“Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a Gram-negative bacillus present in the environment across much of Southeast Asia and in northern Australia. Infection occurs following bacterial inoculation, inhalation or ingestion and predominantly affects agricultural Inhibitor Library in vitro workers with risk factors such as diabetes mellitus and renal impairment. Retrospective case series from Thailand have reported high rates of intra-abdominal abscesses in patients with melioidosis, with around half of cases having one or more abscesses in the liver and/or spleen. 1 This rate is much higher
than our clinical experience from treating patients with melioidosis in northeast Thailand would suggest. Furthermore, we have reported lower rates in the context buy CT99021 of a comparative
drug trial in which 23% (48/212) of cases with culture-proven melioidosis had liver and/or splenic abscesses, 2 although ultrasound was not performed in all cases. We hypothesized that the rate of intra-abdominal abscesses was lower in our setting than that reported in retrospective case series, and performed a prospective observational study to test this on the basis that an accurate estimate of frequency would contribute to our bedside understanding of the disease. Patients with culture-confirmed melioidosis were recruited from the adult wards (aged ≥16 years) of Sappasithiprasong Hospital in Ubon Ratchathani, northeast Thailand, between 16 August 2008 and 17 August 2009. The hospital diagnostic laboratory was contacted daily to identify patients with one or more cultures positive for B. pseudomallei. Active surveillance for suspected cases was also performed through daily rounds of the medical and intensive care wards.
Any patient suspected of having melioidosis based on presenting clinical features had samples taken for culture, including blood, respiratory secretions (sputum or tracheal aspirate if intubated), urine, throat swab, pus and surface swabs from skin lesions. tuclazepam Patients with microbiologically confirmed melioidosis were recruited into the study following written informed consent from the patient or next of kin. A history was taken and examination performed during the first visit, and the patient seen daily until discharge or death. An abdominal ultrasound was performed by an experienced operator on the day of recruitment, or as soon as possible thereafter. Patient outcome (survival/death) was determined 4 weeks post-discharge by telephone call and/or home visit. A minority of relatives took moribund patients home to die and these cases were followed up to confirm the outcome. Ethical approval for this study was obtained from Sappasitthiprasong Hospital Ethics Committee. Statistical analysis was performed using STATA version 11.0 (Stata Corporation, College Station, TX, USA). Fisher exact or χ2 tests were used to assess categorical variables.