Proceeding | By Andrew Chang et. al.

Ocular Involvement in Melioidosis: A Case Series

Introduction:

Melioidosis, an infection caused by Burkholderia pseudomallei, is endemic in Southeast Asia and northern Australia. Melioidosis is well-known for its diverse clinical manifestations, ranging from pneumonia, genitourinary infection, skin infection, liver and splenic abscesses, neurological melioidosis to fatal septicaemia. Ocular involvement in melioidosis has rarely been reported.

 

Methods:

This was a retrospective case series of four patients with ocular melioidosis who presented to Kapit Hospital from 2017- 2018.

 

Results:

All 4 patients presented with fever and unilateral periorbital swelling. Two of them were diabetics and farmers by occupation which predisposed to melioidosis, while there were no apparent risk factors identified in another two patients. Melioidosis was confirmed through positive blood culture for Burkholderia pseudomallei in three patients and strongly positive serology in 1 patient. All 4 patients were diagnosed with periorbital cellulitis with eyelid abscess, either via clinically or CT scan, but none complained of visual loss. Melioidosis has a propensity for multi-organ, disseminated infection as two patients described in this case series had concomitant pneumonia. Besides, splenic abscesses which frequently associated with melioidosis were also present in 3 patients. Surgical drainage of eyelid abscess was indicated in 2 cases and useful for diagnostic purpose. All 4 patients were treated with intravenous ceftazidime for 2-4 weeks, followed by eradication therapy which consists of trimethoprim-sulfamethoxazole and doxycycline. All of them achieved complete resolution of eyelid and splenic abscesses post-treatment without any long-term ophthalmic complications.

 

Conclusion:

Melioidosis affecting the eye can present as periorbital cellulitis and eyelid abscess. High clinical suspicion in the presence of risk factors and early treatment initiation were key to successful outcome. Surgical drainage of abscess is an important part of management besides standard antibiotic therapy.

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