Pyogenic liver abscess caused by Burkholderia pseudomallei in Taiwan.
Pyogenic liver abscess in Taiwan is a well-known disease entity, commonly associated with a single pathogen, Klebsiella pneumoniae. Melioidosis is an endemic disease in Taiwan that can manifest as multiple abscesses in sites including the liver. We report three cases of liver abscesses caused by Burkholderia pseudomallei. The first patient was a 54-year-old diabetic woman, who presented with liver abscess and a left subphrenic abscess resulting from a ruptured splenic abscess, co-infected with K. pneumoniae and B. pseudomallei. The second patient, a 58-year-old diabetic man, developed bacteremic pneumonia over the left lower lung due to B. pseudomallei with acute respiratory distress syndrome, and relapsed 5 months later with bacteremic abscesses of the liver, spleen, prostate and osteomyelitis, due to lack of compliance with prescribed antibiotic therapy. The third patient was a 61-year-old diabetic man with a history of travel to Thailand, who presented with jaundice and fever of unknown origin. Liver and splenic abscesses due to B. pseudomallei were diagnosed. A high clinical alertness to patients' travel history, underlying diseases, and the presence of concomitant splenic abscess is essential to early detection of the great mimicker, melioidosis. The treatment of choice is intravenous ceftazidime for at least 14 days or more. An adequate duration of maintenance oral therapy, with amoxicillin-clavulanate or trimethoprim-sulfamethoxazole for 12-20 weeks, is necessary to prevent relapse. Liver abscess in Taiwan is most commonly due to K. pneumoniae, but clinicians should keep in mind that this may be a presenting feature of melioidosis.
Lee
Yu-Lin
YL
Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Lee
Susan Shin-Jung
SS
Tsai
Hung-Chin
HC
Chen
Yao-Shen
YS
Wann
Shue-Ren
SR
Kao
Chih-Hsiang
CH
Liu
Yung-Ching
YC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016957:Burkholderia pseudomallei / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D046290:Liver Abscess, Pyogenic / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008554:Melioidosis / Q000150:complications; D008875:Middle Aged
D000900:Anti-Bacterial Agents