Pitfalls and optimal approaches to diagnose melioidosis

Paul Vijay Kingsley, Govindakarnavar Arunkumar, Meghan Tipre, Mark Leader, Nalini Sathiakumar

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

Original languageEnglish
Pages (from-to)515-524
Number of pages10
JournalAsian Pacific Journal of Tropical Medicine
Volume9
Issue number6
DOIs
Publication statusPublished - 01-06-2016

Fingerprint

Melioidosis
Pneumonia
Physicians
Recurrence
Early Diagnosis
Sepsis
Fever
Infection
Diagnostic Services
Therapeutics
Microbiology
Diagnostic Errors
Abscess
Communicable Diseases
Registries
Tuberculosis
Mortality

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kingsley, Paul Vijay ; Arunkumar, Govindakarnavar ; Tipre, Meghan ; Leader, Mark ; Sathiakumar, Nalini. / Pitfalls and optimal approaches to diagnose melioidosis. In: Asian Pacific Journal of Tropical Medicine. 2016 ; Vol. 9, No. 6. pp. 515-524.
@article{7b21b60ce301445f9f9604cbf6203f1d,
title = "Pitfalls and optimal approaches to diagnose melioidosis",
abstract = "Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.",
author = "Kingsley, {Paul Vijay} and Govindakarnavar Arunkumar and Meghan Tipre and Mark Leader and Nalini Sathiakumar",
year = "2016",
month = "6",
day = "1",
doi = "10.1016/j.apjtm.2016.04.003",
language = "English",
volume = "9",
pages = "515--524",
journal = "Asian Pacific Journal of Tropical Medicine",
issn = "1995-7645",
publisher = "Elsevier (Singapore) Pte Ltd",
number = "6",

}

Pitfalls and optimal approaches to diagnose melioidosis. / Kingsley, Paul Vijay; Arunkumar, Govindakarnavar; Tipre, Meghan; Leader, Mark; Sathiakumar, Nalini.

In: Asian Pacific Journal of Tropical Medicine, Vol. 9, No. 6, 01.06.2016, p. 515-524.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Pitfalls and optimal approaches to diagnose melioidosis

AU - Kingsley, Paul Vijay

AU - Arunkumar, Govindakarnavar

AU - Tipre, Meghan

AU - Leader, Mark

AU - Sathiakumar, Nalini

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

AB - Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

UR - http://www.scopus.com/inward/record.url?scp=84966731075&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84966731075&partnerID=8YFLogxK

U2 - 10.1016/j.apjtm.2016.04.003

DO - 10.1016/j.apjtm.2016.04.003

M3 - Review article

AN - SCOPUS:84966731075

VL - 9

SP - 515

EP - 524

JO - Asian Pacific Journal of Tropical Medicine

JF - Asian Pacific Journal of Tropical Medicine

SN - 1995-7645

IS - 6

ER -