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Surgical management of Melioidosis: 10-year retrospective data from a tertiary hospital in India

Ajith John George, Cecil T Thomas, Divya Elizabeth Mathew, Harshdeep, Aasher Kurien, Pranay Gaikwad, Balaji, Rajiv Karthik.

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Introduction: Melioidosis is endemic in Southeast Asia. Burkholderia pseudomallei is the causative agent. Abscess formation is the commonest surgical presentation. This usually occurs in the skin and subcutaneous tissues but it has also been reported at unusual sites such as the liver, spleen, lung, brain, prostate, bone and joints, lymph nodes, muscles, and eyes. The mortality of those diagnosed with Melioidosis ranges from 10-25%. Early diagnosis and initiation of early surgical and medical treatment can decrease mortality.
Methods: Data were collected over 10 years (2007-2017), from culture-proven patients who were admitted into the emergency department or in the wards.
Results: There were 153 patients recruited. 21 % of patients were farmers or agricultural workers. The most common risk factor was type 2 Diabetes Mellitus. Patients presented with spleen as the most common organ involved (39%). 10 % of those with intra-abdominal abscesses have the involvement of lungs as well. Various interventional radiological procedures such as abscess drainage by ultrasound-guided pig tailing and aspirations are common. Peripheral soft tissue abscess drainage was common and easy to perform. Splenectomy was the least common procedure performed for an abscess.
The mortality is 14.7 % and is significantly associated with those presenting with bacteremia and sepsis.
The surgical intervention had resulted in 92 % of patients discharged alive.
Conclusions: Early surgical referral and intervention can decrease mortality and morbidity. Further imaging of the abdomen and thorax could decrease the mortality among those with bacteremia and sepsis.

Key words: Melioidosis, Surgical Intervention, Bacteremia, Septic Shock

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