course of oral trimethoprim-sulfamethoxazole, which led to resolution of the splenic abscess.

FIGURE 1:
Abdominal ultrasound scan showing a hypoechoic splenic lesion measuring 0.8 cm × 0.8 cm, indicative of an abscess.

Melioidosis is a potentially fatal disease caused by the B. pseudomallei bacterium, endemic to Southeast Asia and Northern Australia. Melioidosis is commonly complicated by the development of liver or splenic abscesses, which can be difficult to diagnose because of nonspecific symptoms¹. The Darwin melioidosis study reported that internal organ abscesses, including prostatic (20%), splenic (5%), and liver abscesses (3%) were common in this patient population². Bedside ultrasonography is noninvasive, readily available, and has high sensitivity and specificity; therefore, this modality has emerged as a valuable tool for diagnosis of melioidosis-induced liver/splenic abscesses. A recent study in Laos reported that abscesses had a positive predictive value of 93% (88-96%) for melioidosis³. Therefore, bedside ultrasonography is a useful method for detection of visceral abscesses in febrile patients in endemic areas and facilitates initiation of prompt empirical antibiotic therapy for melioidosis while awaiting confirmation of culture results.

ACKNOWLEDGMENTS

None.

REFERENCES

• ¹
  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.
• ²
  Currie BJ, Ward L, Cheng AC. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis. 2010;4(11):e900.
• ³
  Huson MAM, Kling K, Chankongsin S, Phongluxa K, Keoluangkhot V, Newton PN, et al. Point-of-Care Ultrasound in the Diagnosis of Melioidosis in Laos. Am J Trop Med Hyg. 2020;103(2):675-8.

• Financial Support: None.

Publication Dates

• Publication in this collection
  02 June 2023
• Date of issue
  2023

History

• Received
  07 Mar 2023
• Accepted
  20 Apr 2023