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1399. Pancreatic Abscess in Disseminated Melioidosis

BACKGROUND: Melioidosis is an infection caused by the gram-negative bacterium Burkholderia pseudomallei that is widely distributed in the tropical regions of Southeast Asia. It is commonly associated with intraabdominal abscesses, particularly the liver and spleen. However, there is scarce literatur...

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Autores principales: Saw, Yen Tsen, Lee, Heng Gee, Yong, Kylie Sze Tyng, Kok, Suet Hwa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677309/
http://dx.doi.org/10.1093/ofid/ofad500.1236
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author Saw, Yen Tsen
Lee, Heng Gee
Yong, Kylie Sze Tyng
Kok, Suet Hwa
author_facet Saw, Yen Tsen
Lee, Heng Gee
Yong, Kylie Sze Tyng
Kok, Suet Hwa
author_sort Saw, Yen Tsen
collection PubMed
description BACKGROUND: Melioidosis is an infection caused by the gram-negative bacterium Burkholderia pseudomallei that is widely distributed in the tropical regions of Southeast Asia. It is commonly associated with intraabdominal abscesses, particularly the liver and spleen. However, there is scarce literature regarding pancreatic involvement in melioidosis. We describe a case series of pancreatic manifestations of disseminated melioidosis in a tertiary hospital in Sabah, Malaysia. METHODS: We conducted a retrospective case review of 63 patients with culture-positive melioidosis admitted in Queen Elizabeth Hospital, Sabah between December 2021 and March 2023 and identified cases with pancreatic involvement diagnosed by radiological imaging. RESULTS: Pancreatic involvement was reported in 3 patients (4.8%). Median duration of symptoms was 20 days. All three patients had risk factors for melioidosis (3 had poorly controlled diabetes mellitus and 1 had chronic kidney disease), and had infection involving other organs (lungs, liver, spleen and prostate). Pancreatic lesions were all detected by computed tomography scans in the tail region and ranged from small microabscesses to large solitary lesions (largest dimension 5.6 cm) with peripancreatic fat stranding. One patient required emergency hemodialysis and intensive care. Drainage of concurrent prostatic abscess was done for one patient. All 3 patients were treated with antibiotics alone (median 38 days of intensive therapy) without drainage of pancreatic abscess and showed regression of pancreatic lesions upon reassessment imaging. [Figure: see text] Patient demographic and disease details. DM, diabetes mellitus; CKD, chronic kidney disease; CT, computed tomography. Figure 1 [Figure: see text] (A) Contrast-enhanced computed tomography image showing a heterogenous hypodense lesion at the pancreatic tail (arrow) and multiple ill-defined splenic lesions (arrowhead). (B) Smaller lesions at the pancreatic tail and spleen after 35 days of antibiotics (Case 1). CONCLUSION: Surgical drainage is required for source control of large melioidotic abscesses, however it may not be feasible for smaller pancreatic abscesses which are often multifocal and deep seated. In our study, the patients with pancreatic abscesses showed good clinical improvement with antibiotics therapy without drainage. Further studies are needed on the role of debridement for pancreatic melioidosis. Published guidelines recommend treatment of melioidosis with deep-seated abscesses with four weeks of intravenous ceftazidime as intensive therapy, followed by three to six months of oral trimethoprim-sulfamethoxazole or doxycycline as eradication therapy. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-106773092023-11-27 1399. Pancreatic Abscess in Disseminated Melioidosis Saw, Yen Tsen Lee, Heng Gee Yong, Kylie Sze Tyng Kok, Suet Hwa Open Forum Infect Dis Abstract BACKGROUND: Melioidosis is an infection caused by the gram-negative bacterium Burkholderia pseudomallei that is widely distributed in the tropical regions of Southeast Asia. It is commonly associated with intraabdominal abscesses, particularly the liver and spleen. However, there is scarce literature regarding pancreatic involvement in melioidosis. We describe a case series of pancreatic manifestations of disseminated melioidosis in a tertiary hospital in Sabah, Malaysia. METHODS: We conducted a retrospective case review of 63 patients with culture-positive melioidosis admitted in Queen Elizabeth Hospital, Sabah between December 2021 and March 2023 and identified cases with pancreatic involvement diagnosed by radiological imaging. RESULTS: Pancreatic involvement was reported in 3 patients (4.8%). Median duration of symptoms was 20 days. All three patients had risk factors for melioidosis (3 had poorly controlled diabetes mellitus and 1 had chronic kidney disease), and had infection involving other organs (lungs, liver, spleen and prostate). Pancreatic lesions were all detected by computed tomography scans in the tail region and ranged from small microabscesses to large solitary lesions (largest dimension 5.6 cm) with peripancreatic fat stranding. One patient required emergency hemodialysis and intensive care. Drainage of concurrent prostatic abscess was done for one patient. All 3 patients were treated with antibiotics alone (median 38 days of intensive therapy) without drainage of pancreatic abscess and showed regression of pancreatic lesions upon reassessment imaging. [Figure: see text] Patient demographic and disease details. DM, diabetes mellitus; CKD, chronic kidney disease; CT, computed tomography. Figure 1 [Figure: see text] (A) Contrast-enhanced computed tomography image showing a heterogenous hypodense lesion at the pancreatic tail (arrow) and multiple ill-defined splenic lesions (arrowhead). (B) Smaller lesions at the pancreatic tail and spleen after 35 days of antibiotics (Case 1). CONCLUSION: Surgical drainage is required for source control of large melioidotic abscesses, however it may not be feasible for smaller pancreatic abscesses which are often multifocal and deep seated. In our study, the patients with pancreatic abscesses showed good clinical improvement with antibiotics therapy without drainage. Further studies are needed on the role of debridement for pancreatic melioidosis. Published guidelines recommend treatment of melioidosis with deep-seated abscesses with four weeks of intravenous ceftazidime as intensive therapy, followed by three to six months of oral trimethoprim-sulfamethoxazole or doxycycline as eradication therapy. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2023-11-27 /pmc/articles/PMC10677309/ http://dx.doi.org/10.1093/ofid/ofad500.1236 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Saw, Yen Tsen
Lee, Heng Gee
Yong, Kylie Sze Tyng
Kok, Suet Hwa
1399. Pancreatic Abscess in Disseminated Melioidosis
title 1399. Pancreatic Abscess in Disseminated Melioidosis
title_full 1399. Pancreatic Abscess in Disseminated Melioidosis
title_fullStr 1399. Pancreatic Abscess in Disseminated Melioidosis
title_full_unstemmed 1399. Pancreatic Abscess in Disseminated Melioidosis
title_short 1399. Pancreatic Abscess in Disseminated Melioidosis
title_sort 1399. pancreatic abscess in disseminated melioidosis
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10677309/
http://dx.doi.org/10.1093/ofid/ofad500.1236
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